A nurse reviews the chart of a client with migraine before administering sumatriptan 6 mg SC. Which finding most warrants holding the medication?

1 Mild seasonal allergies
2 Caffeine intake of 2 cups daily
3 Use of a multivitamin
4 History of unstable angina with recent positive stress test ✓ Correct answer

Explanation

Correct (2): Triptans cause vasoconstriction via 5-HT1B/1D agonism — contraindicated in ischemic heart disease, uncontrolled hypertension, recent MI, Prinzmetal angina, peripheral vascular disease, and stroke. Concomitant ergotamines or another triptan within 24 hours are also contraindicated. (1,3,4) Not contraindications.

In-depth explanation

Memory Tip Triptan = "Tighten vessels" — avoid with ischemia. Caution Serotonin syndrome with SSRI/SNRI/MAOI — monitor; rebound headache with frequent use (>10 days/month).

Clinical scenario

Scenario 54-year-old male with severe migraine presents for sumatriptan 6 mg SC. Chart: history of unstable angina with recent positive stress test.

Key concepts

Triptan — 5-HT1B/1D agonist abortive migraine therapy; vasoconstrictive.
Cardiovascular contraindications — Ischemic heart disease, recent MI, uncontrolled HTN, Prinzmetal angina, PVD, stroke.
Serotonin syndrome risk — Triptans + serotonergic drugs (SSRIs, SNRIs, MAOIs) raise serotonin syndrome risk; monitor.

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A nurse reviews the chart of a client with migraine before administering sumatriptan 6 mg SC. Which finding most warrants holding the medication?

In-depth explanation

Clinical scenario

Key concepts

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