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INTRODUCTION

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almotriptan (al-moe-trip-tan)

Axert

Classification

Therapeutic: vascular headache suppressants

Pharmacologic: 5-HT1 agonists

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Indications
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Acute treatment of migraine headache.

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Action
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Acts as an agonist at specific 5-HT1 receptor sites in intracranial blood vessels and sensory trigeminal nerves. Therapeutic Effects: Cranial vessel vasoconstriction with associated decrease in release of neuropeptides and resultant decrease in migraine headache.

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Adverse Reactions/Side Effects
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CNS: drowsiness, headache. CV: CORONARY ARTERY VASOSPASM, MI, myocardial ischemia, VENTRICULAR FIBRILLATION, VENTRICULAR TACHYCARDIA. GI: dry mouth, nausea. Neuro: paresthesia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Continually monitor for signs of coronary artery vasospasm and MI, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, and nausea. Seek immediate medical assistance if patient develops these signs.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, dizziness, and fatigue/weakness. Seek immediate medical assistance if patient exhibits signs associated with ventricular fibrillation such as fainting and loss of consciousness.

  • Assess the frequency and severity of headaches, and document whether drug therapy is successful in decreasing migraine attacks.

  • Assess signs of paresthesia such as numbness and tingling. Perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

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Interventions
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  • Because of the risk of MI and serious arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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Patient/Client-Related Instruction
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  • Advise patient and family or caregiver about the signs of MI and arrhythmias (see above under Examination and Evaluation), and to seek immediate medical assistance if these signs develop.

  • Advise the patient to bring this drug to each therapy session; almotriptan drug is most effective when taken at the first signs of a migraine attack. Patients should also adhere to the correct dosing procedures; that is, a second dose can be taken 2 hr after the first dose, but patients should not exceed 2 doses in each 24-hr period.

  • Instruct patient to report other troublesome side effects such as severe or prolonged headache, drowsiness, or GI problems (nausea, dry mouth).

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Pharmacokinetics
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Absorption: Well absorbed following oral administration (70%).

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Distribution: Unknown.

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Metabolism and Excretion: 40% excreted unchanged in urine; 27% metabolized by monoamine oxidase-A (MAO-A); 12% metabolized by cytochrome P450 hepatic enzymes (3A4 and 2D6); 13% excreted in feces as unchanged and metabolized drug.

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Half-life: 3–4 hr.

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