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Originally Posted by Oak A 53 year old man with chronic obstructive pulmonary disease (COPD) is beginning to experience frequent migraine headaches. Which of the following drugs used to treat migraine headaches would most likely exacerbate the signs and symptoms of his COPD? A. Amitriptyline
B. Diclofenac
C. Propranolol
D. Sumatriptan
E. Verapamil
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well oak bro. i also supprot Hero for the answer it shuld be C.Propronolol because contraindication of it include :-
·Propranolol should not be used in patients with a known hypersensitivity to the substance.
·Propranolol should not be used in the presence of second or third degree heart block.
·Propranolol should not be used in patients with cardiogenic shock, uncontrolled heart failure, hypotension, severe peripheral arterial circulatory disturbances, untreated phaeochromocytoma, Prinzmetal's angina, sinus bradycardia or sick sinus syndrome.
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Propranolol should not be used if there is a history of bronchospasm, bronchial asthma or other obstructive lung disease or after prolonged fasting or in patients with metabolic acidosis.
and Warnings and Precautions include
Asthma/Bronchospasm: Beta-andrenergic blockade of the smooth muscle of the bronchi and bronchioles results in increased airway resistance. Fatality could occur.
while contraindication in COPD include
CONTRAINDICATIONS
Antitussives. Cough, although sometimes a troublesome symptom in COPD, has a significant protective role. For this reason, regular use of antitussives in stable COPD is contraindicated.
Beta blockers. Beta blockers may produce bronchospasm in patients with airway disease and may be relatively contraindicated. However, beta blockers do not negatively affect the action of ipratropium.
Diuretics. Routine administration of diuretics to patients with COPD is not warranted. Diuretics may pose particular risks for patients with COPD and should be prescribed with caution. Hypokalemia may occur when beta-2 agonist treatment is combined with thiazide diuretics. Overuse of diuretics may produce excessive volume depletion.
Mucolytics. Widespread or routine use of these agents to treat COPD is not recommended. Although they may be helpful in a few patients with viscous sputum, evidence suggests that overall they are of minimal benefit in patients with COPD.
Narcotics. Narcotics should be used cautiously in treating individuals with more advanced COPD because of their respiratory depressant effects. Studies suggest that the use of morphine to control dyspnea may have serious adverse effects, with benefits limited to a few sensitive subjects. Narcotics may be appropriate, however, to provide comfort care to the end-stage patient with severe dyspnea. Narcotics should be used with caution to treat pain in patients with significant COPD.
Respiratory stimulants. Current evidence does not support the use of respiratory stimulants in stable COPD. In large clinical trials, almitrine bismethylate was associated with several significant side effects, particularly peripheral neuropathy. There is no evidence that it improves survival or quality of life. Doxapram, a nonspecific respiratory stimulant, is also not recommended in stable COPD.
Vasodilators. Studies of inhaled nitric oxide to treat pulmonary hypertension in COPD have produced disappointing results. On the basis of current evidence, inhaled nitric oxide is contraindicated in COPD because it may worsen gas exchange.
Other Medications Contraindicated In COPD
Other medications that are contraindicated in patients with COPD include the following: antihistamines, which promote drying, and sedatives, which depress respiratory drive, and ephedrine, an ingredient in many over-the-counter medications.
Re: Frequent migraine headaches in a COPD patient -
19-08-2006, 10:13 AM
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