A nurse is caring for a client who reports an increase in migraine headaches over the past 2 weeks and asks if sumatriptan might be helpful.
Which of the following conditions from the client's medical history should the nurse recognize as a contraindication for this medication?

Choice A rationale

Naloxone is an opioid antagonist used to reverse opioid-induced respiratory and central nervous system depression. Midazolam is a benzodiazepine, not an opioid. Therefore, naloxone would not be effective in reversing the adverse effects of midazolam. Its mechanism of action specifically targets opioid receptors.

Choice B rationale

Flumazenil is a benzodiazepine receptor antagonist. It specifically binds to benzodiazepine receptors, competitively inhibiting the effects of benzodiazepines like midazolam. In cases of benzodiazepine overdose or excessive sedation leading to adverse effects such as hypotension, flumazenil can rapidly reverse these central nervous system depressant effects.

Choice C rationale

Moxifloxacin is a fluoroquinolone antibiotic. It is used to treat bacterial infections and has no pharmacological action that would counteract the effects of benzodiazepines or specifically address drug-induced hypotension during a procedure like a colonoscopy. Administering an antibiotic in this scenario would be inappropriate.

Choice D rationale

Fludrocortisone is a mineralocorticoid used primarily for its effects on electrolyte and fluid balance, often in conditions like Addison's disease or orthostatic hypotension. It would not be an appropriate choice for rapidly reversing acute drug-induced hypotension caused by midazolam during a medical procedure. Its action is not immediate.

Choice A rationale

Constipation is a very common and expected adverse effect of codeine due to its opioid effects on gastrointestinal motility, specifically by decreasing propulsive contractions. While it requires management, it is generally not the highest priority unless it leads to severe complications like impaction, making other acute symptoms more immediately concerning. Normal bowel frequency varies but ranges from three times daily to three times weekly.

Choice B rationale

Dry mouth, or xerostomia, is a common anticholinergic-like effect of opioid medications like codeine. While uncomfortable, it is typically a mild, non-life-threatening side effect. It can be managed with hydration and oral hygiene measures and does not represent an acute physiological threat requiring immediate reporting as a priority.

Choice C rationale

Agitation, especially in the context of opioid use, can be a sign of central nervous system excitation or an idiosyncratic reaction. It can indicate a paradoxical effect of the medication or an emerging adverse event that could escalate to more serious neurological complications, such as seizures or respiratory compromise if not promptly addressed.

Choice D rationale

Urinary retention is a known adverse effect of opioids due to their effect on bladder detrusor muscle tone and sphincter function. While it is important to monitor and manage, potentially requiring catheterization, it is generally not as immediately life-threatening as signs of central nervous system instability or respiratory compromise, making agitation a higher priority in the acute setting.