A nurse is completing a medication history for a client who reports using over-the-counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication?

Choice A reason: Monoamine oxidase inhibitors (MAOIs) are not the correct class of medications to which escitalopram (Lexapro) belongs. MAOIs are a group of antidepressants that work by inhibiting the enzyme monoamine oxidase, which breaks down neurotransmitters such as serotonin, norepinephrine, and dopamine. MAOIs can increase the levels of these neurotransmitters in the brain and improve mood and energy. However, MAOIs can also cause serious side effects and interactions with other drugs and foods, and they are not commonly used as firstline treatment for depression. Escitalopram is not an MAOI, and it should not be taken with MAOIs or within 14 days of stopping or starting MAOIs, as this can cause a dangerous drug interaction called serotonin syndrome.

Choice B reason: Betablockers are not the correct class of medications to which escitalopram (Lexapro) belongs. Betablockers are a group of drugs that work by blocking the beta receptors on the heart and blood vessels, which are stimulated by adrenaline and noradrenaline. Betablockers can lower the heart rate, blood pressure, and cardiac output, and they are used to treat conditions such as hypertension, angina, arrhythmias, and heart failure. Betablockers can also reduce anxiety and tremors, but they are not antidepressants and they do not affect serotonin levels. Escitalopram is not a betablocker, and it does not have any significant effect on the cardiovascular system.

Choice C reason: Benzodiazepines are not the correct class of medications to which escitalopram (Lexapro) belongs. Benzodiazepines are a group of drugs that work by enhancing the activity of the neurotransmitter gammaaminobutyric acid (GABA), which has a calming and sedating effect on the brain. Benzodiazepines are used to treat anxiety, insomnia, seizures, and muscle spasms, and they can also cause relaxation, drowsiness, and amnesia. Benzodiazepines are not antidepressants and they do not affect serotonin levels. Escitalopram is not a benzodiazepine, and it does not have any significant effect on GABA receptors .

Choice D reason: Selective serotonin reuptake inhibitors (SSRIs) are the correct class of medications to which escitalopram (Lexapro) belongs. SSRIs are a group of antidepressants that work by blocking the reuptake of serotonin by the nerve cells, which increases the availability of serotonin in the synaptic cleft. Serotonin is a neurotransmitter that regulates mood, appetite, sleep, and cognition, and low levels of serotonin are associated with depression and anxiety. SSRIs can improve the symptoms of depression and anxiety by enhancing the serotonin signaling in the brain. Escitalopram is an SSRI, and it is used to treat major depressive disorder and generalized anxiety disorder.

Choice A reason: “This medication should be taken after eating to reduce nausea.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron can be taken with or without food, and it does not affect the digestion or absorption of food. Ondansetron is usually taken before the start of chemotherapy, radiation, or surgery, which are the common causes of nausea and vomiting.

Choice B reason: “This medication should not be taken with starfruit.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron does not interact with starfruit, which is a tropical fruit that contains substances that can inhibit the enzyme CYP3A4, which is involved in the metabolism of many drugs. Ondansetron is mainly metabolized by another enzyme, CYP1A2, and it has a low potential for drug interactions¹.

Choice C reason: “This medication may make me tired and confused.” is a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron can also cross the blood brain barrier and affect other serotonin receptors in the brain, which are involved in regulating mood, cognition, and sleep. Ondansetron can cause side effects such as fatigue, drowsiness, headache, and confusion, which can impair the mental alertness and performance of the client. The client should be advised to avoid driving, operating machinery, or doing other tasks that require attention after taking ondansetron.

Choice D reason: “This medication may cause rebound nausea.” is not a correct statement that demonstrates understanding about ondansetron. Ondansetron is a medication that prevents nausea and vomiting by blocking the action of serotonin, a chemical that stimulates the vomiting center in the brain. Ondansetron does not cause rebound nausea, which is a condition of nausea that occurs after the discontinuation of a medication that suppresses nausea. Ondansetron is not a medication that suppresses nausea, but rather prevents it by blocking the stimulation of the vomiting center. Ondansetron does not cause dependence or withdrawal symptoms, and it can be stopped without causing rebound nausea.