A patient with frequent tension headaches asks the nurse about over-the-counter remedies. The nurse knows that Excedrin combines which of the following active ingredients to address pain, inflammation, and increased vascular tone associated with headaches?

Choice A reason: Past medical history of benign prostatic hyperplasia (BPH) is not a contraindication or a concern for administering Reglan, which is a medication that stimulates the motility of the upper gastrointestinal tract and treats nausea, heartburn, and gastroparesis¹. Reglan does not affect the prostate or urinary function.

Choice B reason: Blood pressure of 132/82 is slightly above the normal range of 120/80, but it is not a cause for concern or a reason to withhold Reglan. Reglan can lower the blood pressure by reducing the fluid volume and preventing sodium retention¹. The nurse should monitor the blood pressure regularly, but does not need to notify the health care provider about this finding.

Choice C reason: Allergy to corn is a concern for administering Reglan, as some formulations of Reglan may contain corn starch as an inactive ingredient. Corn starch can trigger an allergic reaction in people who are sensitive to corn, causing symptoms such as rash, itching, swelling, or anaphylaxis. The nurse should check the label of the Reglan product and avoid using it if it contains corn starch. The nurse should also notify the health care provider and the pharmacy about the patient's allergy and request an alternative medication or formulation.

Choice D reason: Past medical history of gout is not a contraindication or a concern for administering Reglan, which is a medication that stimulates the motility of the upper gastrointestinal tract and treats nausea, heartburn, and gastroparesis¹. Reglan does not affect the uric acid levels or the joints.

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.