A nurse in an outpatient clinic is caring for a 32-year-old female client who presents for evaluation of headaches. Select the 6 statements the nurse should include when reinforcing teaching to the client about the newly prescribed medication (sumatriptan).

Choice A rationale: Sumatriptan is a selective serotonin receptor agonist (5-HT1B/1D) that can cause vasoconstriction of cranial blood vessels. Because of its vasoconstrictive properties, it may reduce uterine blood flow and pose a risk to fetal development. Therefore, it is contraindicated during pregnancy unless the benefits outweigh the risks. Women planning pregnancy or suspecting they are pregnant should discontinue use and consult their healthcare provider to avoid potential teratogenic effects or fetal hypoxia. Choice B rationale: A rash is not a common or expected adverse effect of sumatriptan. While hypersensitivity reactions can occur with any medication, dermatologic manifestations such as rash are rare with triptans. The more typical side effects involve cardiovascular, neurological, and gastrointestinal systems. Therefore, this statement is inaccurate and not a standard part of patient education for sumatriptan. If a rash does occur, it may indicate an allergic reaction, but it is not a routine or expected outcome. Choice C rationale: Sumatriptan can cause transient chest pressure or tightness due to its vasoconstrictive action on coronary arteries, even in patients without underlying heart disease. This sensation is usually non-cardiac in origin but can mimic angina. It results from stimulation of 5-HT1 receptors in the chest wall or coronary vasculature. Patients should be advised to report severe or persistent chest symptoms, especially if they have cardiovascular risk factors, as this may necessitate further cardiac evaluation. Choice D rationale: Sumatriptan has a rapid onset of action, typically providing relief within 30 to 60 minutes after oral administration. It works by binding to serotonin receptors in cranial blood vessels, causing vasoconstriction and inhibiting the release of pro-inflammatory neuropeptides. This mechanism helps alleviate migraine symptoms such as pain, nausea, and photophobia. Patients should be informed that early administration during the onset of migraine symptoms enhances efficacy and may prevent progression of the headache. Choice E rationale: Fatigue or drowsiness is a known side effect of sumatriptan, likely due to its central nervous system effects. It may result from serotonin receptor activation in the brain, which can influence sleep-wake cycles and cause sedation. Patients should be cautioned about engaging in activities requiring mental alertness, such as driving or operating machinery, until they know how the medication affects them. This side effect is generally mild and transient but should be anticipated. Choice F rationale: If the migraine persists or recurs after the initial dose, a second dose of sumatriptan may be taken at least 2 hours later. However, this should not exceed the maximum daily dosage. The 2-hour interval allows for assessment of the initial dose’s effectiveness and reduces the risk of cumulative vasoconstrictive effects. This dosing strategy is supported by pharmacokinetic data showing peak plasma concentrations within 2 hours and a half-life of approximately 2 hours. Choice G rationale: The maximum recommended dosage of oral sumatriptan is 200 mg in 24 hours. This limit is based on clinical trials and safety data to minimize the risk of adverse cardiovascular and neurological effects, including serotonin syndrome and coronary vasospasm. Exceeding this dose increases the likelihood of serious complications due to excessive serotonin receptor stimulation. Patients should be instructed to track their doses carefully and avoid combining sumatriptan with other serotonergic agents without medical supervision.