NCSBN – Lesson 6B: Medications Study Guide ,100% CORRECT

NCSBN – Lesson 6B: Medications Study Guide The following is a list of the major drug classifications. "Memory tricks" are included where applicable. A • Anti-anemics o prevention and treatment of anemias • Antian ...

NCSBN – Lesson 6B: Medications Study Guide The following is a list of the major drug classifications. "Memory tricks" are included where applicable. A • Anti-anemics o prevention and treatment of anemias • Antianginals: o Nitrates: used to treat and prevent attacks of angina; acute treatment o Calcium channel blockers and beta blockers are used prophylactically for longer- term management • Antianxiety agents: o Benzodiazepines: better for intermittent or short-term use in the management of anxiety o Buspirone, paroxetine, venlafaxine: better for long-term use • Antiarrhythmics: o Suppression of cardiac arrhythmias o Generally classified by their effects on cardiac conduction tissue (Class IA, IB, IC, II, III & IV) o Atropine and digoxin: also used as antiarrhymics • Antiasthmatics o management of acute and chronic episodes of reversible bronchoconstriction • Anticholinergics: o Atropine: bradyarrhythmias o Ipratropium: bronchospasm o Atropine: also used as ophthalmic mydriatic o Benztropine: management of Parkinson's disease • Anticoagulants o prevention and treatment of thromboembolic disorders • Anticonvulsants o decrease the incidence and severity of seizures due to different etiologies • Antidepressants • Antidiabetics: o Insulin: type 1 diabetes mellitus o Oral agents used primarily in type 2 diabetes mellitus • Antidiarrheals o for control and symptomatic relief of acute and chronic nonspecific diarrhea • Antiemetics o used to manage nausea and vomiting due to many causes, including surgery, anesthesia, and antineoplastic and radiation therapies • Antifungals o memory trick – most end with "AZOLE" • Antihistamines: o Used for relief of symptoms associated with allergies and as adjunctive therapy in anaphylactic reactions o Some are used to treat insomnia and Parkinson-like reactions • Antihypertensives: including, but not limited to, the following: o ACE inhibitors: treatment of choice for hypertension; memory trick – most end with "PRIL" o Angiotension receptor blockers:memory trick – most end with "SARTAN", including losartan, valsartan o Beta blockers (see below) o Calcium channel blockers (see below) • Anti-infectives o treatment and prophylaxis of various bacterial infections • Antineoplastics o used in the treatment of various solid tumors, lymphomas and leukemias • Antiplatelet agents o used to treat and prevent thromboembolic events, e.g., stroke, myocardial infarction • Antipsychotics • Antipyretics o used to lower fever of many causes, including infection, inflammation and neoplasms • Antirheumatics o used to manage symptoms of rheumatoid arthritis and slow down joint destruction and preserve joint function • Antituberculars o used in the treatment and prevention of tuberculosis • Antiulcer agents: o Used in the treatment and prophylaxis of peptic ulcer and gastric hypersecretory conditions, e.g., Zollinger-Ellison syndrome o Memory trick – most end with "PRAZOLE", including omeprazole, pantoprazole, esomeprazole • Antivirals o memory trick – many end with "CY[I]CLOVIR", including acyclovir, valacyclovir B • Beta blockers: o Used in the management of hypertension, angina pectoris, tachyarrhythmias, migraine headache (prophylaxis), MI (prevention), glaucoma (opthlalmic use), CHF (carvedilol and sustained-release metoprolol only), hyperthyroidism (management of symptoms only) o Memory trick – most end with 'OLOL", "ALOL" or "ILOL" • Bone resorption inhibitors: o Used to treat and prevent osteoporosis in postmenopausal women o Also used to treat osteoporosis due to corticosteriod therapy, treatment of Paget's disease of the bone, and management of hypercalcemia C • Calcium channel blockers: o Used in the treatment of hypertension (amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine, verapamil) o Also used in the treatment and prophylaxis of angina pectoris or coronary artery spasm (amlodipine, diltiazem, felodipine, nicardipine, verapamil) o Memory trick – most end with "DIPINE" • Corticosteriods: o Used in replacement doses (20 mg of hydrocortisone or equivalent) systematically to treat adrenocortical insufficiency o Larger doses are usually used for their anti-inflammatory, immunosuppressive or antineoplastic activity D • Diuretics: o Thiazide diuretics and loop diuretics are used alone or in combination in the treatment of hypertension or edema due to CHF or other causes o Potassium-sparing diuretics have weak diuretic and antihypertensive properties and are used to conserve potassium in clients receiving thiazide or loop diuretics o Osmotic diuretics are often used in the management of cerebral edema H • Hormones: o Used in the treatment of deficiency states including diabetes (insulin), diabetes insipidus (desmopressin), hypothyroidism (thyroid hormones) and menopause (estrogens or estrogens/progestins) o Hormones may be used to treat hormonally sensitive tumors (androgens, estrogens) I • Immunosuppressants: o Most are used in the prevention of transplantation rejection reactions o Others are used in the management of selected autoimmune diseases (nephrotic syndrome of childhood and severe rheumatoid arthritis) L • Laxatives o used to treat or prevent constipation or to prepare the bowel for radiologic or endoscopic procedures • Lipid-lowering agents: o Used as a part of a total plan, including diet and exercise, to reduce blood lipids in an effort to reduce the morbidity and mortality of atherosclerotic cardiovascular disease and its sequelae o Memory trick – many end with "STATIN", e.g., atorvastatin, simvastatin, rosuvastatin M • Minerals/electrolytes/pH modifiers: o Used in the prevention and treatment of deficiencies or excesses of electrolytes and maintenance of optimal acid/base balance for homeostasis o Ccidifiers and alkalinizers are also used to promote urinary excretion of substances that accumulate in some disease states, e.g., kidney stones N • Nonopioid analgesics o used to control mild to moderate pain and/or fever • Nonsteroidal anti-inflammatory agents o used to control mild to moderate pain, fever, and various inflammatory conditions, e.g., rheumatoid arthritis and osteoarthritis O • Opioid analgesics o used in the management of moderate to severe pain S • Sedative/hypnotics: o Used to provide sedation, usually prior to procedures o Selected agents are useful as anticonvulsants, skeletal muscle relaxants, adjuncts in general surgery and adjuncts for the treatment of alcohol withdrawal syndrome • Skeletal muscle relaxants: o Used to treat spasticity (associated with spinal cord diseases or lesions) o Used as adjunctive therapy in the symptomatic relief of acute painful musculoskeletal conditions o IV dantrolene is also used to treat and prevent malignant hyperthermia T • Thrombolytics o used for the acute management of coronary thrombosis (MI), massive pulmonary emboli, deep vein thrombosis, and arterial thromboembolism V • Vascular headache suppressants: o Used for the treatment of vascular headaches, e.g., migraine and cluster headaches;memory trick - many end with "TRIPTAN", including sumatriptan o Other agents are used for suppression of frequently occurring vascular headaches, e.g., some beta blockers and calcium channel blockers Anticoagulants • Anticoagulant medications inhibit clotting factor synthesis, inhibit thrombin or interfere with blood platelet formation. o Prevent or treat blood clots associated with stroke, heart attack, heart valve disease, coronary artery disease, heart failure, arrhythmia, atrial fibrillation, deep vein thrombosis and pulmonary embolism. Alpha Blockers • Alpha blockers cause vasodilation by blocking the binding of norepinephrine to the smooth muscle receptors in blood vessels; they also relax the prostate and bladder neck in benign prostatic hyperplasia (BHP) clients. o Alpha blockers are used to to prevent, treat or improve symptoms in conditions such as hypertension, BPH, Raynaud's disease, scleroderma and pheochromocytoma. Angiotensin Converting Enzyme (ACE) Inhibitors • ACE inhibitors are medications that slow the activity of the angiotensin converting enzyme (ACE), decreasing the production of angiotensin II, which causes blood vessels to relax and dilate, lowers blood pressure and allows more oxygen-rich blood to reach the heart. o ACE inhibitors control blood pressure, treat heart failure and help prevent stroke. Angiotensin Receptor Blockers (ARBs) • ARBs block the action of angiotensin II by preventing it from binding to the angiotensin II receptors on the muscles around the blood vessels. As a result, blood vessels dilate and blood pressure is lowered. o ARBs control high blood pressure and treat heart failure. They are also used with clients who cannot tolerate ACE inhibitors. Anti-Alzheimer's Agents • Anti-Alzheimer's agents may prevent the breakdown of acetylcholine by blocking the activity of acetylcholinesterase (cholinesterase inhibitors). • They also help regulate the activity of glutamate, a chemical involved in the processing, storage and retrieval of information (NMDA receptor antagonists). o Anti-Alzheimer's agents are used to treat mild-to-moderate Alzheimer's disease (donepezil, rivastigmine and galantamine). o Nemenda (Memantine) is used to treat moderate-to-severe Alzheimer's disease. Aminoglycosides: Anti-Infectives • Anti-infective medications are bactericidal. They inhibit protein synthesis in bacteria and compromise the structure of the bacterial cell wall. o Anti-infective medications are used to treat and prevent severe infections, such as septicemia and severe urinary tract infections. o They can also be used to treat hospital-acquired respiratory infections, caused by aerobic, gram-negative bacteria, e.g., Escherichia coli and Klebsiella species. Cephalosporins: Anti-Infectives • Cephalosporins are medications that belong to a group of broad spectrum, semi-synthetic beta-lactam antibiotics derived from the mold Cephalosporium. • Like penicillins, they interfere with bacterial cell wall synthesis. o These medications treat and prevent a wide variety of bacterial infections, including respiratory tract infections, skin and soft-tissue infections, and urinary tract infections. Fluoroquinolones: Anti-Infectives • Fluoroquinolones are bactericidal and they are the only class of antimicrobial agents in clinical use that directly inhibit DNA synthesis in bacteria. o Fluoroquinolones treat a wide range of infections caused by gram-negative and gram-positive organisms, including: sinuses, skin, lungs, ears, airways, urinary tract, bones and joints. o They also prevent and treat anthrax. Macrolides: Anti-Infectives Macrolides are bacteriostatic. They inhibit bacterial growth and reproduction by interfering with the bacteria's ability to make proteins. • Macrolides treat various systemic and local bacterial infections of the respiratory tract, GI tract and soft tissues. • They also treat severe acne and sexually transmitted infections. • Macrolides prevent pertussis (whooping cough), as well as endocarditis in dentistry. Penicillins: Anti-Infectives • These medications belong to a class of antibiotics called beta-lactams, which exert bactericidal action by inhibiting bacterial cell wall production. Currently this group includes more than 20 antibiotics. o Penicillins are used to treat and prevent of wide range of bacterial infections including streptococcal infections, syphilis and Lyme disease. Sulfonamides: Anti-Infectives • Sulfonamides are bacteriostatic medications and provide a broad spectrum of activity against both gram-positive and gram-negative bacteria. o Sulfonamides are used to treat urinary tract infections, ulcerative colitis, and Crohn's disease, some types of bacterial pneumonia, and shigellosis. They are also effective in treating some protozoal infections, otitis media and toxoplasmosis. Tetracyclines: Anti-Infectives • These broad spectrum anti-infectives exert their bacteriostatic effect by inhibiting protein synthesis in bacteria. o Tetracyclines are used to treat respiratory tract infections. They also treat acne, skin infections, genital infections (e.g. syphilis, chlamydia), and urinary tract infections. o They have also been used for Lyme disease, mycoplasmal infections, rickettsial infections and the treatment of the infection that causes stomach ulcers (caused by Helicobacter pylori). Medication Allergies Client Outcomes • Client will maintain an effective breathing pattern • Client will demonstrate improved ventilation • Client will display hemodynamic stability • Client/caregiver will verbalize understanding of the allergic reaction and its prevention and management • Client/caregiver will verbalize understanding of the need to carry emergency components for intervention, need to inform health care providers of allergies and the need to wear medical alert bracelet/necklace Nursing Intervention • Monitor the client's airway • Monitor the oxygenation status • Focus breathing • Position the client for maximum oxygenation • Activity tolerance with adequate rest • Encourage adequate rest and limit activities to within client's tolerance • Hemodynamic parameters • Monitor the client's urine output Antianginals – Nitrates • Nitrates are used to dilate the blood vessels, improve blood flow and allow more oxygen- rich blood to reach the heart muscle. They also relax the veins. • Treat and prevent attacks of (acute) angina. Antianxiety Agents – Benzodiazepines • Antianxiety medications act at many levels in the central nervous system (CNS), producing an anxiolytic effect. They may produce CNS depression. The effects may be mediated by GABA (an inhibitory neurotransmitter). o Benzodiazepines are used to treat of generalized anxiety disorder (GAD) and panic disorder, as well as manage anxiety associated with depression. Antiarrhythmics • These medications are generally classified by their effects on cardiac conduction tissue (Class IA, IB, IC, II, III, IV). They slow down the heart and can slow the heart's electrical impulses by blocking the heart's potassium channels. o These medications can suppress potentially lethal cardiac arrhythmias. Anticonvulsants • Anticonvulsant medications depress CNS function. They target specific neurochemical processes, suppress excess neuron function and regulate electrochemical signals in the brain. o These medications help control epileptic seizures and treat neuropathic pain associated with diabetes, shingles and fibromyalgia. They are also used for migraine headaches and bipolar disorder. Tricyclic: Antidepressants • Tricyclic medications inhibit the nerve cell's ability to reuptake serotonin and norepinephrine, resulting in increased levels of these neurotransmitters in the brain. They also block the action of acetylcholine and histamine (causing many of the side effects of these medications). • These mediations relieve depression and help treat obsessive compulsive disorder (OCD) and bedwetting. o Off-label uses include panic disorder, bulimia and chronic pain, including migraine, diabetic neuropathy and post-herpetic neuralgia. Selective Serotonin Reuptake Inhibitors (SSRIs): Antidepressants • Selective Serotonin Reuptake Inhibitors (SSRIs) block the reabsorption (reuptake) of serotonin. o SSRIs are used to primarily treat moderate-to-severe depression and chronic fatigue syndrome. They also treat premenstrual dysphoric disorder (PMDD), obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). Insulins: Antidiabetics • Insulin is used in the treatment of type 1 diabetes mellitus and may be used to treat type 2 diabetes mellitus. o Rapid-acting insulin covers meals eaten at the same time as the injection. o Short-acting insulin covers meals eaten within 30-60 minutes. o Intermediate-acting insulin covers about half of the day or overnight (and is often combined with rapid- or short-acting insulin). o Long-acting insulin covers about one full day. Oral Agents: Antidiabetics • Oral agents are used to stimulate insulin release from the beta cells of the pancreas (sulfonylureas and meglitinides). They can improve the insulin's ability to move glucose into cells, especially muscle cells (biguanides). Oral agents can also enhance insulin effectiveness in both muscle and adipose tissue (thiazolidinediones). o Additionally, oral agents block enzymes that help digest starches, slowing the rise in blood sugar (alpha-glucosidase inhibitors) and block an enzyme that deactivates a protein (GLP-1), which will keep insulin circulating in the blood (DPP-4 inhibitors). o Used in the treatment of type 2 diabetes mellitus. Antidiarrheals • Antidiarrheals slow the passage of stools through the intestines; loperamide and bismuth subsalicylate decrease the secretion of fluid into the intestine and inhibit the activity of bacteria. o They are used to control and relieve symptoms of acute and chronic nonspecific diarrhea. Antiemetics • Some antiemetics inhibit the chemoreceptor trigger zone in the medulla by blocking dopamine receptors, and others decrease the sensitivity of the vestibular apparatus. Still others block the effects of serotonin in the brain and small intestine. o These medications are used to manage the various causes of nausea and vomiting, including surgery, anesthesia, antineoplastic and radiation therapies and motion sickness. Antifungals • Antifungal medications are also called antimycotic agents. They kill or inactivate fungi. o These medications are used to treat systemic, localized or topical fungal infections (including yeast infections). Antihistamines • Antihistamines compete with histamine for histamine receptor sites. When antihistamines occupy the histamine receptor sites, they prevent histamine from causing allergic symptoms. o Antihistamines provide relief of symptoms associated with allergies including rhinitis, urticaria and angioedema and adjunctive therapy in anaphylactic reactions. They can also be used to treat insomnia (diphenhydramine), motion sickness, (dimenhydrinate and meclizine), Parkinson-like reactions (diphenhydramine) and other nonallergic conditions. Antineoplastics • Antineoplastic medications inhibit or prevent the development, maturation or spread of neoplastic cells by various mechanisms of action. They also can cause damage to the DNA of cancer cells, interfere with the cancer cell's metabolism or affect cell division. Additionally, they create an unfavorable environment for cancer cell growth. o These medications are used to treat various solid tumors, lymphomas and leukemias. They are also prescribed for some autoimmune disorders, such as rheumatoid arthritis. Antiparkinson Agents • Antiparkinson agents replenish dopamine. They also mimic the role of dopamine or block the effects of other chemicals that cause problems in the brain when dopamine levels drop. o These medications relieve the symptoms of parkinsonism, including tremor or trembling in the hands, arms, legs, jaw and face; stiffness or rigidity of the arms, legs and trunk; bradykinesia; poor balance and coordination. Antiplatelet Agents • Antiplatelets block the formation of blood clots by preventing the clumping of platelets. o These medications treat and prevent thromboembolic events, such as stroke, MI or peripheral vascular disease. They are also prescribed after devices are placed inside the heart or blood vessels, such as stents and artificial heart values. Antipsychotics • Antipsychotic medications block a specific subtype of the dopamine receptor (the D2 receptor). The second generation medications not only block D2 receptors, but also a specific subtype of serotonin receptor (5HR2A receptor). o Antipsychotics are used to treat acute and chronic psychosis, especially when accompanied by increased psychomotor activity. o Off-label uses include Tourette's syndrome, substance abuse, stuttering, OCD, PTSD, depression, bipolar disorder and personality disorders. Antituberculars • Antitubercular medications have various actions that affect mycobacteria, with most having bactericidal (for example, rifampin) and/or bacteriostatic (for example, isoniazid) actions. • Used to treat and prevent tuberculosis (TB). Antiulcer Agents • These medications block the secretion of gastric acid by the gastric parietal cells (PPIs). They also stop the action of histamine on the gastric parietal cells, which inhibits the secretion of gastric acid (H-2 receptor blockers). o Antiulcer agents are used to treat and prevent peptic ulcers and gastric hypersecretory conditions, e.g., Zollinger-Ellison syndrome and to manage the symptoms of gastroesophageal reflux disease (GERD). ‘ o They also treat recurrent gastric and duodenal ulcers caused by Helicobacter pylori infections (with a combined antibiotic and gastric acid suppression therapy). Antivirals • Antiviral medications are designed to work in one of two ways - they either inhibit the ability of viruses to multiply or they mimic the virus attachment protein, disrupting the replication process. o Antivirals prevent, manage and/or treat viral infections, such as HIV, herpes simplex and cytomegalovirus, pneumonia, measles and mumps and influenza strains (including swine flu). o Antiviral drugs work best when started within two days after the client becomes sick. They reduce the severity of symptoms and shorten the length of illness but they will not cure the disease. Beta-Adrenergic Blocking Agents (Beta Blockers) o Beta blockers block norepinephrine and epinephrine from binding to the beta receptors on nerves. By blocking the effects of these neurotransmitters and dilating blood vessels, they reduce heart rate and blood pressure. o Beta blockers are used to treat hypertension, heart failure, arrhythmias and angina. (They are not used for immediate relief). They can also treat glaucoma, prevent future heart attacks in heart attack patients and prevent migraine headaches. • Nursing Considerations o Warning! Clients should contact their physician before they discontinue their medication. Abrupt withdrawal can cause severe exacerbation of angina and cause heart attacks or sudden death. o The spelling of the generic names of beta blockers ends with "lol." o Beta blockers are also used to calm the brain. They decrease palpitations during panic attacks, decrease essential tremors and decrease situational anxiety. They may also decrease migraine headaches in some people. o Lipid soluble beta blocker eye drops for glaucoma can be absorbed systemically. A CNS side effect of these drugs (timolol and betaxolol) is fatigue. If your client complains of feeling "blah" or has no energy, don't assume the client is depressed. Bronchodilators/Antiasthmatics • Bronchodilator medications relax bronchial smooth muscle, making the airways larger and allowing air to pass through the lungs. They may also increase mucociliary clearance (beta agonists). o Bronchodilaters that are short-acting serve as asthma "rescue" medications, and those that are long-acting help control asthma daily in conjunction with an inhaled steroid. • Contraindications o These medications should not be used for clients that have a known hypersensitivity to adrenergic amines. If a person has heart disease, hypertension, hypothyroidism or a seizure disorder, use of this drug is cautioned. Calcium Channel Blockers (CCBs) • CCB medications slow the rate at which calcium passes into the heart muscle and into the vessel walls. This relaxes the vessels and allows blood to flow more easily through them, lowering blood pressure. o CCBs are used to treat hypertension, angina and abnormal heart rhythms (e.g. atrial fibrillation, paroxysmal supraventricular tachycardia). They are also used to to treat post-MI clients who cannot tolerate beta-blockers. Central Nervous System (CNS) Stimulants • These medications increase physical activity (energy), mental alertness and attention span. The exact mechanism of action is not known. • CNS stimulants are used to improve concentration and focus for those with attention- deficit hyperactivity disorder (ADHD). They can also be used to decrease appetite and promote weight loss. Some clients may take CNS stimulants to alleviate sleep disorders, including narcolepsy and shift work sleep disorder, as well as jet lag. Corticosteroids • Corticosteroid medications mimic the effect of hormones produced naturally by the adrenal glands. When the dose exceeds the body's usual hormone levels, they will suppress inflammation, as well as the immune system. They are also used for their antineoplastic activity. o Oral forms are used to treat inflammation and pain associated with arthritis and autoimmune diseases (such as lupus and Crohn's). Inhaled medications treat Osmotic asthma and allergies. Topical application helps heal skin conditions. The injected forms treat the pain and inflammation of arthritis, gout and other inflammatory diseases. • Osmotic diuretics are low-molecular-weight substances that produce a rapid loss of sodium and water by inhibiting their reabsorption in the kidney tubules and the loop of Henle. They increase plasma osmolality, which increases diffusion of water from the intraocular and cerebrospinal fluids. o Osmotic diuretics manage cerebral edema to decrease intracranial pressure. Potassium-Sparing • Potassium-sparing medications conserve potassium in clients receiving thiazide or loop diuretics. They decrease sodium reabsorption in the collecting tubules of the kidneys. o Potassium-sparing medications are used to treat clients with heart failure, since they do not significantly lower blood pressure. Laxatives • Laxative medications are typically classified as either bulk-forming agents, osmotics, salines, stimulant laxatives or stool softeners. o Laxatives treat or prevent constipation. Lipid-Lowering Agents • Lipid-lowering agents reduce LDL (the "bad" or "lousy") cholesterol by inhibiting the enzyme in the liver (HMG-CoA reductase) responsible for making cholesterol. They also shrink, stabilize and prevent rupture of fatty plaques and formation of clots; and prevent inflammation (statins). • They also reduce LDL by binding to bile acid and preventing absorption of cholesterol from the small intestine (bile acid sequestrants) and can prevent cardiovascular disease in clients with elevated triglycerides and low HDL when diet and lifestyle changes are unsuccessful. o To reduce blood lipids in an effort to reduce the morbidity and mortality of atherosclerotic cardiovascular disease, along with diet and exercise. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) • NSAIDs block the cyclooxygenase (COX-1 and COX-2) enzymes and reduce prostaglandins throughout the body, reducing inflammation, pain and fever. o NSAIDs control mild-to-moderate pain, reduce fever and treat various inflammatory conditions, such as osteoarthritis. • NSAIDs (with the exception of aspirin) increase the risk of heart attack and stroke. The risk may occur within a few weeks of using an NSAID and increases with longer use. • NSAIDs decrease the ability of blood to clot and therefore increase bleeding; all NSAID medicines should be stopped prior to surgery. Non-opioid Analgesics • There are multiple non-opioid analgesic medications, including NSAIDs and aspirin. They target and block the chemical substances released by the brain (particularly prostaglandin) in response to injury. o Non-opioid analgesics are used to control mild-to-moderate pain and fever. Opioid Analgesics • Opioid medications o Any synthetic narcotic not derived from opium. o Indicating substances such as enkephalins or endorphins occurring naturally in the body that act on the brain to decrease the sensation of pain. o interact with opioid receptors in the central nervous system, acting as agonists of endogenously occurring opioid peptides (enkephalins and endorphins). This action alters perception and response to pain. They can be categorized as long- acting, short-acting or rapid-onset agents. o They are all Schedule II drugs. ▪ Opioid analgesics are used to manage moderate-to-severe pain. • Contraindications o Clients should be screened for allergy to opioids. Careful consideration should be made with clients who also take CNS depressants and use alcohol. If a health care provider suspects diversion, an assessment should be made. Skeletal Muscle Relaxants • Muscle relaxant medications act centrally on the spinal cord or brain stem and inhibit neuronal transmission. They are typically classified by their pharmacologic properties as either anti-spasticity or antispasmodic agents. o Muscle relaxants are used to treat spasticity associated with spinal cord diseases (such as cerebral palsy, multiple sclerosis) or lesions. They also relieve symptoms of acute painful musculoskeletal conditions (such as adjunctive therapy). Tocolytics Agents • Tocolytics are medications used to suppress premature labor. o These medications are used for pre-term labor. • May not be given to clients with cardiac arrhythmias or diabetes. Vasopressors • Vasopressor medications are potent vasoconstrictors that produce a rise in blood pressure (specifically, an increase in mean arterial pressure). o Vasopressor medications control blood pressure in hypotensive states, such as (cardiogenic, septic) shock, drug reactions and spinal anesthesia. They can be used to prolong anesthesia and treat certain heart rhythm problems, including cardiac arrest. Vaccinations • Immunizing biological antimicrobial agents (biologicals) are any substance or organism that provokes an immune response when introduced into the body. o Immunizing agents can prevent infectious diseases. • Immunocompromised clients should not receive vaccinations and the nurse should verify all allergies before vaccine administration. Vitamins • These organic compounds, present in minute amounts in foods, are essential for normal growth and development. Fat-soluble vitamins are stored in the liver and excreted via the feces; water-soluble vitamins are not stored in the body and are excreted in the urine. o Vitamins are used as a dietary supplement and to treat vitamin deficiency and some skin conditions.