Pharmacology: Muscle Relaxants, Antiemetics, Gastrointestinal, Hormonal, and Sedative Agents

Vocabulary review flashcards covering indications, therapeutic effects, adverse effects, clinical checks, and patient teaching for muscle relaxants, bone agents, antiemetics, immunomodulators, GI drugs, endocrine therapies, anesthetics, and uterine care medications.

Dantrolene (Dantrium)

A muscle relaxant used for spasticity and malignant hyperthermia (trigger: Hyperthermia) that decreases muscle rigidity. Adverse effects include severe hepatotoxicity (liver failure) and muscle weakness; requires monitoring liver function tests (LFTs) and instructing patients to report yellow skin or eyes and avoid alcohol.

Tizanidine (Zanaflex)

An antispasticity agent indicated for muscle spasms (trigger: Spasms) that reduces muscle tone and cramping. Adverse effects include severe hypotension, profound sedation, and hepatotoxicity; requires monitoring blood pressure and liver enzymes, avoiding sudden position changes due to orthostatic hypotension, and avoiding abrupt cessation.

Baclofen (Lioresal)

A muscle relaxant indicated for chronic spasticity related to multiple sclerosis or spinal cord injury (trigger: Spasticity) that decreases muscle spasms and rigidity. Adverse effects include severe CNS depression and seizures upon abrupt withdrawal; requires monitoring neurological status and renal function, avoiding alcohol and driving, and never stopping abruptly.

Diazepam (Valium)

A benzodiazepine used for anxiety, muscle spasms, and acute status epilepticus (trigger: Sedation) that causes skeletal muscle relaxation, sedation, and seizure cessation. Adverse effects include respiratory depression, profound sedation, and physical dependence; requires monitoring respiratory rate and level of consciousness (LOC), avoiding alcohol, and not stopping abruptly due to severe withdrawal risk.

Alendronate (Fosamax)

A bisphosphonate indicated for osteoporosis prevention and treatment (trigger: Upright) that increases bone mineral density and decreases fractures. Adverse effects include esophageal erosions/ulcers and jaw osteonecrosis; requires checking calcium levels and the patient's ability to sit upright for $30\text{ minutes}$, taking first thing in the morning with a full glass of plain water, and remaining upright for $30\text{ minutes}$ before eating.

Calcium Citrate (Citracal)

A mineral supplement indicated for hypocalcemia and osteoporosis prevention (trigger: Absorption) that normalizes calcium levels and provides bone protection. Adverse effects include hypercalcemia, kidney stones, and cardiac dysrhythmias; requires monitoring serum calcium levels and renal function, and can be taken with or without food while reporting severe flank pain or constipation.

Vitamin D3 (Cholecalciferol)

A fat-soluble vitamin used for vitamin D deficiency and as an adjunct for osteoporosis (trigger: Calcium-absorber) to correct serum vitamin D levels and improve calcium absorption. Adverse effects include hypervitaminosis D and hypercalcemia; requires monitoring serum calcium and vitamin D levels, ensuring adequate dietary calcium intake, and avoiding exceeding the prescribed dose.

Ondansetron (Zofran)

A serotonin receptor antagonist indicated for chemotherapy, radiation, or post-operative nausea and vomiting (trigger: Serotonin). Adverse effects include QT prolongation, severe headache, and serotonin syndrome; requires checking baseline EKG for prolonged QT intervals and bowel sounds, and instructing patients to report palpitations or chest pain immediately.

Scopolamine (Transderm Scop) Patch

An anticholinergic agent indicated for motion sickness prevention and reduction of pre-operative secretions (trigger: Dryness) that prevents nausea and reduces salivation. Adverse effects include anticholinergic crisis (blurred vision, severe urinary retention, tachycardia); requires checking vision, urinary output, and narrow-angle glaucoma history, applying the patch behind the ear $4\text{ hours}$ before needed, and washing hands thoroughly.

Metoclopramide (Reglan)

A prokinetic antiemetic indicated for gastroparesis, GERD, and nausea (trigger: Motility) that accelerates gastric emptying. Adverse effects include tardive dyskinesia (irreversible involuntary movements) and extrapyramidal symptoms (EPS); requires checking neurological status for involuntary muscle twitching and immediately reporting unusual tongue or facial movements.

Dronabinol (Marinol)

A cannabinoid agent indicated for chemotherapy-induced nausea and anorexia in HIV/AIDS (trigger: Appetite) that stimulates appetite and resolves nausea. Adverse effects include a dissociative state, tachycardia, and psychoactive effects; requires monitoring mental status and heart rate, avoiding alcohol or other CNS depressants, and anticipating potential mood shifts.

Promethazine (Phenergan)

An antiemetic and sedative indicated for nausea, vomiting, motion sickness, and sedation (trigger: Vein-irritant). Adverse effects include severe tissue necrosis from IV extravasation, respiratory depression, and EPS; requires verifying IV patency (preferring deep IM or oral administration), monitoring respiratory status, and avoiding dangerous activities or alcohol due to heavy drowsiness.

Methotrexate (Trexall)

A DMARD and antineoplastic agent used for rheumatoid arthritis, psoriasis, and various cancers (trigger: Infection) that reduces joint pain and inflammation and slows disease progression. Adverse effects include bone marrow suppression (infection, bleeding), hepatotoxicity, and fetal death; requires CBC, liver function tests, pregnancy testing, strict contraception, and reporting fevers, chills, or unusual bleeding.

Sulfasalazine (Azulfidine)

A DMARD indicated for ulcerative colitis and rheumatoid arthritis (trigger: Sulfa) that decreases GI inflammation and joint pain. Adverse effects include severe sulfa allergy reactions (Stevens-Johnson syndrome) and bone marrow suppression; requires checking CBC, renal function, and allergy history to sulfa or salicylates, maintaining high water intake to prevent kidney stones, and noting skin or urine may turn orange-yellow.

Azathioprine (Imuran)

An immunosuppressive DMARD indicated for rheumatoid arthritis, prevention of kidney transplant rejection, and inflammatory bowel disease (Crohn's/Ulcerative Colitis). Adverse effects include severe bone marrow suppression (profoundly low white blood cells), hepatotoxicity, and increased long-term risk of malignancy (lymphoma); requires frequent CBC and LFT monitoring, avoiding crowds and sick contacts, and avoiding live vaccines.

Lubiprostone (Amitiza)

A chloride channel secretagogue indicated for chronic idiopathic constipation and IBS-C (trigger: Secretagogue) that increases the frequency of soft bowel movements. Adverse effects include severe diarrhea and first-dose syncope/hypotension; requires monitoring bowel patterns and baseline hydration, taking with food and water to minimize nausea, and reporting severe diarrhea.

Dicyclomine (Bentyl)

An antispasmodic anticholinergic indicated for irritable bowel syndrome (IBS) cramping (trigger: Antispasmodic) that decreases abdominal pain and cramping. Adverse effects include paralytic ileus, severe urinary retention, and tachycardia; requires monitoring bowel sounds and urine output, avoiding overheating due to decreased sweating, and using ice chips for dry mouth.

Rifaximin (Xifaxan)

A non-absorbable antibiotic indicated for traveler's diarrhea and hepatic encephalopathy prevention (trigger: Ammonia) that reduces diarrhea and improves mental status by lowering ammonia levels. Adverse effects include Clostridioides difficile-associated diarrhea and hypersensitivity; requires monitoring mental status, tracking bowel movements, and completing the full course.

Calcium Carbonate (Tums)

An antacid and mineral supplement indicated for heartburn, dyspepsia, and hypocalcemia (trigger: Rebound) that provides immediate relief of gastric burning. Adverse effects include acid rebound, hypercalcemia, and constipation; requires monitoring serum calcium levels with chronic use, separating by $1\text{ to }2\text{ hours}$ from other oral medications due to binding interactions, and avoiding overuse.

Famotidine (Pepcid)

An H2-receptor antagonist indicated for GERD, gastric/duodenal ulcers, and heartburn (trigger: H2-blocker) that reduces gastric acid secretion to heal ulcerations. Adverse effects include arrhythmia and CNS changes in elderly patients (confusion, agitation); requires checking renal function for dose adjustments, taking before meals or at bedtime, and avoiding smoking, caffeine, and alcohol.

Pantoprazole (Protonix)

A proton pump inhibitor (PPI) indicated for GERD, erosive esophagitis, and Zollinger-Ellison syndrome (trigger: PPI) that produces long-term reduction of gastric acid and promotes esophageal healing. Adverse effects include C. diff infection, osteoporosis/fractures from long-term use, and hypomagnesemia; requires monitoring magnesium levels and watery stools, taking $30\text{ to }60\text{ minutes}$ before breakfast, and never crushing delayed-release tablets.

Sucralfate (Carafate)

A mucosal protective agent indicated for the treatment and maintenance of duodenal ulcers (trigger: Coating) that forms a physical barrier over the ulcer bed. Adverse effects include constipation and gastric bezoar formation; requires taking on an empty stomach $1\text{ hour}$ before meals and at bedtime, and separating administration from other medications by $2\text{ hours}$.

Amoxicillin

A penicillin antibiotic indicated for bacterial infections of the ENT, respiratory tract, skin, and urinary tract (trigger: Penicillin) to eradicate bacteria and normalize WBC counts. Adverse effects include severe anaphylaxis, Stevens-Johnson syndrome, and C. diff-associated diarrhea; requires screening for penicillin/cephalosporin allergies, checking renal function, finishing the entire regimen, and immediately reporting rash or watery diarrhea.

Estrogen (Estradiol)

A hormone therapy indicated for menopausal vasomotor symptoms and hypogonadism (trigger: Clotting) that reduces hot flashes and maintains bone density. Adverse effects include thromboembolism (DVT, PE, stroke) and endometrial cancer if used without progestin; requires monitoring blood pressure and clotting history, strictly avoiding smoking, and reporting calf swelling, pain, or shortness of breath.

Progestin (Progesterone)

A hormone therapy indicated for endometrial hyperplasia prevention during estrogen therapy and amenorrhea (trigger: Uterus-protection) that regulates bleeding cycles and prevents uterine overgrowth. Adverse effects include thromboembolic disease, breast tenderness, and breakthrough bleeding; requires monitoring liver function, conducting monthly breast self-exams, and reporting sudden vision changes or chest pain.

Testosterone

An androgen indicated for male hypogonadism and delayed puberty (trigger: Virilization) that stimulates the development of secondary male sex characteristics. Adverse effects include polycythemia (elevated hematocrit), hepatic carcinoma, and premature epiphyseal closure; requires monitoring hematocrit/hemoglobin (H&H), liver function, and PSA, and washing hands immediately after topical gel application to prevent transfer to women or children.

Spironolactone (Aldactone)

A potassium-sparing diuretic and aldosterone antagonist indicated for heart failure, hypertension, ascites, and acne/hirsutism (trigger: Potassium) that reduces edema and blood pressure while improving cardiac output. Adverse effects include severe hyperkalemia and gynecomastia; requires monitoring serum potassium, blood pressure, and creatinine, while avoiding high-potassium foods and potassium-based salt substitutes.

Finasteride (Proscar)

A 5-alpha reductase inhibitor indicated for benign prostatic hyperplasia (BPH) and male pattern baldness (trigger: Teratogenic) that improves urinary flow stream and reduces prostate size. Adverse effects include high-grade prostate cancer risk, sexual dysfunction, and severe fetal harm; requires baseline PSA and DRE checks, and pregnant or childbearing-age women must never handle crushed or broken tablets.

Oral Contraceptive (Ortho Tri-Cyclen, Yaz)

An estrogen-progestin combination indicated for pregnancy prevention, acne management, and menstrual cycle regulation (trigger: Thrombus). Adverse effects include deep vein thrombosis (DVT), pulmonary embolism (PE), and myocardial infarction; requires checking smoking history, blood pressure, and pregnancy status, taking at the exact same time every day, and reporting unilateral leg swelling or shortness of breath immediately.

Propofol

An intravenous anesthetic indicated for induction and maintenance of general anesthesia or ICU sedation (trigger: Airway) that causes rapid unconsciousness. Adverse effects include profound respiratory depression, severe hypotension, and Propofol Infusion Syndrome (PRIS); requires continuous airway/ventilator support, continuous blood pressure monitoring, monitoring serum triglycerides, and strict use by trained providers.

Fentanyl

A potent synthetic opioid indicated for severe acute or chronic pain and anesthesia adjunct (trigger: Opioid) that provides profound analgesia. Adverse effects include fatal respiratory depression, severe constipation, and urinary retention; requires monitoring respiratory rate, oxygen saturation, pain scale, and LOC; transdermal patches must be folded with adhesive sides together, safely discarded, and protected from direct heat.

Midazolam (Versed)

A short-acting benzodiazepine indicated for preoperative sedation and procedural amnesia (trigger: Amnesia) that provides conscious sedation and lack of procedural memory. Adverse effects include apnea, respiratory depression, and paradoxical agitation; requires continuous respiratory monitoring, pulse oximetry, availability of flumazenil, and avoiding driving or signing legal documents for at least $24\text{ hours}$.

Lidocaine (Xylocaine)

An amide local anesthetic and Class IB antiarrhythmic indicated for local/regional anesthesia and ventricular arrhythmias (trigger: Numbing). Adverse effects include lidocaine toxicity (CNS excitation, seizures, bradycardia, cardiac arrest); requires assessing skin integrity at application sites, continuous EKG monitoring during IV infusion, and avoiding chewing or hot liquids until oral numbness resolves.

Misoprostol

A synthetic prostaglandin E1 analog indicated for cervical ripening/labor induction, postpartum hemorrhage, and NSAID-induced ulcer prevention (trigger: Contraction) that induces uterine contractions and protects gastric mucosa. Adverse effects include severe uterine rupture, miscarriage/fetal death (when used off-label for ulcers), and severe abdominal cramping; requires a confirmed negative pregnancy test when used for gastric ulcer prophylaxis.