{"id":432,"date":"2019-12-01T20:17:12","date_gmt":"2019-12-01T20:17:12","guid":{"rendered":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/10-8-adjuvant-analgesics\/"},"modified":"2025-01-16T22:28:52","modified_gmt":"2025-01-16T22:28:52","slug":"10-8-adjuvant-analgesics","status":"publish","type":"chapter","link":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/chapter\/10-8-adjuvant-analgesics\/","title":{"raw":"10.8 Adjuvant Analgesics","rendered":"10.8 Adjuvant Analgesics"},"content":{"raw":"
\n\nAdjuvant analgesics are medications that were developed for other purposes but were later found to be effective to treat pain. Examples of adjuvant medications include gabapentin (an anticonvulsant) and amitriptyline (a tricyclic antidepressant). Additional information about these specific adjuvant medications can be found in the \"Central Nervous System<\/a>\" chapter. Muscle relaxants are also considered an adjuvant analgesic and are used for various musculoskeletal disorders such as multiple sclerosis. Three different types of muscle relaxants will be discussed below: baclofen, cyclobenzaprine, and tizanidine.\n

Baclofen<\/h2>\nMechanism of Action: <\/strong>Baclofen inhibits reflexes at the spinal level.\n\nIndications: <\/strong>Baclofen is used to treat muscle symptoms, such as spasm, pain, and stiffness, caused by multiple sclerosis, spinal cord injuries, or other spinal cord disorders.\n\nNursing Considerations: <\/strong>Baclofen is safe for clients 12 years and older.\n\nSide Effects\/Adverse Effects: <\/strong>Adverse effects include drowsiness, dizziness or light-headedness, confusion, nausea, constipation, and muscle weakness.\n\nAbrupt Drug Withdrawal:<\/strong> Hallucinations and seizures have occurred on abrupt withdrawal of baclofen. Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.\n\nImpaired Renal Function:<\/strong> Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce the dosage.\n\nSigns and symptoms of overdose include vomiting, muscular hypotonia, drowsiness, accommodation disorders of the eye, coma, respiratory depression, and seizures.\n\nHealth Teaching & Health Promotion: <\/strong>The medication should be taken as directed and abrupt withdrawal of the medication should be avoided. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let\u2019s take a closer look at the medication grid on baclofen in Table 10.8a.[footnote]Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company.[\/footnote],[footnote]This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>.[\/footnote]<\/span><\/sup>\n\nTable 10.8a Baclofen Medication Grid\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing\n<\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Skeletal Muscle Relaxant and Antispasticity Agent<\/strong><\/th>\nbaclofen<\/a><\/td>\nGiven parentally and orally\n\nAdminister orally with milk or food to minimize gastric upset\n\nAssess for muscle spasticity before and during therapy\n\nObserve for drowsiness\n\nFor intrathecal administration monitor client closely during test dose and titration and have resuscitative equipment available<\/td>\nTo relieve muscle spasms and spasticity<\/td>\nDrowsiness\n\nConfusion\n\nDizziness or light-headedness\n\nNausea\n\nConstipation\n\nMuscle weakness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n
\n

Critical Thinking Activity 10.8a\"Image<\/h2>\n<\/header>\n
\n\nA client just started taking baclofen for muscle spasticity due to multiple sclerosis.\n\nWhat teaching should the nurse provide?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" section at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n
\n

Cyclobenzaprine<\/h2>\nMechanism of Action: <\/strong>Cyclobenzaprine reduces tonic somatic muscle activity at the level of the brain stem. It is structurally similar to tricyclic antidepressants.\n\nIndications: <\/strong>Cyclobenzaprine is used to treat acute muscle spasms.\n\nNursing Considerations: <\/strong>Cyclobenzaprine is safe for clients 15 years and older. Use cautiously with elderly clients, clients with hepatic impairment, and those who take antidepressants and other CNS depressants.\n\nIn the elderly, the frequency and severity of adverse events associated with the use of cyclobenzaprine, with or without concomitant medications, are increased. In elderly clients, cyclobenzaprine should be initiated with a 5 mg dose and titrated slowly upward.\n\nSide Effects\/Adverse Effects: <\/strong>Adverse effects include dizziness, drowsiness, dry mouth, urinary retention, serotonin syndrome with antidepressant use, or increased sedation with other CNS depressants.\n\nSerotonin Syndrome: <\/strong>The development of a potentially life-threatening serotonin syndrome has been reported with cyclobenzaprine hydrochloride when used in combination with other drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tramadol, bupropion, meperidine, verapamil, or MAO inhibitors (MAOIs). The concomitant use of cyclobenzaprine hydrochloride with MAO inhibitors is contraindicated.\n\nSerotonin syndrome symptoms may include mental status changes (e.g., confusion, agitation, hallucinations), autonomic instability (e.g., diaphoresis, tachycardia, labile blood pressure, hyperthermia), neuromuscular abnormalities (e.g., tremor, ataxia, hyperreflexia, clonus, muscle rigidity), and\/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Treatment with cyclobenzaprine hydrochloride and any concomitant serotonergic agents should be discontinued immediately if the above reactions occur, and supportive symptomatic treatment should be initiated. If concomitant treatment with cyclobenzaprine hydrochloride and other serotonergic drugs is clinically warranted, careful observation is advised, particularly during treatment initiation or dose increases.\n\nGeneral: <\/strong>Because of its atropine-like action, cyclobenzaprine hydrochloride should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in those taking anticholinergic medication.\n\nImpaired Hepatic Function: <\/strong>The plasma concentration of cyclobenzaprine is increased in clients with hepatic impairment.\n\nCyclobenzaprine, especially when used with alcohol or other CNS depressants, may impair mental and\/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.\n\nHealth Teaching & Health Promotion: <\/strong>The medication should be taken as directed. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants. Clients should be aware that constipation may occur as a side effect of medication therapy and increased fluid intake may assist in preventing complications.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let\u2019s take a closer look at the medication grid on cyclobenzaprine in Table 10.8b.[footnote]Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company.[\/footnote],[footnote]This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>.[\/footnote]<\/sup>\n\nTable 10.8b Cyclobenzaprine Medication Grid\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Skeletal Muscle Relaxant<\/strong><\/th>\ncyclobenzaprine<\/a><\/td>\nMay be administered with meals to minimize GI upset\n\nAssess for pain and muscle stiffness\n\nUse cautiously with antidepressants and other CNS depressants<\/td>\nReduction of muscle spasms<\/td>\nDizziness\n\nDrowsiness\n\nDry mouth\n\nUrinary retention\n\nSerotonin syndrome<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n
\n

Critical Thinking Activity 10.8b\"Image<\/h2>\n<\/header>\n
\n\nA client asks if they can drive their car while taking cyclobenzaprine.\n\nWhat is the nurse\u2019s best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" section at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>\n
\n

Tizanidine<\/h2>\nMechanism of Action: <\/strong>Tizanidine acts as an agonist at central alpha-adrenergic receptor sites. It reduces spasticity by increasing presynaptic inhibition of motor neurons.\n\nIndications: <\/strong>Tizanidine is used to treat increased muscle tone, spasms, and spasticity.\n\nNursing Considerations: <\/strong>Tizanidine is safe for adults. Dosage adjustment may be required for the geriatric population.\n\nSide Effects\/Adverse Effects: <\/strong>Adverse effects include somnolence, dry mouth, hypotension, bradycardia, dizziness, fatigue, weakness or asthenia, hallucinations, liver function test abnormality, and hepatotoxicity.\n\nHealth Teaching & Health Promotion: <\/strong>The medication should be taken as directed. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.[footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]<\/sup>\n\nNow let\u2019s take a closer look at the medication grid on tizanidine in Table 10.8c.[footnote]Frandsen, G., & Pennington, S. (2018).\u00a0Abrams\u2019 clinical drug: Rationales for nursing practice\u00a0<\/em>(11th ed.). pp. 305, 310, 952-953, 959-960. Wolters Kluwer.[\/footnote],[footnote]Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company.[\/footnote],[footnote]This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>.[\/footnote]<\/span><\/sup>\n\nTable 10.8c Tizanidine Medication Grid\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antispasticity<\/strong><\/th>\n\u00a0tizanidine<\/a><\/td>\nGiven orally\n\nMay be given with or without food\n\nAssess muscle spasticity before and during therapy\n\nAssess blood pressure and pulse\n\nMonitor for sedation\n\nAssess liver function<\/td>\nReduction of muscle spasms and spasticity<\/td>\nSomnolence\n\nDry mouth\n\nHypotension\n\nBradycardia\n\nDizziness\n\nFatigue\n\nWeakness or asthenia\n\nHallucinations\n\nLiver function test abnormality and hepatotoxicity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n
\n
\n

Critical Thinking Activity 10.8c\"Image<\/h2>\n<\/header>\n
\n\nA client asks, \u201cWhy should I not drink alcohol with tizanidine?\u201d\n\nWhat is the nurse\u2019s best response?\n\nNote: Answers to the Critical Thinking activities can be found in the \"Answer Key<\/a>\" section at the end of the book.\n\n<\/div>\n<\/div>\n<\/div>","rendered":"
\n

Adjuvant analgesics are medications that were developed for other purposes but were later found to be effective to treat pain. Examples of adjuvant medications include gabapentin (an anticonvulsant) and amitriptyline (a tricyclic antidepressant). Additional information about these specific adjuvant medications can be found in the “Central Nervous System<\/a>” chapter. Muscle relaxants are also considered an adjuvant analgesic and are used for various musculoskeletal disorders such as multiple sclerosis. Three different types of muscle relaxants will be discussed below: baclofen, cyclobenzaprine, and tizanidine.<\/p>\n

Baclofen<\/h2>\n

Mechanism of Action: <\/strong>Baclofen inhibits reflexes at the spinal level.<\/p>\n

Indications: <\/strong>Baclofen is used to treat muscle symptoms, such as spasm, pain, and stiffness, caused by multiple sclerosis, spinal cord injuries, or other spinal cord disorders.<\/p>\n

Nursing Considerations: <\/strong>Baclofen is safe for clients 12 years and older.<\/p>\n

Side Effects\/Adverse Effects: <\/strong>Adverse effects include drowsiness, dizziness or light-headedness, confusion, nausea, constipation, and muscle weakness.<\/p>\n

Abrupt Drug Withdrawal:<\/strong> Hallucinations and seizures have occurred on abrupt withdrawal of baclofen. Therefore, except for serious adverse reactions, the dose should be reduced slowly when the drug is discontinued.<\/p>\n

Impaired Renal Function:<\/strong> Because baclofen is primarily excreted unchanged through the kidneys, it should be given with caution, and it may be necessary to reduce the dosage.<\/p>\n

Signs and symptoms of overdose include vomiting, muscular hypotonia, drowsiness, accommodation disorders of the eye, coma, respiratory depression, and seizures.<\/p>\n

Health Teaching & Health Promotion: <\/strong>The medication should be taken as directed and abrupt withdrawal of the medication should be avoided. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.[1]<\/sup><\/a><\/sup><\/p>\n

Now let\u2019s take a closer look at the medication grid on baclofen in Table 10.8a.[2]<\/sup><\/a>,[3]<\/sup><\/a><\/span><\/sup><\/p>\n

Table 10.8a Baclofen Medication Grid<\/p>\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing
\n<\/strong>Considerations<\/strong><\/th>\n		Therapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Skeletal Muscle Relaxant and Antispasticity Agent<\/strong><\/th>\nbaclofen<\/a><\/td>\nGiven parentally and orally<\/p>\n

Administer orally with milk or food to minimize gastric upset<\/p>\n

Assess for muscle spasticity before and during therapy<\/p>\n

Observe for drowsiness<\/p>\n

For intrathecal administration monitor client closely during test dose and titration and have resuscitative equipment available<\/td>\n

To relieve muscle spasms and spasticity<\/td>\nDrowsiness<\/p>\n

Confusion<\/p>\n

Dizziness or light-headedness<\/p>\n

Nausea<\/p>\n

Constipation<\/p>\n

Muscle weakness<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

\n
\n
\n

Critical Thinking Activity 10.8a\"Image<\/h2>\n<\/header>\n
\n

A client just started taking baclofen for muscle spasticity due to multiple sclerosis.<\/p>\n

What teaching should the nurse provide?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” section at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Cyclobenzaprine<\/h2>\n

Mechanism of Action: <\/strong>Cyclobenzaprine reduces tonic somatic muscle activity at the level of the brain stem. It is structurally similar to tricyclic antidepressants.<\/p>\n

Indications: <\/strong>Cyclobenzaprine is used to treat acute muscle spasms.<\/p>\n

Nursing Considerations: <\/strong>Cyclobenzaprine is safe for clients 15 years and older. Use cautiously with elderly clients, clients with hepatic impairment, and those who take antidepressants and other CNS depressants.<\/p>\n

In the elderly, the frequency and severity of adverse events associated with the use of cyclobenzaprine, with or without concomitant medications, are increased. In elderly clients, cyclobenzaprine should be initiated with a 5 mg dose and titrated slowly upward.<\/p>\n

Side Effects\/Adverse Effects: <\/strong>Adverse effects include dizziness, drowsiness, dry mouth, urinary retention, serotonin syndrome with antidepressant use, or increased sedation with other CNS depressants.<\/p>\n

Serotonin Syndrome: <\/strong>The development of a potentially life-threatening serotonin syndrome has been reported with cyclobenzaprine hydrochloride when used in combination with other drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), tramadol, bupropion, meperidine, verapamil, or MAO inhibitors (MAOIs). The concomitant use of cyclobenzaprine hydrochloride with MAO inhibitors is contraindicated.<\/p>\n

Serotonin syndrome symptoms may include mental status changes (e.g., confusion, agitation, hallucinations), autonomic instability (e.g., diaphoresis, tachycardia, labile blood pressure, hyperthermia), neuromuscular abnormalities (e.g., tremor, ataxia, hyperreflexia, clonus, muscle rigidity), and\/or gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea). Treatment with cyclobenzaprine hydrochloride and any concomitant serotonergic agents should be discontinued immediately if the above reactions occur, and supportive symptomatic treatment should be initiated. If concomitant treatment with cyclobenzaprine hydrochloride and other serotonergic drugs is clinically warranted, careful observation is advised, particularly during treatment initiation or dose increases.<\/p>\n

General: <\/strong>Because of its atropine-like action, cyclobenzaprine hydrochloride should be used with caution in clients with a history of urinary retention, angle-closure glaucoma, increased intraocular pressure, and in those taking anticholinergic medication.<\/p>\n

Impaired Hepatic Function: <\/strong>The plasma concentration of cyclobenzaprine is increased in clients with hepatic impairment.<\/p>\n

Cyclobenzaprine, especially when used with alcohol or other CNS depressants, may impair mental and\/or physical abilities required for performance of hazardous tasks, such as operating machinery or driving a motor vehicle.<\/p>\n

Health Teaching & Health Promotion: <\/strong>The medication should be taken as directed. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants. Clients should be aware that constipation may occur as a side effect of medication therapy and increased fluid intake may assist in preventing complications.[4]<\/sup><\/a><\/sup><\/p>\n

Now let\u2019s take a closer look at the medication grid on cyclobenzaprine in Table 10.8b.[5]<\/sup><\/a>,[6]<\/sup><\/a><\/sup><\/p>\n

Table 10.8b Cyclobenzaprine Medication Grid<\/p>\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Skeletal Muscle Relaxant<\/strong><\/th>\ncyclobenzaprine<\/a><\/td>\nMay be administered with meals to minimize GI upset<\/p>\n

Assess for pain and muscle stiffness<\/p>\n

Use cautiously with antidepressants and other CNS depressants<\/td>\n

Reduction of muscle spasms<\/td>\nDizziness<\/p>\n

Drowsiness<\/p>\n

Dry mouth<\/p>\n

Urinary retention<\/p>\n

Serotonin syndrome<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

\n
\n
\n

Critical Thinking Activity 10.8b\"Image<\/h2>\n<\/header>\n
\n

A client asks if they can drive their car while taking cyclobenzaprine.<\/p>\n

What is the nurse\u2019s best response?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” section at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

\n

Tizanidine<\/h2>\n

Mechanism of Action: <\/strong>Tizanidine acts as an agonist at central alpha-adrenergic receptor sites. It reduces spasticity by increasing presynaptic inhibition of motor neurons.<\/p>\n

Indications: <\/strong>Tizanidine is used to treat increased muscle tone, spasms, and spasticity.<\/p>\n

Nursing Considerations: <\/strong>Tizanidine is safe for adults. Dosage adjustment may be required for the geriatric population.<\/p>\n

Side Effects\/Adverse Effects: <\/strong>Adverse effects include somnolence, dry mouth, hypotension, bradycardia, dizziness, fatigue, weakness or asthenia, hallucinations, liver function test abnormality, and hepatotoxicity.<\/p>\n

Health Teaching & Health Promotion: <\/strong>The medication should be taken as directed. It may cause dizziness or drowsiness. Clients should be advised to change positions slowly because of the potential orthostatic changes that may occur. Additionally, clients should avoid concurrent use with alcohol or other CNS depressants.[7]<\/sup><\/a><\/sup><\/p>\n

Now let\u2019s take a closer look at the medication grid on tizanidine in Table 10.8c.[8]<\/sup><\/a>,[9]<\/sup><\/a>,[10]<\/sup><\/a><\/span><\/sup><\/p>\n

Table 10.8c Tizanidine Medication Grid<\/p>\n\n\n\n\n
Class\/<\/strong>Subclass<\/strong><\/th>\nPrototype\/G<\/strong>eneric<\/strong><\/th>\nNursing <\/strong>Considerations<\/strong><\/th>\nTherapeutic Effects<\/strong><\/th>\nSide\/Adverse Effects<\/strong><\/th>\n<\/tr>\n
Antispasticity<\/strong><\/th>\n\u00a0tizanidine<\/a><\/td>\nGiven orally<\/p>\n

May be given with or without food<\/p>\n

Assess muscle spasticity before and during therapy<\/p>\n

Assess blood pressure and pulse<\/p>\n

Monitor for sedation<\/p>\n

Assess liver function<\/td>\n

Reduction of muscle spasms and spasticity<\/td>\nSomnolence<\/p>\n

Dry mouth<\/p>\n

Hypotension<\/p>\n

Bradycardia<\/p>\n

Dizziness<\/p>\n

Fatigue<\/p>\n

Weakness or asthenia<\/p>\n

Hallucinations<\/p>\n

Liver function test abnormality and hepatotoxicity<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

\n
\n
\n

Critical Thinking Activity 10.8c\"Image<\/h2>\n<\/header>\n
\n

A client asks, \u201cWhy should I not drink alcohol with tizanidine?\u201d<\/p>\n

What is the nurse\u2019s best response?<\/p>\n

Note: Answers to the Critical Thinking activities can be found in the “Answer Key<\/a>” section at the end of the book.<\/p>\n<\/div>\n<\/div>\n<\/div>\n

  1. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  2. Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company. ↵<\/a><\/li>
  3. This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li>
  4. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  5. Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company. ↵<\/a><\/li>
  6. This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li>
  7. uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral<\/a> ↵<\/a><\/li>
  8. Frandsen, G., & Pennington, S. (2018).\u00a0Abrams\u2019 clinical drug: Rationales for nursing practice\u00a0<\/em>(11th ed.). pp. 305, 310, 952-953, 959-960. Wolters Kluwer. ↵<\/a><\/li>
  9. Vallerand, A., & Sanoski, C. A. (2019). Davis\u2019s drug guide for nurses <\/em>(16th ed.). F. A. Davis Company. ↵<\/a><\/li>
  10. This work is a derivative of DailyMed<\/a>\u00a0by\u00a0U.S. National Library of Medicine<\/a> in the\u00a0Public Domain<\/a>. ↵<\/a><\/li><\/ol><\/div>","protected":false},"author":83,"menu_order":8,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[48],"contributor":[],"license":[],"class_list":["post-432","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":410,"_links":{"self":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/432","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/users\/83"}],"version-history":[{"count":1,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/432\/revisions"}],"predecessor-version":[{"id":433,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/432\/revisions\/433"}],"part":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/410"}],"metadata":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/432\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/media?parent=432"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=432"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/contributor?post=432"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.ccconline.org\/accnursingpharmacology\/wp-json\/wp\/v2\/license?post=432"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}