Analgesic Drug Introduction Analgesic medications can be broken down into the following categories antirheumatic agents muscle relaxants narcotic agonists narcotic agonists-antagonists narcotic antagonists narcotic analgesic combo NSAIDS other analgesics Analgesic Drug Table Antirheumatic Agents Name Mechanism of Action Key Indication Key Toxicity TNFα Inhibitors Infliximab Monoclonal antibody against TNF-alpha (infliximab, adalimumab, certolizumab) Decoy receptor for TNF-alpha (etanercept) Disease modifying drug for Crohn's, psoriasis, rheumatoid arthritis, ankylosing spondylitis Opportunistic infection, in particular mycobacterial infection due to TNF destabilization of granulomas Adalimumab Etanercept Gold Preparations Auranofin Gold complex Not commonly used Gold toxicity Myelosuppression Aurothioglucose Other Antirheumatics Cyclophosphamide Alkylating agent - nitrogen mustard type Hodgkin lymphoma Leukemia RA Alkylating agent Hemorrhagic cystitis (treat with mesna) Myelosuppression Azathioprine Purine synthesis inhibitor Renal transplant immunosuppresion Autoimmune disease PTLPD Myelosuppression Hydroxychloroquine Lysosomal accumulation/inhibition Malaria prophylaxi SLE RA Can excacerbate G6PD deficiency Methotrexate Dihydrofolate reductase competitive inhibitor RA Psoriasis Anti-folate chemotherapy Ectopic pregnancy Must monitor pregnancy status, extremely toxic to fetus including neural tube defects Muscle Relaxants Carbamic Acid Esters Methocarbamol Mechanism unknown Potential carbonic anhydrase inhibition Adjunct for tetanus, muscle spams Ataxia Seizures Carisoprodol Mechanism unknown Central skeletal muscle relaxant Muscle spams Musculoskeletal pain Other Baclofen GABAB receptor activation Spasticity CNS depression Respiratory depression Cyclobenzaprine Mechanism unkown Muscle relaxant Muscle spasms Contraindicated with MAOIs Heart block Dantrolene Binds ryanodine receptor Decreases calcium release from the sarcomplasmic reticulum Neuroleptic malignant syndrome Malignant hyperthermia Hepatotoxicity CNS depression Metaxalone Mechanism unkown CNS depression Musculoskeletal pain CNS depression Orphenadrine Ach receptor antagonism H1 receptor blocker (antihistamine) NMDA receptor antagonist Norepinephrine reuptake inhibitor Na+ channel blocker K+ channel blocker Discontinued in the U.S. Anticholinergic effects Tizanidine Central α2 agonist (Gi coupled) Spasticity Hypotension (α2 agonist) Diazepam GABA type A positive modulator Anxiety Status epilepticus Alcohol withdrawal Seizures Sedative Muscle relaxant Dependency Abuse potential Narcotic Agonists Alfentanil Opioid analgesic (short acting) Induction agent for general anesthesia Respiratory depression Dependency Abuse potential Codeine Opioid (μ agonist) Acute pain Levorphanol Oxymorphone Hydromorphone Morphine Oxycodone Meperidine Acute pain Sedation Dextropropoxyphene Antitussive Mild pain Restless leg syndrome Methadone Very long acting opioid (μ agonist) Opioid dependence Chronic pain Fentanyl Very potent opioid (μ agonist) Induction agent Chronic pain Narcotic Agonists-Antagonists Buprenorphine Partial opioid receptor (μ) modulator Moderate pain Opioid dependence Respiratory depression Seizures Bradycardia Butorphanol Partial agonist/antagonist activity of μ receptors Competitive antagonis of κ opioid receptors Anesthesia induction Seizures CNS depression Anticholinergic effects Nalbuphine Pentozocine Agonist-antagonist at opioid (μ) receptor Mild pain Opioid dependence Hypertension Tachycardia Buprenorphine/naloxone Partial opioid receptor (μ) modulator (buprenorphine) μ receptor antagonist (naloxone) Opioid dependence maintenance therapy Seizures CNS depression Anticholinergic effects Opiod withdrawal if abused Narcotic Antagonists Naloxone μ receptor antagonist Acute opioid toxicity Opioid withdrawal Narcotic Analgesic Combo Acetaminophen/oxycodone μ agonist + unknown mechanism of acetaminophen Acute pain moderate Respiratory depression Dependency Abuse potential Acetaminophen/hydrocodone NSAIDS Salicylates Aspirin Irreversible inhibitor of COX-1 Antiplatelet therapy for CAD Pain Antipyretic Reye's Syndrome in children Tinnitus Mixed metabolic acidosis and respiratory alkalosis Proprionic Acids Ibuprofen COX inhibitor Mild pain Gastritis NSAID nephropathy GI bleeding Naproxen Acetic Acids Ketorolac COX inhibitor (competitive) Mild pain Gastritis NSAID nephropathy GI bleeding Indomethicin COX inhibitor Patent ductus arteriosus Pain COX-2 Selective Inhibitors Celecoxib COX-2 inhibition Osteoarthritis Increased risk of MI, thrombosis in at-risk individuals Other Analgesics Acetominophen Not well characterized Antipyrretic Mild pain Hepatotoxicity Tramadol Opioid agonist (μ) Chronic, moderate-severe pain Hepatotoxicity Seizures Withdrawal symptoms
QUESTIONS 1 of 1 1 Previous Next (M2.PH.14.35) A 58-year-old man presents to the emergency department with a chief complaint of ringing in his ears that started several hours previously that has progressed to confusion. The patient denies any history of medical problems except for bilateral knee arthritis. He was recently seen by an orthopedic surgeon to evaluate his bilateral knee arthritis but has opted to not undergo knee replacement and prefers medical management. His wife noted that prior to them going on a hike today, he seemed confused and not himself. They decided to stay home, and roughly 19 hours later, he was no longer making any sense. Physical exam is notable for a confused man. The patient's vitals are being performed and his labs are being drawn. Which of the following is most likely to be seen on blood gas analysis? QID: 104309 Type & Select Correct Answer 1 pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L 12% (2/16) 2 pH: 7.31, PaCO2: 31 mmHg, HCO3-: 15 mEq/L 31% (5/16) 3 pH: 7.37, PaCO2: 41 mmHg, HCO3-: 12 mEq/L 25% (4/16) 4 pH: 7.41, PaCO2: 65 mmHg, HCO3-: 34 mEq/L 19% (3/16) 5 pH: 7.47, PaCO2: 11 mmHg, HCO3-: 24 mEq/L 6% (1/16) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic