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 AgentsNameMechanism of Action Key Indication Key ToxicityTNFα InhibitorsInfliximabMonoclonal antibody against TNF-alpha (infliximab, adalimumab, certolizumab)Decoy receptor for TNF-alpha (etanercept)Disease modifying drug for Crohn's, psoriasis, rheumatoid arthritis, ankylosing spondylitisOpportunistic infection, in particular mycobacterial infection due to TNF destabilization of granulomasAdalimumabEtanerceptGold PreparationsAuranofin Gold complexNot commonly usedGold toxicityMyelosuppressionAurothioglucoseOther AntirheumaticsCyclophosphamideAlkylating agent - nitrogen mustard typeHodgkin lymphomaLeukemiaRAAlkylating agentHemorrhagic cystitis (treat with mesna)MyelosuppressionAzathioprinePurine synthesis inhibitorRenal transplant immunosuppresionAutoimmune diseasePTLPDMyelosuppressionHydroxychloroquineLysosomal accumulation/inhibitionMalaria prophylaxiSLERACan excacerbate G6PD deficiencyMethotrexateDihydrofolate reductase competitive inhibitorRAPsoriasisAnti-folate chemotherapyEctopic pregnancyMust monitor pregnancy status, extremely toxic to fetus including neural tube defectsMuscle RelaxantsCarbamic Acid EstersMethocarbamolMechanism unknownPotential carbonic anhydrase inhibitionAdjunct for tetanus, muscle spamsAtaxiaSeizuresCarisoprodolMechanism unknownCentral skeletal muscle relaxantMuscle spamsMusculoskeletal painOtherBaclofenGABAB receptor activationSpasticityCNS depressionRespiratory depressionCyclobenzaprineMechanism unkownMuscle relaxantMuscle spasmsContraindicated with MAOIsHeart blockDantroleneBinds ryanodine receptorDecreases calcium release from the sarcomplasmic reticulumNeuroleptic malignant syndromeMalignant hyperthermiaHepatotoxicityCNS depressionMetaxaloneMechanism unkownCNS depressionMusculoskeletal painCNS depressionOrphenadrineAch receptor antagonismH1 receptor blocker (antihistamine)NMDA receptor antagonistNorepinephrine reuptake inhibitorNa+ channel blockerK+ channel blockerDiscontinued in the U.S.Anticholinergic effectsTizanidineCentralα2 agonist (Gicoupled)SpasticityHypotension (α2 agonist)DiazepamGABA type A positive modulatorAnxietyStatus epilepticusAlcohol withdrawalSeizuresSedativeMuscle relaxantDependencyAbuse potentialNarcotic AgonistsAlfentanilOpioid analgesic (short acting)Induction agent for general anesthesiaRespiratory depressionDependencyAbuse potentialCodeineOpioid (μ agonist)Acute painLevorphanolOxymorphoneHydromorphoneMorphineOxycodoneMeperidineAcute painSedationDextropropoxypheneAntitussiveMild painRestless leg syndromeMethadoneVery long acting opioid (μagonist)Opioid dependenceChronic painFentanylVery potent opioid (μ agonist)Induction agentChronic painNarcotic Agonists-AntagonistsBuprenorphinePartial opioid receptor (μ) modulatorModerate painOpioid dependenceRespiratory depressionSeizuresBradycardiaButorphanolPartial agonist/antagonist activity ofμreceptorsCompetitive antagonis of κ opioid receptors Anesthesia inductionSeizuresCNS depressionAnticholinergic effectsNalbuphinePentozocineAgonist-antagonist at opioid (μ) receptorMild painOpioid dependenceHypertensionTachycardiaBuprenorphine/naloxonePartial opioid receptor (μ) modulator (buprenorphine)μreceptor antagonist (naloxone)Opioid dependence maintenance therapySeizuresCNS depressionAnticholinergic effectsOpiod withdrawal if abusedNarcotic AntagonistsNaloxoneμreceptor antagonistAcute opioid toxicityOpioid withdrawalNarcotic Analgesic ComboAcetaminophen/oxycodoneμagonist + unknown mechanism of acetaminophenAcute pain moderateRespiratory depressionDependencyAbuse potentialAcetaminophen/hydrocodoneNSAIDSSalicylatesAspirinIrreversible inhibitor of COX-1Antiplatelet therapy for CADPainAntipyreticReye's Syndrome in childrenTinnitusMixed metabolic acidosis and respiratory alkalosisProprionic AcidsIbuprofenCOX inhibitorMild painGastritisNSAID nephropathyGI bleedingNaproxenAcetic AcidsKetorolacCOX inhibitor (competitive)Mild painGastritisNSAID nephropathyGI bleedingIndomethicinCOX inhibitorPatent ductus arteriosusPainCOX-2 Selective InhibitorsCelecoxibCOX-2 inhibitionOsteoarthritisIncreased risk of MI, thrombosis in at-risk individualsOther AnalgesicsAcetominophenNot well characterizedAntipyrreticMild painHepatotoxicityTramadolOpioid agonist (μ)Chronic, moderate-severe painHepatotoxicitySeizuresWithdrawal symptoms