Updated: 3/3/2021

Analgesics

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  • 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
      • Centralα2 agonist (Gicoupled)
      • 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 (μagonist)
      • 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 ofμreceptors
      • 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)
      • μreceptor antagonist (naloxone)
      • Opioid dependence maintenance therapy
      • Seizures
      • CNS depression
      • Anticholinergic effects
      • Opiod withdrawal if abused
      Narcotic Antagonists
      Naloxone
      • μreceptor antagonist
      • Acute opioid toxicity
      • Opioid withdrawal
      Narcotic Analgesic Combo
      Acetaminophen/oxycodone
      • μagonist + 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
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(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

pH: 7.30, PaCO2: 15 mmHg, HCO3-: 16 mEq/L

19%

(4/21)

pH: 7.31, PaCO2: 31 mmHg, HCO3-: 15 mEq/L

29%

(6/21)

pH: 7.37, PaCO2: 41 mmHg, HCO3-: 12 mEq/L

19%

(4/21)

pH: 7.41, PaCO2: 65 mmHg, HCO3-: 34 mEq/L

19%

(4/21)

pH: 7.47, PaCO2: 11 mmHg, HCO3-: 24 mEq/L

10%

(2/21)

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