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Updated: Mar 3 2021

Analgesics

  • 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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