Pain and Inflammation Pharmacology Flashcards

Comprehensive vocabulary flashcards covering pain assessment, inflammatory mediators, nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, anti-rheumatic therapies, anti-gout medications, migraine treatments, and opioid analgesics.

Pain (IASP Definition)

An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage, influenced by biological, psychological, and social factors.

PAINAD Scale

A pain assessment scale designed for patients with advanced dementia that evaluates breathing, negative vocalization, facial expression, body language, and consolability.

Histamine

A chemical mediator of inflammation that causes the dilation of arterioles and increases capillary permeability.

Kinins (Bradykinin)

Inflammatory chemical mediators that increase capillary permeability and heighten pain perception, commonly associated with angioedema.

Prostaglandins

Inflammatory mediators synthesized via the COX pathway that cause increased capillary permeability, vasodilation, pain, and fever.

COX-1 Isoform

Known as 'Good COX,' it maintains gastric mucosal protection, regulates blood platelets, and converts arachidonic acid into Thromboxane A2 ($TXA_2$) to promote platelet aggregation.

COX-2 Isoform

Known as 'Bad COX,' it is induced at sites of tissue injury to produce prostaglandins that drive inflammation, pain, swelling, and fever.

Acetylsalicylic Acid (Aspirin)

A 1st-generation nonselective COX inhibitor that irreversibly inhibits COX-1 and COX-2, indicated for inflammatory disorders, pain, fever, and cardiovascular protection against MI and stroke.

Salicylism / Salicylate Poisoning

A severe toxic reaction to aspirin characterized by nausea, vomiting, tinnitus, and rapid, deep breathing.

Reye Syndrome

A severe, potentially fatal condition characterized by encephalopathy and fatty liver degeneration with a $30\text{\%}$ to $40\text{\%}$ mortality rate; linked to giving aspirin to children or adolescents with viral infections like influenza or chickenpox.

Ibuprofen

A 1st-generation nonselective NSAID used for fever, mild to moderate pain, and primary dysmenorrhea, capped at an OTC daily maximum of $1,200\,mg/24\,hrs$ and an RX daily maximum of $3,200\,mg/24\,hrs$.

Celecoxib

A 2nd-generation selective COX-2 inhibitor that relieves joint pain and inflammation with less gastroduodenal ulceration, but increases MI and stroke risks and is contraindicated in sulfa allergies.

Acetaminophen

A centrally acting analgesic and antipyretic drug that inhibits COX in the CNS without producing peripheral anti-inflammatory effects, GI ulceration, or platelet suppression.

Acetylcysteine

The specific antidote for acute acetaminophen toxicity that provides $100\text{\%}$ protection against severe liver damage when given within $8$ to $10\,hours$ post-ingestion.

Glucocorticoids

Adrenal cortex steroid hormones that regulate carbohydrate metabolism and exert powerful anti-inflammatory and immunosuppressive actions by interrupting multiple steps in the inflammatory process.

Adrenal Suppression

A life-threatening secondary effect of prolonged glucocorticoid therapy ($> 3\,weeks$) caused by pituitary ACTH suppression and adrenal gland atrophy, necessitating gradual dose tapering upon discontinuation.

Rheumatoid Arthritis (RA)

An autoimmune inflammatory disorder characterized by symmetric joint stiffness and pain that is worst in the morning and decreases with activity throughout the day.

Osteoarthritis vs Rheumatoid Arthritis Pathophysiology

Osteoarthritis involves progressive mechanical erosion of articular cartilage, whereas Rheumatoid Arthritis involves autoimmune inflammation of the synovial membrane leading to pannus formation and joint destruction.

Methotrexate

A conventional folate antagonist DMARD considered the first-choice drug for rheumatoid arthritis; requires folic acid supplementation and strict monitoring for bone marrow suppression, hepatotoxicity, and pneumonitis.

Sulfasalazine

A sulfa-containing conventional DMARD for RA that can cause agranulocytosis, crystalluria, photosensitivity, and orange/yellow discoloration of urine and skin.

Etanercept

A biologic DMARD that neutralizes tumor necrosis factor (TNF), carrying black box warnings for severe infections, tuberculosis (TB) activation, and hepatitis B virus (HBV) reactivation.

Gout

A recurrent inflammatory disorder caused by hyperuricemia that leads to severe, sudden joint pain flares and gritty urate crystal deposits (tophi) in joints or tissues.

Colchicine

An anti-gout agent with a narrow therapeutic index that blocks neutrophil migration to inflammatory sites; must be discontinued immediately if GI toxicity (diarrhea, nausea, vomiting) develops.

Allopurinol

A xanthine oxidase inhibitor used as lifelong urate-lowering therapy to prevent uric acid formation in patients with chronic gout.

Migraine Headache

A neurovascular disorder caused by dilation and inflammation of intracranial blood vessels, causing moderate to severe throbbing pain (often unilateral) accompanied by nausea, photophobia, and phonophobia.

Sumatriptan

A serotonin $5\text{-HT}_{1B/1D}$ receptor agonist used to abort acute migraine attacks by constricting intracranial blood vessels and inhibiting the release of inflammatory neuropeptides.

Ergotamine

A second-line ergot alkaloid used for abortive migraine therapy that carries a risk of ergotism (severe peripheral vasoconstriction leading to ischemia and gangrene) and drug dependence.

Morphine

The prototype pure opioid agonist that binds mu receptors in the CNS to relieve moderate to severe pain, but carries significant risks of respiratory depression, sedation, constipation, and orthostatic hypotension.

Opioid Overdose Triad

The classic combination of three clinical signs indicating severe opioid toxicity: coma, respiratory depression, and pinpoint pupils (miosis).

Pupillary Miosis

Constriction of the pupils to a small or pinpoint size with absent pupillary response to light, characteristic of opioid toxicity.

Naloxone

A pure opioid antagonist used for emergency reversal of opioid overdose and opioid-induced respiratory depression.

Incentive Spirometer

A medical device used to facilitate deep breathing exercises ($10\,times/hour$ while awake) postoperatively to maintain lung inflation and clear secretions when taking opioids.

Fentanyl

A Schedule II strong synthetic opioid agonist with high milligram potency ($\approx 100\times$ that of morphine) where respiratory depression is the primary adverse safety concern.

Opioid Equianalgesic Chart

A clinical reference chart used to convert relative potencies and dosing durations between different IV and oral opioid formulations based on morphine equivalents.

Hydromorphone

A strong Schedule II synthetic opioid agonist (Dilaudid) that is more potent than morphine and causes significantly less histamine release.

Codeine

A moderate opioid agonist metabolized into morphine in the liver by the CYP2D6 enzyme; contraindicated in pediatric patients under $18\,years$ due to unpredictable metabolism risks.

Hydrocodone

A widely prescribed Schedule II oral moderate-to-strong opioid agonist commonly formulated in fixed combinations with acetaminophen or ibuprofen to treat mild to moderate pain.

Oxycodone

A strong Schedule II oral opioid analgesic available in immediate-release (Roxicodone) and extended-release (OxyContin) formulations with high abuse liability.

Tramadol

A centrally acting Schedule IV synthetic opioid analog of codeine that weakly binds mu receptors and inhibits reuptake of serotonin and norepinephrine, carrying risks of seizures and serotonin syndrome.

Patient Controlled Analgesia (PCA)

An IV delivery system allowing patients to self-administer programmed doses of opioid analgesics on demand within strict safety intervals, operated exclusively by the patient.