Pain Management Pharmacology Lecture

75 vocabulary flashcards covering key medications, concepts, and routes from the pain treatment lecture.

Analgesic

Any medication or therapy intended to relieve, treat, target, or manage pain.

Opioid

A class of strong analgesics that act primarily on the central nervous system (e.g., morphine, fentanyl).

Non-opioid

Pain-relieving drugs that are not opioids and act mainly on the peripheral nervous system, such as NSAIDs and acetaminophen.

Adjuvant Analgesic

Drug from a different therapeutic class (e.g., antidepressant, anticonvulsant, steroid) used to enhance pain control.

Ceiling Effect

Point at which a drug produces its maximum analgesic effect; higher doses only add side/adverse effects.

Central Nervous System (CNS) Action

Site where opioids exert analgesia by altering pain perception in brain and spinal cord.

Peripheral Nervous System (PNS) Action

Mechanism by which non-opioids reduce pain by dampening peripheral inflammation and nociception.

NSAID

Non-steroidal anti-inflammatory drug that inhibits COX enzymes to decrease inflammation, pain, and fever.

COX-1 Enzyme

Constitutive cyclooxygenase isoform whose inhibition can cause gastric irritation and bleeding.

COX-2 Enzyme

Inducible cyclooxygenase isoform targeted for anti-inflammatory effect with fewer GI side effects.

Acetaminophen (Tylenol)

Non-opioid analgesic/antipyretic without anti-inflammatory action; hepatotoxic in high doses.

Aspirin

NSAID that irreversibly inhibits COX-1/2; used for pain, inflammation, fever, and antiplatelet effect.

Ibuprofen (Motrin/Advil)

OTC NSAID used for mild-moderate pain, fever, and inflammation.

Naproxen (Aleve)

Long-acting NSAID commonly used for musculoskeletal and arthritic pain.

Meloxicam (Mobic)

Prescription NSAID often used for chronic arthritic pain; carries higher GI bleed risk; limited to short courses.

Ketorolac (Toradol)

Potent parenteral NSAID frequently used post-operatively; limited to 24-48 h due to bleeding risk.

Morphine

Prototype opioid analgesic against which others are measured; strong μ-receptor agonist.

Hydrocodone

Moderate opioid often formulated with acetaminophen for oral pain relief.

Hydromorphone (Dilaudid)

Opioid approximately 10 × stronger than morphine; used for severe pain.

Oxycodone

Strong oral opioid; active ingredient in Percocet and OxyContin.

Codeine

Weak opioid prodrug; commonly combined with acetaminophen for mild pain.

Fentanyl

Synthetic opioid about 100 × stronger than morphine; available IV, transdermal, lozenge.

Tramadol

Schedule IV opioid-like analgesic with dual opioid and SNRI action; considered ‘light’ opioid.

Percocet

Combination tablet containing oxycodone and acetaminophen.

Meperidine (Demerol)

Older opioid rarely used due to neurotoxic metabolite that can provoke seizures.

Black Box Warning (Tylenol)

FDA alert stating that total acetaminophen intake must not exceed 4 g in 24 h.

Maximum Daily Acetaminophen Dose

4,000 mg per 24 hours from all sources, including combination products.

Opioid Antagonist

Drug that reverses opioid effects by competing for receptors.

Naloxone (Narcan)

Short-acting opioid antagonist kept in emergency kits to treat overdose or respiratory depression.

World Health Organization (WHO) Analgesic Ladder

Three-step guideline for escalating pain therapy from non-opioids to strong opioids.

WHO Step 1

Use non-opioids ± adjuvant for mild pain.

WHO Step 2

Add a weak opioid (low-dose) ± adjuvant for mild-to-moderate pain.

WHO Step 3

Employ strong opioids (e.g., morphine, hydromorphone, fentanyl) ± adjuvant for severe pain.

Corticosteroid

Anti-inflammatory hormone (e.g., prednisone) used as adjuvant to reduce pain caused by inflammation.

Prednisone

Oral corticosteroid that decreases inflammatory pain but carries systemic side effects.

Antidepressant (Elavil)

Tricyclic agent amitriptyline; adjuvant for neuropathic and psychosomatic pain.

Duloxetine (Cymbalta)

SNRI antidepressant effective for chronic back pain and neuropathic pain.

Anticonvulsant

Seizure medication repurposed to calm neuropathic pain by modulating nerve firing.

Gabapentin (Neurontin)

Anticonvulsant commonly prescribed for diabetic neuropathy and nerve pain.

Carbamazepine (Tegretol)

Anticonvulsant useful for trigeminal neuralgia and neuropathic pain.

Benzodiazepine

Sedative class (e.g., diazepam) that decreases anxiety-related pain and muscle spasm.

Diazepam (Valium)

Long-acting benzodiazepine used for muscle spasms, bladder spasms, and pain-related anxiety.

Anxiolytic Role in Pain

Reducing fear and tension with agents like benzodiazepines can lower perceived pain.

Muscle Relaxant

Drug that diminishes muscle spasm pain, e.g., cyclobenzaprine.

Cyclobenzaprine (Flexeril)

Common skeletal muscle relaxant given for musculoskeletal aches.

Baclofen

Centrally acting antispastic muscle relaxant used in neurological spasm pain.

Local Anesthetic

Medication that blocks nerve conduction at site (e.g., lidocaine) for pain control without systemic opioids.

Lidocaine Patch

5 % transdermal anesthetic worn 12 hours on/12 hours off for localized pain.

Fentanyl Patch

Transdermal system delivering fentanyl over 72 hours; doses 25-150 µg/h; dispose with witness.

Transdermal Route

Drug delivery through intact skin via a medicated patch for sustained systemic effect.

Topical Route

Direct application of cream, gel, or ointment (e.g., Voltaren gel) to treat local pain.

Rectal Route

Suppository administration (e.g., Tylenol, aspirin, steroid) for systemic or local anorectal pain relief.

Oral Route

Preferred method of analgesic delivery via pills, capsules, liquids, or dissolving tablets.

Intravenous (IV) Route

Parenteral delivery providing rapid onset and precise titration of analgesics.

Patient-Controlled Analgesia (PCA)

IV pump allowing patient to self-administer preset opioid doses.

PCA Bolus Dose

Single programmed amount of opioid delivered when patient presses the PCA button.

Lock-out Interval

Safety time period on PCA during which additional doses cannot be delivered (e.g., 6 min).

Continuous Infusion Rate

Optional background opioid flow on PCA providing constant analgesia between boluses.

Intracavity On-Q Pump

Surgically placed device that bathes incision with continuous local anesthetic post-operatively.

Ketamine

IV anesthetic with powerful analgesic properties, reserved for severe chronic pain.

Actiq (Fentanyl Lollipop)

Oral transmucosal fentanyl lozenge for breakthrough cancer pain; highly addictive.

Withdrawal Symptoms

Autonomic and psychological signs (tachycardia, irritability, clammy skin) that appear when dependent patients stop opioids.

Opioid Withdrawal Treatment

Benzodiazepines (e.g., Valium, Librium) may be given to ease agitation during detox.

Antiemetic

Drug that relieves nausea and can indirectly decrease pain caused by vomiting or GI distress.

Ondansetron (Zofran)

Common serotonin-antagonist antiemetic used in postoperative and chemo-induced nausea.

Aprepitant (Emend)

Neurokinin-1 antagonist reserved for refractory or chemotherapy-related nausea.

Marijuana (Cannabis) for Pain

Inhaled, oral, or topical cannabinoids (CBD/THC) used in some states to reduce chronic pain and spasms.

Botox (OnabotulinumtoxinA)

Neurotoxin injected to relieve some neuropathic and muscle-spasm pain conditions.

Inhalation Route

Administration of drugs via lungs (e.g., marijuana smoke, nebulized steroids) for localized respiratory pain relief.

Subcutaneous Route

Injection into fatty tissue; unreliable absorption for analgesics, so rarely used today.

Intramuscular Route

Deep muscle injection formerly common for opioids but avoided due to unpredictable absorption and pain.

Combination Medication

Single product containing more than one analgesic class, such as oxycodone + acetaminophen.

Acetaminophen-Opioid Cautions

When giving combination products, total daily acetaminophen must be tracked to avoid liver toxicity.

Ice/Heat with Patches Precaution

Temperature extremes can alter drug release from transdermal systems and should be avoided.

Controlled Substance Schedule II (Opioids)

Legal category for high-abuse-potential drugs like morphine and fentanyl requiring secure storage.