Pain, Inflammation, and Dermatology Lecture Review

Vocabulary-style flashcards based on the Pain, Inflammation, and Dermatology lecture notes covering analgesics, opioids, migraine treatments, acne, and topical steroids.

Nocioceptive Pain

Pain due to inflammation or acute damage; most effectively managed with NSAIDs, injections, surgery, and possibly short-term opioids.

Centralized Pain

Pain that is often widespread and associated with fatigue and mood disturbances; treated with CNS-acting drugs and non-pharmacologic therapy such as exercise.

Peripheral Pain

Pain described as a pins and needles sensation following nerve distribution; managed with local treatments (topical, surgery, injection) or CNS-acting drugs.

Acetaminophen

A simple analgesic with anti-pyretic effects but no anti-inflammatory effect; unlike NSAIDs, it is not associated with increased risk for bleeding or renal dysfunction.

Acetaminophen Max Daily Dose

The standard maximum for an adult is $4\,grams$, though some suggest $3\,grams$; a lower dose of $2\,grams$ is recommended for those at risk for hepatotoxicity (e.g., alcohol use disorder).

COX-1 Enzyme

A ‐house-keeping‑ enzyme responsible for maintaining GI mucosa, hemostatic integrity, and renal hemodynamics.

COX-2 Enzyme

The primary target of NSAIDs responsible for triggering pain and inflammation in the body.

NSAID COX-2 Selectivity Ranking

Ordered from most to least selective: CELECOXIB > MELOXICAM > IBUPROFEN > NAPROXEN.

Valdecoxib

Removed from the market in 2005 due to concerns regarding an increased risk for cardiovascular events like myocardial infarction.

Ketorolac

An NSAID that must not be used for more than 5 consecutive days due to an increased risk of gastrointestinal bleeding.

Diclofenac

The only NSAID available as a topical formulation (topical gel and patch).

Hydrocortisone

A short-acting systemic corticosteroid with a mineralcorticoid activity rating of ++.

Dexamethasone

A long-acting systemic corticosteroid with 0 mineralcorticoid activity.

HPA Axis Suppression

The risk that the body stops producing cortisol after taking systemic corticosteroids ($\ge 5\,mg$ daily of prednisone equivalent) for 21 days or longer.

Adrenal Crisis

A condition caused by the abrupt discontinuation of systemic steroids following HPA axis suppression; symptoms include abdominal pain, hypotension, and dehydration.

Morphine

A naturally occurring full mu-agonist opioid.

Tramadol

A weak mu-agonist opioid known to increase serotonin and norepinephrine.

Fentanyl Patch

A synthetic opioid that should only be initiated in patients taking at least $60\,mg$ of morphine or equivalent per day.

Kappa Receptor Clinical Effects

Analgesia and dysphoria.

Hydrocodone-to-Oxycodone Conversion

A total daily dose of $40\,mg$ hydrocodone is equivalent to $26.67\,mg$ of oral oxycodone per day.

Naloxone

A medication that reverses the effect of opioids, primarily if opioids slow down breathing; it cannot be given orally due to poor oral bioavailability and slow onset.

Hydrocodone Metabolites

Norhydrocodone and hydromorphone (found in urine drug tests).

Naltrexone

An opioid antagonist that blocks the effects of opioids; usually administered as a once-monthly intramuscular injection for opioid use disorder.

Methadone

A full opioid agonist at the mu receptor with a long duration of action used for opioid use disorder to provide relief from cravings; must be administered via an opioid treatment program.

Neuropathic Pain Neurotransmitters

Norepinephrine and GABA.

Gabapentin Clinically Effective Dose

Generally considered to be $1800\,mg/day$, as lower or higher doses may lack benefit or increase adverse effects.

Lidocaine 5% Patch

A topical treatment only FDA approved for postherpetic neuralgia.

Fibromyalgia First-Line Treatment

Tricyclic antidepressants (e.g., amitriptyline), which should be dosed at bedtime to target symptoms and minimize daytime drowsiness.

Milnacipran

A serotonin-norepinephrine reuptake inhibitor (SNRI) that is only indicated for fibromyalgia.

Triptans

Serotonin agonists at intracranial blood vessels and sensory nerves that cause vasoconstriction to reduce migraine pain and inflammation.

Frovatriptan

The longest-acting triptan medication.

CGRP Antagonists

Neuropeptide blockers used for migraines; examples include Ubrelvy (acute), Aimovig (prophylaxis), and Nurtec (both).

Retinoids

Vitamin A derivatives that enhance skin cell turnover; should be avoided in pregnancy due to severe risk of teratogenicity.

Isotretinoin Monitoring

Requires the documentation of two forms of birth control, monthly pregnancy tests for females, and periodic lipid and liver function tests.

Propionibacterium acnes

The bacteria most commonly associated with acne.

Topical Potency by Site

High (Soles/Palms), Intermediate (Trunk/Legs/Arms), and Low (Face/Armpits/Genitals).

Topical Steroid Potency Ranking

Most to least potent: Clobetasol propionate = Augmented betamethasone dipropionate > Triamcinolone acetonide > Hydrocortisone.

Topical Absorption Factors

Factors increasing absorption include heat, hydrated skin, application to denuded or intertriginous areas, occlusive dressings, and increased body surface area to body weight ratio.