Pain Management Medications: A PTCB Pharmacology Guide
Review pain medication classes from acetaminophen to opioids, including the WHO pain ladder, equianalgesic dosing concepts, and safety considerations for the PTCE.
Understanding Pain Management in Pharmacy
Pain management involves multiple drug classes, and pharmacy technicians handle these prescriptions across all practice settings. The PTCE tests your knowledge of pain medications, their classifications, key side effects, and safety protocols.
Non-Opioid Analgesics
Acetaminophen (Tylenol) - First-line for mild pain. Maximum daily dose: 3,000-4,000 mg (lower in liver disease and alcohol use). No anti-inflammatory effect. Hepatotoxicity risk with overdose. Found in hundreds of combination products; patients must be warned about inadvertent overdose from multiple sources.
NSAIDs - Ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren). Anti-inflammatory, analgesic, and antipyretic. Risks: GI bleeding, renal impairment, cardiovascular events. Black box warning for cardiovascular and GI risks. Avoid in third trimester of pregnancy.
The WHO Pain Ladder
The World Health Organization developed a stepwise approach to pain management:
- Step 1 (Mild pain) - Non-opioid analgesics (acetaminophen, NSAIDs)
- Step 2 (Moderate pain) - Weak opioids (codeine, tramadol) plus non-opioids
- Step 3 (Severe pain) - Strong opioids (morphine, oxycodone, hydromorphone, fentanyl) plus non-opioids
Opioid Analgesics
Common opioids: hydrocodone/APAP (Vicodin, Norco), oxycodone (OxyContin, Percocet), morphine, hydromorphone (Dilaudid), fentanyl (Duragesic patch), tramadol (Ultram). All are controlled substances (C-II except tramadol C-IV). Side effects: constipation, nausea, sedation, respiratory depression, physical dependence.
Adjuvant Pain Medications
- Gabapentin (Neurontin) and pregabalin (Lyrica) - Neuropathic pain
- Duloxetine (Cymbalta) - Neuropathic pain and fibromyalgia
- Muscle relaxants - Cyclobenzaprine (Flexeril), methocarbamol (Robaxin)
Safety Considerations
Always check for duplicate opioid therapy, concomitant benzodiazepine use (boxed warning for combined respiratory depression risk), and appropriate naloxone co-prescribing. Report any concerns to the pharmacist.
Pain management pharmacology spans multiple PTCE domains. Master these drug classes thoroughly.
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