Drug Deliveruy for Pain Management in Oncology

Question 1

What is the WHO Analgesic Ladder for Cancer Pain?

Answer 1

A stepwise approach consisting of: 1. Non-opioids → 2. Weak opioids → 3. Strong opioids (± adjuvants)

Question 2

Why change the route/method of delivery for opioids?

Answer 2

To achieve faster onset, avoid first-pass metabolism, provide sustained release, improve patient convenience, and allow non-invasive alternatives.

Question 3

What are the characteristics of Oral Opioids?

Answer 3

Immediate Release (IR): for acute/breakthrough pain, dosed every 2–6 hours. Sustained Release (SR/CR): for chronic pain, dosed every 12–24 hours.

Must be opioid-tolerant before use.

Question 4

What is the pharmacokinetics and dosing for short-acting and long-acting opioids?

Answer 4

Short-acting opioids reach steady-state within ~1 day. Long-acting opioids reach steady-state in 2–4 days. It is better to schedule than to chase pain.

Question 5

What is linked to opioid abuse potential?

Answer 5

High Cmax and low Tmax are linked to euphoric effects, increasing abuse potential. Common abuse routes include injection, inhalation, and smoking.

Question 6

What are Abuse-Deterrent Formulations (ADFs)?

Answer 6

ADFs include: 1. Physical barriers (gel formation), 2. Aversion components (e.g., niacin), 3. Agonist/Antagonist combos (e.g., morphine + naltrexone), 4. Prodrugs requiring metabolic activation.

Question 7

What are the characteristics of Transdermal Opioids?

Answer 7

Fentanyl (Duragesic): long-lasting, applied every 3 days, risk of gel extraction. Buprenorphine: partial agonist/antagonist, used for pain and opioid dependence, applied transdermally (5–75 µg/hr).

Question 8

What is Breakthrough Cancer Pain (BTcP)?

Answer 8

Transient spikes in pain despite stable opioid use, requiring rapid-onset opioids (ROOs).

Question 9

What are Rapid-Onset Opioids (Fentanyl-Based)?

Answer 9

Formulations include OTFC (oral transmucosal lozenge), buccal tablet (FBT), sublingual tablet (FST), and nasal spray (INFS/FPNS). Advantages include fast absorption and bypassing first-pass metabolism.

Question 10

What are key product examples for rapid-onset opioids?

Answer 10

Instanyl® – intranasal fentanyl spray, Abstral® – fentanyl sublingual tablets, Remoxy® – abuse-deterrent oxycodone matrix.

Question 11

What are the conclusions regarding cancer pain control?

Answer 11

Various drug formulations meet patient needs for cancer pain control. ADFs are critical in combating the opioid crisis. Rapid-onset and alternate-route opioids improve BTcP management.