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Intrathecal Ziconotide — SCE Palliative Medicine MCQ

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HardPain ManagementIntrathecal ZiconotideSCE Palliative Medicine

A 70‑year‑old man with advanced prostate cancer has severe perineal pain from local pelvic recurrence. All systemic and interventional analgesic options have been exhausted. The pain team suggests a trial of intrathecal ziconotide. What is ziconotide?

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Correct answer: D — An intrathecal‑administered synthetic N‑type calcium‑channel blocker (cone‑snail venom analogue) — a non‑opioid analgesic for refractory pain

Ziconotide is a synthetic peptide derived from cone‑snail venom (ω‑conotoxin), and it acts by selectively blocking N‑type voltage‑sensitive calcium channels in the dorsal horn when administered into the intrathecal space. It is a non‑opioid analgesic licensed in the UK for severe refractory cancer pain delivered intrathecally. Distractors describe entirely different drug classes or routes and are not applicable to intrathecal delivery in this context.

Reference: NHS Specialist Pharmacy Service (2025) – Ziconotide: informing intrathecal risk assessment; eMC (Patient Information Leaflet for Prialt® – ziconotide), c.2024.