课件：四疼痛的药物治疗节.ppt

羟考酮（Oxycodone）羟二氢可待因 效力：3/4吗啡，无封顶现象 一般认为强效（中效） 羟考酮5mg + 对乙酰氨基酚500mg = 泰勒宁 盐酸羟考酮控释片 = 奥施康定 ( Oxycontin ) 1h起效，持续12 h，不封顶；中度痛；整片吞服； 嚼服或碾成粉末后 鼻吸，或注射，会有强烈麻醉感觉。 第三节 a片类镇痛药 布托啡诺 机制：a片受体激动拮抗剂 临床应用：癌症疼痛 手术后疼痛 不良反应：嗜睡头晕、恶心、呕吐 第四节 类阿片类镇痛药 曲马多 机制：弱a片机制和非a片机制 应用：癌症疼痛、骨折和术后疼痛 不良反应：出汗、恶心、呕吐 四、类阿片类镇痛药 -Opioid analgesics 曲马多(tramadol)：具有双重镇痛作用机制 弱阿片机制 抑制神经元突触对去甲肾上腺素再摄取，增加神经元外5-羟色胺浓度 不良反应 出汗、恶心、呕吐、纳差、头晕、无力、嗜睡等 皮疹、心悸、体位性低血压 * * 第四章 复习思考题 1、非甾体类抗炎药的作用机制及不良反应？ 2、非甾体类抗炎的分类及代表用药？ 3、阿片类药物的急性中毒的抢救？ 4、激素类药的分类及代表用药？ THANK YOU SUCCESS * * 可编辑 pain management 2007 3 * 转导-传导-传递-知觉 PG的主要生理功能 pge2能诱发炎症，促进局部血管扩张，毛细血管通透性增加，引起红、肿、痛、热等症状。 The major problem with use of nonspecific NSAIDs is the occurrence of adverse events, which can limit their utilization in perioperative analgesia. Gastrointestinal: Gastropathy associated with the use of both Rx and OTC nonselective NSAIDs is the most frequent adverse drug event in the U.S. It was conservatively estimated that it is associated with approximately 16,500 deaths and 107,000 hospitalizations annually in patients with arthritis1 Hematologic: Hematologic reactions associated with nonspecific NSAIDs include inhibition of platelet aggregation and function, which can lead to an increased risk of bleeding and bruising2 Cardiorenal: Nonspecific NSAIDs can increase blood pressure and interfere with the blood pressure-lowering effects of certain antihypertensive agents, especially the ACE inhibitors, beta blockers, and diuretics.3 Because they inhibit renal prostaglandins, use of nonspecific NSAIDs can result in acute renal failure, fluid and electrolyte imbalances, exacerbation of chronic renal insufficiency, interstitial nephritis, and nephrotic syndrome4 References: 1. Singh G. Recent considerations in nonsteroidal anti-inflammatory drug gastropathy. Am J Med. 1998;105(1B):31S-38S. 2. Atcheson R, Rowbotham DJ. Pharmacology of acute and chronic pain. In: Rawal N, ed. Management of Acute and Chr