20xx年醫(yī)學專題—癌性疼痛的處理-資料下載頁
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【正文】 Step 1: Stop morphine (or other strong opioid) Step 2: Give a fixed dose of methadone that is 1/10 of the 24 h oral morphine dose when 24 h dose is 300 mg., the fixed dose should be 30 mg. Step 3: The fixed dose is taken PO prn but not more frequently than q 3 h. b Morley JS, Makin MK. Pain Reviews. 1998.,第二十八頁，共三十二頁。,美沙酮起始劑量的計算 第四步：第六天，計算前兩天美沙酮的平均(p237。ngjūn)口服用量，并轉(zhuǎn)換為定時的q12h用量（和q3h prn） 第五步：如果持續(xù)需要臨時給藥，每46天一次增加1/21/3的美沙酮用量（即，10mg bid 變?yōu)?5mg bid。30mg bid變?yōu)?0mg bid) Calculating the starting dose of methadone Step 4: On day 6, the amount of methadone taken over the previous 2 days is averaged and converted into a regular q 12 dose (and q 3 h pr n). Step 5: If prn medication continues to be needed, increase the dose of methadone 1/21/3 every 46 days (i.e., 10 mg bid to 15 mg bid。 30 mg bid to 40 mg bid). Morley JS, Makin MK. Pain Reviews. 1998.,第二十九頁，共三十二頁。,不推薦…… 度冷丁 口服(kǒuf)吸收少 半衰期短（23小時） 去甲度冷?。ㄈゼ走咛驵ぃ┦且环N毒性代謝產(chǎn)物 長半衰期（6小時），沒有鎮(zhèn)痛作用 擬精神病的不良反應，肌陣攣，驚厥/抽搐 如果以q3h給藥用于鎮(zhèn)痛，去甲哌替啶蓄積增加 腎功能不全時蓄積增加 Not recommended . . . Meperidine Poor oral absorption Short halflife (2 3 hours) Normeperidine is a toxic metabolite Long halflife (6 hours), not analgesic Psychotomimetic adverse effects, myoclonus, seizures If dosing q 3 h for analgesia, normeperidine builds up Accumulates with renal insufficiency,第三十頁，共三十二頁。,不推薦 混合性激動拮抗劑 噴他佐辛，布托啡諾，納布啡，地佐辛 與激動劑競爭?撤藥狀態(tài) 鎮(zhèn)痛的天花板效應(xi224。oy236。ng) 噴他佐辛和布托啡諾的擬精神病性不良反應的風險高 Not recommended Mixed agonistantagonists Pentazocine, butorphanol, nalbuphine, dezocine Compete with agonists ? withdrawal Analgesic ceiling effect High risk of psychotomimetic adverse effects with pentazocine, butorphanol,第三十一頁，共三十二頁。,內(nèi)容(n232。ir243。ng)總結(jié),癌性疼痛(t233。ngt242。ng)的處理 WHO 3階梯鎮(zhèn)痛療法 Management of Cancer Pain WHO 3 – Step Analgesic Ladder。Morphine嗎啡 A 。Fentanyl芬太尼 A ,第三十二頁，共三十
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