医学课件 镇痛药.pptVIP

* +/- adjuvant Non-opioid Weak opioid Strong opioid Pain persists or increases 阶 梯 递 增 给 药 By the Clock 定时！ 按需X W.H.O. ANALGESIC LADDER +/- adjuvant +/- adjuvant 1 2 3 * Analgesic Guide Mild (1-4) Moderate (5-6) Severe (7-10) Nonopioid Acetaminophen Aspirin NSAID +/- Adjuvant Combination Opioid/Nonopioid Codein Hydrocodon Oxycodon Strong opioid Morphine Fentanyl Oxycodone Hydromorphone. PAIN Pain Persist Pain Persist Adapted from the three step analgesic ladder, WHO1990 什么是毒品 毒品是指非医疗目的而反复使用易成瘾癖的管制类麻醉药品和精神药品，主要有鸦片、吗啡、海洛因、可卡因、大麻及其衍生物冰毒、摇头丸等。 又称去氧麻黄碱，化学名称为甲基苯丙胺，也叫安非他命，因其外观与冰极相似，故称之为“冰”。由于冰毒的刺激性强，持久力强，使用一次便会上瘾，因此被称为毒品之王。冰毒的毒性甚于海洛因。海洛因极易形成强烈的生存欲望，而冰毒则使吸毒者不希望生存，只渴望死去。长期使用使人坐立不安，浑身颤抖，易怒、失眠、忧郁、神志不清，惊慌偏执，心律不齐，腹部疼痛性痉挛甚至发疯死去。吸食冰毒死亡率较高，特别对婴儿毒害最严重。 珍爱生命 拒绝毒品 决不尝试！ * This figure, taken from Kalant and Roschlau’s Principles of Medical Pharmacology, illustrates one experimental technique used to investigate the reinforcing properties of psychoactive substances. An animal is maintained in an environment where a certain behaviour, such as pressing a lever, can be monitored and linked to drug administration (in this case intravenously). The relationship between the animals behaviour and drug consumption can then be studied in several ways. For example, after conditioning the animal to a certain ratio between lever presses and drug injection, the ratio can be slowly increased until each dose of the drug requires such effort that the animal ceases the activity. This break-point has been shown to be predictive of the ability of a substance to produce dependence in humans. For cocaine, for instance, animals will perform an almost infinite number of lever presses per dose. In another variant the drug administration can be linked to another stimulus, such as a coloured light. The frequency of lever presses can then be compared between periods with and without the light. Experiments such as these have led to a much clearer understanding of how psychoactive