麻醉性镇痛药学习资料.pptxVIP

Review;2;Objectives;Section one;5;1.2 Analgesics ;Peripheral analgesics;;;10;Naturally occurring in the poppy (16%)- Only needs to be isolated Very strong pain reliever but also very addictive (2nd to Heroin) Usually injected but can be smoked, sniffed or swallowed Commonly used in hospitals;12;;14;15;Morphine and opioids produce analgesia, affect mood and rewarding behavior, and alter respiratory, cardiovascular, gastrointestinal, and neuroendocrine function. ;17;18;19;20;21;22;23;24;(5) Ureter （输尿管）and Urinary Bladder. Therapeutic doses of morphine may increase the tone and amplitude of contractions of the ureter, although the response is variable. (6) Uterus（子宫）. If the uterus has been made hyperactive by oxytocics（催产素）, morphine tends to restore the tone, frequency, and amplitude of contractions to normal. (7) Morphine causes histamine release, which can cause bronchoconstriction and vasodilation.;26;27;2.5 Therapeutic Uses;Fig. 19-3 The analgesic regimen recommended by WHO for cancer pain. ;2.5.2 Dyspnea（呼吸困难） Morphine is used to alleviate the dyspnea of acute left ventricular failure and pulmonary edema, and the response to intravenous morphine may be dramatic. It may involve an alteration of the patient’s reaction to impaired respiratory function and an indirect reduction of the work of the heart owing to reduced fear and apprehension（忧虑）. However, it is more probable that the major benefit is due to cardiovascular effects, such as decreased peripheral resistance and an increased capacity of the peripheral and splanchnic （内脏的）vascular compartments. ;2.5.3 Cough 2.5.4 Diarrhea（腹泻） ;2.6 Side Effects;Side Effects;Side Effects;35;2.7 Kinetics;37;Section 3;Codeine;Codeine is considered a prodrug, since it is metabolised in vivo to the principal active analgesic agent morphine. It is, however, less potent than morphine since only about 10% of the codeine is converted.;Uses of Codeine;42;43;Methadone;45;46;47