1、Step3 Drugs for Pain Management Equanalgesic dosage Opioid drug Oral dosage Parenteral dosage Initial oral dosage Comments Morphine 30 mg every 3 to 4 hours 10mg 30 mg every 4 hours Available in a long-acting preparation Codeine 180mg every 3 to 4 hours NA 60mg every 3 to 4 hours Higher incidence of
2、 side effects than morphine Tramadol(Ultram)100 mg 4 times daily 80 mg 50 mg every 6 hours Maxium of 8 tablets per day Fentanyl(Duragesic)24 hours does of any of the above is equivalent to 50ug per hour of transdermal fentanyl 25 ug per hour patch Lower incidence of side effects than morphine.Best u
3、sed in patients with stable pain because the patch is applied only every three days.Meperidine(Demerol)300 mg every 3 to 4 hours 75 mg NR Possible accumulation of toxic metabolites Site Pain vomiting Distension Bowel sound Duodenum None Severe;large amounts with undigested food None Succussion splash may be present Small bowel Upper to central abdominal colic Moderate to severe Moderate Usually hyperactive with borborygmi Large bowel Central to lower Develops late great Borborygmi 現有非典型抗精神藥物（e.g.Seroguel）其EPS等副作用少。謝謝聆聽！謝謝聆聽！
