【最後一哩路加油】評論

Meperidine 在肝臟會代謝成 Normeperidine 並由尿液中排除，腎功能不佳者（本題患者具有CKD stage 4病史）易蓄積，容易造成癲癇27.有關meperidine之敘述，下列何者正確？

【吳富豪】評論

Initial non-invasive approach Analgesicsbegin with nonsteroidal antiinflammatory drugs (NSAIDs) and acetaminophen opioid analgesiainitially use lower-potency opioid agents like tramadoladjunctive agentstricyclic antidepressantsserotonin reuptake inhibitors (SSRIs)combined serotonin and norepinephrine reuptake inhibitors →(eg, duloxetine) or gabapentoids (pregabalin or gabapentin).Antioxidants and other therapies combination of vitamin E (200 international units [IU]), vitamin C (500 mg), beta-carotene (5000 IU), selenium (500 mcg), and methionine (1000 mg)Subsequent approachdepends on pancreatic ductal anatomy and the available expertise

【IG:Pharmabook】評論

補充腎功能不佳者會蓄積的藥物 (from koda & kimble applied) Meperidine肝氧化N-去甲基normeperidine會降低止痛效果，造成神經毒性(癲癇)因此腎功能不佳者易蓄積meperidine的代謝物引發癲癇 15.王先生56歲，腎功能不佳，無癲癇病史，服用procainamide治療心律不整。近日使用meperidine 100 mg im q4h，數天後發生癲癇，最可能之原因為何？