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June 18, 2021
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Samenvatting Praktische Psychofarmacologie
Inhoudsopgave
INLEIDING DEEL 1: ANATOMIE EN FUNCTIE VAN DE HERSENEN .......................................................................5
CEREBRUM (GROTE HERSENEN) ..................................................................................................................................5
CORTEX CEREBRI ......................................................................................................................................................5
PREFRONTALE CORTEX ..............................................................................................................................................5
PRIMAIRE MOTORISCHE CORTEX ..................................................................................................................................6
SECUNDAIRE MOTORISCHE SCHORS ..............................................................................................................................6
PRIMAIRE SENSORISCHE CORTEX..................................................................................................................................6
SECUNDAIRE SENSORISCHE SCHORS ..............................................................................................................................6
VISUELE CORTEX ......................................................................................................................................................7
AUDITIEVE CORTEX ...................................................................................................................................................7
GNOSTISCH CENTRUM ...............................................................................................................................................7
CEREBRUM .............................................................................................................................................................7
DIENCEPHALON .......................................................................................................................................................8
HERSENSTAM ..........................................................................................................................................................8
CEREBELLUM ...........................................................................................................................................................8
SENSIBEL SYSTEEM VOOR ZINTUIGLIJKE WAARNEMINGEN..................................................................................................9
MOTORISCH SYSTEEM VOOR BEWEGING .......................................................................................................................9
LIMBISCH SYSTEEM VOOR EMOTIONEEL GEDRAG .............................................................................................................9
NUCLEUS ACCUMBENS OF VENTRAAL STRIATUM ...........................................................................................................10
INLEIDING DEEL 2: NEUROTRANSMISSIE........................................................................................................ 10
KLASSIEKE ANTEROGRADE NEUROTRANSMISSIE ............................................................................................................10
HOE COMMUNICEREN ZENUWCELLEN .........................................................................................................................10
DE ACTIEPOTENTIAAL ..............................................................................................................................................11
SYNAPTISCHE NEUROTRANSMISSIE .............................................................................................................................12
RETROGRADE NEUROTRANSMISSIE (E.G. ENDOCANNABINOÏDEN) .....................................................................................12
EXTRASYNAPTISCHE NEUROTRANSMISSIE ....................................................................................................................12
INLEIDING DEEL 3: ......................................................................................................................................... 13
AANGRIJPINGSPUNTEN PSYCHOFARMACA ................................................................................................... 13
RECEPTOREN .........................................................................................................................................................14
IONKANALEN .........................................................................................................................................................16
ENZYMEN .............................................................................................................................................................17
CARRIERS OF TRANSPORTERS ....................................................................................................................................17
INLEIDING DEEL 4: MECHANISMEN VAN NEUROMODULATIE ........................................................................ 17
DESENSITISATIE .....................................................................................................................................................18
DOWN-REGULATIE .................................................................................................................................................18
UP-REGULATIE ......................................................................................................................................................18
SUPERSENSITIVITEIT ................................................................................................................................................19
ANTIDEPRESSIVA .......................................................................................................................................... 19
SYMPTOMEN MAJEURE DEPRESSIE .............................................................................................................................19
MAJEURE DEPRESSIE ...............................................................................................................................................19
BIOSYNTHESE CATECHOLAMINES (CA) ........................................................................................................................20
NORADRENALINE (NAD), BIOSYNTHESE, RECEPTOREN, TRANSPORTERS.............................................................................20
ADRENERGE RECEPTOREN = GPCRS ..........................................................................................................................21
NAD & ADRENALINE METABOLISATIE .........................................................................................................................21
BEËINDIGING VAN DE EFFECTEN VAN NAD & ADRENALINE – METABOLISATIE ....................................................................21
NADERGE BANEN VANAF DE LOCUS COERULEUS ...........................................................................................................22
1
, SEROTONINE 5HT ..................................................................................................................................................22
SEROTONINERGE NEUROTRANSMISSIE ........................................................................................................................22
SEROTONINE RECEPTOREN .......................................................................................................................................22
5HTERGE BANEN VANAF DE RAPHE NUCLEUS ...............................................................................................................23
NEUROBIOLOGIE VAN MAJEURE DEPRESSIE ..................................................................................................................24
BEHANDELING VAN EEN DEPRESSIE ............................................................................................................................26
HEROPNAMEREMMERS ...........................................................................................................................................27
NIET-SELECTIEVE HEROPNAMEREMMERS.....................................................................................................................27
Neveneffecten TCAD & verwante reuptake inhibitoren ...............................................................................28
SNRI’s = serotonine noradrenaline reuptake inhibitoren .............................................................................28
Dopamine reuptake inhibitor + zwakkere NAD reuptake inhibitor + nicotine receptor antagonist .............28
SELECTIEVE HEROPNAMEREMMERS VOOR SEROTONINE ..................................................................................................29
SSRIs werkingsmechanisme..........................................................................................................................29
Neveneffecten eigen aan SSRI’s ...................................................................................................................29
NEVENEFFECTEN VOOR ALLE REUPTAKE INHIBITOREN .....................................................................................................30
SEROTONINESYNDROOM .........................................................................................................................................30
NRI’S = SELECTIEVE NORADRENALINE REUPTAKE INHIBITOR ............................................................................................31
EFFECTEN EN INDICATIES VAN REUPTAKE INHIBITOREN ...................................................................................................31
ANTIDEPRESSIVA DIRECT WERKEND OP DE RECEPTOREN .................................................................................................32
TRAZODON NESTROLAN® ........................................................................................................................................32
MIRTAZAPINE, MIANSERINE .....................................................................................................................................32
AGOMELATINE VALDOXAN® .....................................................................................................................................33
AGOMELATINE VALDOXAN® .....................................................................................................................................33
MAO-INHIBITOREN ................................................................................................................................................34
ANDERE ANTIDEPRESSIVA BIJ MAJEURE DEPRESSIE .........................................................................................................35
SINT-JANSKRUID ....................................................................................................................................................36
PLAATSBEPALING ANTIDEPRESSIVA.............................................................................................................................36
ZWANGERSCHAP ....................................................................................................................................................37
ANTIPSYCHOTICA (MAJEURE TRANQUILISERS) .............................................................................................. 37
SCHIZOFRENIE SYMPTOOMDIMENSIES ........................................................................................................................38
SCHIZOFRENIE .......................................................................................................................................................38
NEUROBIOLOGIE VAN SCHIZOFRENIE ..........................................................................................................................38
CENTRALE DOPAMINERGE BANEN & DOPAMINERGE NEUROTRANSMISSIE ..........................................................................38
GLUTAMATERGE NEUROTRANSMISSIE.........................................................................................................................39
GLUTAMAAT RECEPTORTYPES & RECEPTORSUBTYPES.....................................................................................................40
NEUROBIOLOGIE VAN SCHIZOFRENIE POSITIEVE SYMPTOMEN ..........................................................................................41
NEUROBIOLOGIE VAN SCHIZOFRENIE NEGATIEVE SYMPTOMEN .........................................................................................41
CONVENTIONELE VERSUS ATYPISCHE ANTIPSYCHOTICA ...................................................................................................42
CONVENTIONELE OF TYPISCHE ANTIPSYCHOTICA ...........................................................................................................42
D2 receptor antagonisme: de effecten en neveneffecten ............................................................................42
Andere neveneffecten antipsychotica ..........................................................................................................43
Antipsychotica met verlengde werking ........................................................................................................43
ATYPISCHE OF NIEUWERE ANTIPSYCHOTICA .................................................................................................................44
Serotonine-dopamine antagonist.................................................................................................................44
Andere atypische mechanismen leidend tot verbeterde klinische therapeutische effecten .........................47
Atypische antipsychotica en verbetering van negatieve symptomen: mogelijke werkingsmechanismen ...47
Atypische antipsychotica doeltreffendheid ..................................................................................................47
Atypische antipsychotica ongewenste effecten ...........................................................................................48
INDICATIES ANTIPSYCHOTICA ....................................................................................................................................49
CONTRA-INDICATIES ...............................................................................................................................................49
HYPNOTICA (MINEURE TRANQUILIZERS) ....................................................................................................... 50
NEUROBIOLOGIE VAN SLAAPSTOORNISSEN ..................................................................................................................50
Alertheid .......................................................................................................................................................50
Slaap-waak switch........................................................................................................................................51
Slapeloosheid ...............................................................................................................................................52
2
, GABAERGE NEUROTRANSMISSIE ...............................................................................................................................52
Synthese en metabolisatie van het aminozuur GABA ..................................................................................52
BENZODIAZEPINES ..................................................................................................................................................53
Benzodiazepinebindingsplaats van de GABA-A receptor subtypes ..............................................................54
Benzodiazepine effecten ..............................................................................................................................54
Benzodiazepines farmacokinetiek ................................................................................................................55
Benzodiazepine full agonisten Indicaties......................................................................................................55
Benzodiazepines indicaties ...........................................................................................................................55
Benzodiazepines neveneffecten ...................................................................................................................56
Zwangerschap en borstvoeding ...................................................................................................................57
Contra-indicaties & interacties .....................................................................................................................57
Addendum - Benzodiazepine antagonist ......................................................................................................57
ANDERE GABA-A POSITIEVE ALLOSTERISCHE MODULATOREN: Z DRUGS............................................................................57
Binding van GABA-A PAMs aan alfa 1 subunit van de GABA-A receptor .....................................................58
Z drugs neveneffecten ..................................................................................................................................58
MELATONINE ........................................................................................................................................................59
VALERIAANEXTRACTEN ............................................................................................................................................60
DIVERSEN .............................................................................................................................................................60
AANPAK VAN SLAPELOOSHEID KERNBOODSCHAPPEN .....................................................................................................60
ANXIOLYTICA ................................................................................................................................................ 61
NEUROBIOLOGIE VAN ANGST- EN STRESSSTOORNISSEN ..................................................................................................61
ANXIOLYSE DOOR BENZODIAZEPINES ..........................................................................................................................62
ANXIOLYSE DOOR ANTIDEPRESSIVA ............................................................................................................................63
DIVERSEN .............................................................................................................................................................63
AANPAK VAN GEGENERALISEERDE ANGSTSTOORNISSEN(GAS) .........................................................................................63
AANPAK VAN PANIEKSTOORNISSEN ............................................................................................................................63
AANPAK VAN FOBIE ................................................................................................................................................64
AANPAK VAN SOCIALE ANGSTSTOORNISSEN .................................................................................................................64
AANPAK VAN OCS .................................................................................................................................................64
MOOD STABILISERS (STEMMINGSSTABILISATOREN) ..................................................................................... 64
BIPOLAIRE STOORNIS ..............................................................................................................................................65
Symptomen van manie .................................................................................................................................65
BEHANDELING VAN BIPOLAIRE STOORNISSEN ...............................................................................................................65
LITHIUMZOUTEN ....................................................................................................................................................66
ANDERE MOOD STABILISERS = BEPAALDE ANTI-EPILEPTICA ..............................................................................................67
ANDERE MOOD STABILISERS = ATYPISCHE ANTIPSYCHOTICA BIJ MANIE ...............................................................................67
ANTIEPILEPTICA ............................................................................................................................................ 68
WAT IS EPILEPSIE? .................................................................................................................................................68
SOORTEN EPILEPTISCHE AANVALLEN ...........................................................................................................................69
STATUS EPILEPTICUS ...............................................................................................................................................69
EPILEPSIESYNDROMEN ............................................................................................................................................70
EPILEPSIE INCIDENTIE, OORZAKEN ..............................................................................................................................70
EPILEPSY SPECTRUM DISORDER .................................................................................................................................70
EPILEPSIE BEHANDELING ..........................................................................................................................................70
PLAATSBEPALING ...................................................................................................................................................71
PATHOFYSIOLOGIE VAN EPILEPSIE ..............................................................................................................................71
INDELING AEDS VOLGENS WERKINGSMECHANISMEN.....................................................................................................72
INACTIVATIE VAN EEN NATRIUMKANAAL ......................................................................................................................73
INDELING AED VOLGENS WERKINGSSPECTRUM ............................................................................................................74
Valproïnezuur- Natriumvalproaat ................................................................................................................74
Lamotrigine ..................................................................................................................................................75
Levetiracetam en analogen ..........................................................................................................................76
Topiramaat...................................................................................................................................................76
Perampanel ..................................................................................................................................................77
3
, Carbamazepine en Oxcarbazepine ...............................................................................................................77
Gabapentine en Pregabaline ........................................................................................................................78
Fenobarbital en Primidon .............................................................................................................................79
Fenytoïne en Natriumfenytoïne....................................................................................................................80
Lacosamide...................................................................................................................................................80
STOPPEN VAN DE ANTI-EPILEPTISCHE BEHANDELING ......................................................................................................81
BEHANDELING VAN VROUWELIJKE EPILEPSIEPATIË NTEN ..................................................................................................81
TAKE HOME MESSAGES (!) .......................................................................................................................................81
AAN MIDDELEN GEBONDEN STOORNISSEN EN HUN BEHANDELING .............................................................. 82
MESOLIMBISCHE DOPAMINERGE BAAN MEDIEERT “REWARDING” ....................................................................................82
OPIOÏDEN EN MIDDELEN BIJ OPIOÏDVERSLAVING ...........................................................................................................83
OPIOID̈ EN .............................................................................................................................................................83
MEDICATIE BIJ OPIOID̈ VERSLAVING ............................................................................................................................84
ALCOHOL EN MIDDELEN BIJ ALCOHOLMISBRUIK ............................................................................................................85
ALCOHOLVERSLAVING .............................................................................................................................................85
Middelen bij alcoholmisbruik - Alcoholontwenning .....................................................................................86
Middelen bij alcoholmisbruik - Terugvalpreventie .......................................................................................86
INTERACTIES TUSSEN GENEESMIDDELEN EN ALCOHOL.....................................................................................................87
NICOTINE EN MIDDELEN BIJ TABAKSMISBRUIK ..............................................................................................................88
CANNABINOID̈ EN ...................................................................................................................................................90
DISSOCIATIEVE ANESTHETICA ....................................................................................................................................91
CP, KETAMINE EN DEXTROMETHORPHAN ....................................................................................................................91
CENTRALE STIMULANTIA ..........................................................................................................................................92
Amfetamines effecten algemeen .................................................................................................................92
Amfetamines neveneffecten ........................................................................................................................93
Cocaïne = centraal stimulerend ....................................................................................................................93
Middelen bij verslaving aan centrale stimulantia ........................................................................................93
HALLUCINOGENEN (VERWANT MET MONOAMINES) ......................................................................................................94
ADHD EN NARCOLEPSIE................................................................................................................................. 94
MIDDELEN BIJ ADHD .............................................................................................................................................94
ADHD aandacht ............................................................................................................................................95
ADHD hyperactiviteit en impulsiviteit ..........................................................................................................95
ADHD bij volwassenen..................................................................................................................................97
Behandeling van ADHD ................................................................................................................................97
MIDDELEN BIJ NARCOLEPSIE .................................................................................................................................. 100
Modafinil (100 mg).................................................................................................................................... 100
Pitolisant ................................................................................................................................................... 101
Oxybaat ..................................................................................................................................................... 102
Behandeling van narcolepsie: addendum ................................................................................................. 102
EXAMEN: VOORBEELDVRAGEN ............................................................................................................................... 103
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