Summary
Samenvatting boek 5 farmacologie geneeskunde
- Course
- Institution
Volledige samenvatting farmacologie boek 5. Met glans geslaagd in eerste zit. Alle delen samen beschikbaar in bundel.
[Show more]
Seller
Follow
Gnkkuleuven
Reviews received
Content preview
DEEL 5Inleiding: autacoïden bij inflammatie en allergie ........................................................................................6
1. Niet-steroïdale anti-inflammatoire geneesmiddelen .............................................................................7
1.1 Chemie van NSAIDs ...........................................................................................................................7
1.2 Werkingsmechanisme van NSAIDs ....................................................................................................7
1.3 Farmacokinetiek van NSAIDs .............................................................................................................8
1.4 Farmacodynamiek van NSAIDs ..........................................................................................................8
1.5 Indicaties ............................................................................................................................................8
1.6 Bijwerkingen ......................................................................................................................................9
Gastro-intestinaal ................................................................................................................................9
Bloedplaatjes .......................................................................................................................................9
Renaal en cardiovasculair ....................................................................................................................9
Overgevoeligheidsreacties ..................................................................................................................9
Hepatotoxiciteit en hematologische toxiciteit....................................................................................9
1.7 Contra-indicaties en risicopopulaties ..............................................................................................10
1.8 Interacties ........................................................................................................................................10
1.9 Kiezen van een NSAID ......................................................................................................................10
1.10 Bespreking van de individuele groepen NSAIDs ...........................................................................10
A. Salicylaten ......................................................................................................................................10
B. Para-aminofenol derivaten ...........................................................................................................12
C. Indool- en arylazijnzuurderivaten .................................................................................................13
D. Arylpropionzuurderivaten .............................................................................................................13
E. Oxicams ..........................................................................................................................................13
F. Pyrazolonderivaten ........................................................................................................................14
G. Selectieve COX2 inhibitoren (coxibs) ............................................................................................14
Besluit ....................................................................................................................................................14
2. Glucocorticoiden....................................................................................................................................15
2.1 Producten: chemie van glucocorticoiden .......................................................................................15
2.2 Werkingsmechanisme .....................................................................................................................15
2.3 Farmacokinetiek ..............................................................................................................................16
2.4 Farmacodynamiek ...........................................................................................................................16
2.5 Indicaties ..........................................................................................................................................17
2.6 Bijwerkingen ....................................................................................................................................17
Metabole effecten .............................................................................................................................17
1
, Feedback effecten .............................................................................................................................18
Effecten op mesemchymale cellen ...................................................................................................18
Anti-inflammatoire en immunosuppressief effect ...........................................................................19
Effecten in het CZS ............................................................................................................................19
Andere bijwerkingen .........................................................................................................................19
2.7 Risicopopulaties ...............................................................................................................................19
3. Tweedelijns anti-reumatische geneesmiddelen ...................................................................................20
3.1 Disease modifying antirheumatic drugs (DMARDs) ........................................................................20
Conventionele synthetische small molecule DMARDs (csDMARDs) ................................................20
Biological DMARDs (bDMARDs) ........................................................................................................21
Targeted synthetic DMARDs (tsDMARDs).........................................................................................22
3.2 Andere immunomodulatoren .........................................................................................................22
Ciclosporine .......................................................................................................................................22
Tacrolimus, sirolimus en derivaten ...................................................................................................23
Azathioprine ......................................................................................................................................23
Mycofenolaatmofetil .........................................................................................................................23
Monoklonale antistoffen ...................................................................................................................23
4. Farmacotherapie van migraine .............................................................................................................24
4.1 Medicijnen om een aanval te couperen .........................................................................................24
Niet-specifieke anti-migraine geneesmiddelen ................................................................................24
Specifieke anti-migraine geneesmiddelen ........................................................................................24
5. Farmacotherapie van jicht .....................................................................................................................26
Inleiding .................................................................................................................................................26
5.1 NSAIDs..............................................................................................................................................26
5.2 Colchicine .........................................................................................................................................26
5.3 Glucocorticoïden .............................................................................................................................27
5.4 Uricostatica: allopurinol en febuxostat ...........................................................................................27
5.5 Uricosurica: probenecid (organisch zuur) en lesinurad ..................................................................28
5.6 Recombinant uraat oxidase.............................................................................................................28
5.7 Canakinumab ...................................................................................................................................28
Verbeter je inzicht .................................................................................................................................28
6. Farmacotherapie van hooikoorts, uticaria en angio-oedeem: antihistaminica ...................................29
Inleiding .................................................................................................................................................29
Farmacologische effecten .................................................................................................................29
6.1 H1-receptorantagonisten .................................................................................................................30
Eigenschappen, chemie en werkingsmechanisme ...........................................................................30
2
, Farmacokinetiek ................................................................................................................................31
Farmacodynamiek .............................................................................................................................31
Indicaties ............................................................................................................................................31
Relatieve contra-indicaties ................................................................................................................32
Bijwerkingen ......................................................................................................................................32
Interacties ..........................................................................................................................................32
Behandeling van seizoensgebonden allergische rhino-conjunctivitis ..............................................32
7. Farmacotherapie van astma ..................................................................................................................33
7.1 Inleiding ...........................................................................................................................................33
7.2 Anti-astmageneesmiddelen ............................................................................................................33
Kortwerkende beta-2 mimetica ........................................................................................................33
Langwerkende beta-2 mimetica .......................................................................................................34
Corticosteroïden ................................................................................................................................34
Theofylline .........................................................................................................................................35
Anticholinergica .................................................................................................................................36
Leukotrieenreceptor-antagonisten ...................................................................................................36
Andere geneesmiddelen ...................................................................................................................37
Aandachtspunten ..............................................................................................................................37
Inhalatiesystemen .............................................................................................................................37
8. Farmacotherapie van anafylactische reacties .......................................................................................38
Verbeter je inzicht .................................................................................................................................39
9. Farmacotherapie van diabetes mellitus ................................................................................................40
9.1 Insuline en analogen........................................................................................................................40
Structuur, vrijstelling, werking en effecten.......................................................................................40
Farmacokinetiek ................................................................................................................................41
Indicaties ............................................................................................................................................41
Bijwerkingen ......................................................................................................................................41
9.2 Orale antidiabetica ..........................................................................................................................42
Biguaniden .........................................................................................................................................42
Sulfonylureumderivaten of sulfamiden ............................................................................................42
Gliniden ..............................................................................................................................................43
Thiazolidinedionen of glitazonen ......................................................................................................43
Alfa-glucosidase inhibitoren ..............................................................................................................44
Gliptinen ............................................................................................................................................44
Gliflozinen (SGLT2 inhibitoren) .........................................................................................................44
9.3 Incretinemimetica ....................................................................................................................45
3
,10. Farmacotherapie en preventie van osteoporose ...............................................................................46
10.1 Inleiding .........................................................................................................................................46
10.2 Calcium ..........................................................................................................................................47
10.3 Vitamine D .....................................................................................................................................47
10.4 Bifosfonaten ..................................................................................................................................48
10.5 Selectieve oestrogeenreceptor-modulatoren (SERMs) ................................................................49
10.6 Teriparatide ...................................................................................................................................49
10.7 Denosumab....................................................................................................................................50
11. Farmacotherapie van kanker...............................................................................................................51
11.2 Algemeen .......................................................................................................................................51
Eigenschappen van maligne cellen ...................................................................................................51
11.3 Principes in de kankerchemotherapie ..........................................................................................51
Terminologie ......................................................................................................................................52
Nevenwerkingen/toxiciteit op kankertherapie .................................................................................52
1.4 Stoffen..............................................................................................................................................52
Cytotoxische toffen ...........................................................................................................................52
Hormonale stoffen ............................................................................................................................53
Immuuntherapie ................................................................................................................................54
Proteïnekinase inhibitoren ................................................................................................................55
12. Supportieve behandeling bij kanker....................................................................................................56
13. Famacologische aspecten in palliatieve en terminale zorg ................................................................57
13.2 Symptoomcontrole in de palliatieve zorg .....................................................................................57
Pijn .....................................................................................................................................................57
Gastro-intestinale problemen ...........................................................................................................58
Respiratoire problemen ....................................................................................................................59
Neurologische problemen .................................................................................................................60
13.3 Medicatietoedieningsroutes .........................................................................................................61
14. Farmacotherapie van het gastrointestinaal stelsel .............................................................................62
14.1 Farmacotherapie van peptische aandoeningen: ulcera en GERD ................................................62
H2-receptorantagonisten ..................................................................................................................62
Protonpompinhibitoren ....................................................................................................................63
Misoprostol ........................................................................................................................................63
Antacida .............................................................................................................................................64
Antibiotica ..........................................................................................................................................64
14.2 (Gastro)-prokinetica ......................................................................................................................64
Dopamine-2-receptorantagonisten ..................................................................................................64
4
, Cisapride ............................................................................................................................................65
14.3 Anti-emetica ..................................................................................................................................65
14.4 Pancreasenzym-substituut ............................................................................................................65
14.5 Laxantia ..........................................................................................................................................66
14.6 Anti-diarrheïca ...............................................................................................................................66
14.7 Farmaca bij inflammatoir darmlijden ......................................................................................66
14.8 Behandeling van infestatie met wormen ......................................................................................67
Addendum 1: geneesmiddelen en QT-verlenging ....................................................................................68
Addendum 2: casusbespreking ............................................................ Fout! Bladwijzer niet gedefinieerd.
5
, INLEIDING: AUTACOÏDEN BIJ INFLAMMATIE EN ALLERGIE
Autacoïden
• = endogene stoffen
• Rol in normale celhomeostase
• Rol bij weefselbeschadiging en ontstekingsreacties
o Oa prostanoïden (behoren tot de eicosanoïden)
• Rol bij allergische reacties
• Lokale hormonen, wnt korte halfwaardetijd
o -> autocriene effecten (effecten op cel waardoor ze worden afgescheiden)
o -> paracriene effecten (effecten op naburige cellen)
• Bevatten: neurotransmitters, peptiden, vetzuurderivaten en anorganische moleculen
6
, 1. NIET-STEROÏDALE ANTI-INFLAMMATOIRE GENEESMIDDELEN
• Meeste NSAIDs remmen COX1 en COX2 -> dus remmen synthese PGs en TXs
• - COX2 is waarschijnlijk de oorzaak van de beoogde analgestische, antipyretische en anti-
inflammatoire effecten
• - COX 1 is waarschijnlijk de oorzaak van de ongewenste effecten
• PG = prostaglandines
• LT = leukotreïnen
• TX = tromboxanen
1.1 CHEMIE VAN NSAIDS
• Heterogenen groep verbindingen (meestal zwakke zuren) met gemeenschappelijk
werkingsmechanisme
• Aspirine = prototype
• Onderscheid volgens chemische structuur
o Salicylaten: acetylsalicylzuur, sulfasalazine
o Para-aminofenol of anniline derivaten: paracetamol, fenacetine
o Indool- en arylazijnzuurderivaten: indometacine, diclofenac, aclefenac, ketorolac
o Arylpropionzuurderivaten: ibuprofen, naproxen
o Oxicams: meloxicam, piroxicam, tenoxicam
o Pyrazolonderivaten: metamizol, fenylbutazon
o COX-2 selectieve NSAIDs of Coxibs: celecoxib, etoricoxib, parecoxib
o Fenamaten of N-fenylanthranylzuurdervitane: mefenaminezuur, meclofenaminezuur
1.2 WERKINGSMECHANISME VAN NSAIDS
• Acetylsalicylzuur is enige NSAID dat covalent (irreversiebel) bindt aan COX1 en COX2
Andere binden reversibel
à inhibitie synthese prostanoïden (PGs en TXs)
à kan onrechtstreeks ook leiden tot verhoogde aanmaak van LT door grotere aanbod van
substraat aan enzyme lipoxygenase
• Goede correlatie tussen in vitro potentie en in vivo anti-inflammatoire activiteit
• Inhibitie niet selectief voor COX 1 of COX 2, maar toch verschillende gevoeligheid -> sommige
preferentieel COX-1 inhibitie, andere preferentieel COX-2 inhibitie
7
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller Gnkkuleuven. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $10.31. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75632 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now