3. Niet-depolariserende
tegengegaan dr
Neuromusculaire blokkers Competitief antagonisme van
⁎ Anesthesie cholinesterase-
nicotinereceptoren thv Verslapping dwarsgestreepte spieren
inhibitoren
Tubocurarine neuromusculaire eindplaat niet voorafgegaan door spiertrekkingen ⁎ intensieve zorgen (+ atropine~controle
Atracurium → Reversibel !
cholinerge effecten)
Cisatracurium
4. Depolariserend Agonisme van nicotine Verslapping dwarsgestreepte spieren NIET tegengegaan dr
neuromusculaire blokkers receptoren thv NM eindplaat wel voorafgegaan door spamsen ⁎ Anesthesie (korte ACh – inhibitoren
→ verlengde depolarisatie procedures)
Suxamethonium → verlies elektr exciteerbh Kortwerkend Spierpijn
, Autonoom: ↗Ach
→ Meer secretie, darmperistaltiek
⁎ Glaucoom
→ Minder oogdruk en fixatie accommodatie
→ Bradycardie, bronchoconstrictie ⁎ Opheffing NM blokkade
5. cholinesterase inhibitoren reversibel remmen acetyl – met niet-depolariserende
Neuromusculaire junctie: Organofosfaten :
en butyrylcholinesterase spierverslappers
→ versterking spiercontractie irreversibele inhib
Neostigmine
⁎ Postoperatief (atonie) = perifeer & centraal
Pyridostigmine ↗ACh CZS: passeert BBB niet = gn centrale effecte
→ blaas & darm
Let op, bij zeer hoge dosissen:
⁎ Myastena gravis
- Depolarisatie blok met spierzwakte
- Blokkade autonome ganglia
6. Cholinesterase inhibitor bij
Alzheimer Reversibele cholinesterase Verlies ≠stopzetten
Verbetering cognitieve functies ⁎ Lichte tot matige
inhibitor centraal én perifeer => stoornis
Donepezil Vertraging van de symptomen Alzheimer
= wel dr BHB geheugen en leren
Rivastigmine
Geneesmiddelen i.v.m noradrenerge transmissie (NOR → adrenoreceptoren)
Geneesmiddel Werkingsmechanisme Effecten Indicaties Bijwerkingen
1. Niet-selectief endogeen
Nor IV: vasoconstrictie & BD↗ via α1-receptoren ⁎ Anafylactisch shock NOR: extreme BD &
agonisten adrenoreceptoren Noradrenaline: vnl α
VC => reflex bardyc.
Adrenaline IV: op α1-receptoren & β1-receptoren ⁎ + lokale anesthetica ter
Noradrenaline Adrenaline: vnl β preventie v resorptie (VC) ADR snel IV => BD↗
= hartritme stijgt + mild BD stijgt (≠bradycardie)
Adrenaline
3. α2 selectieve agonisten Auto-R : Daling BD = ↘ sympathische outflow
Selectieve stimulatie van α2 –
⁎ Hypertensie (≠1e keus)
receptoren in hersenstam Presyn- R : vermindering vrijstelling NOR = BD ↘
Clonidine
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