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Samenvatting NHG-richtlijnen FA-MA107 Polyfarmacie
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Alle relevante NHG-richtlijnen behorende bij het vak FA-MA107 Polyfarmacie.
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By: marissa1990 • 11 months ago
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MA107 PolyfarmacieInhoudsopgave
Angststoornis ........................................................................................................................................................................... 3
NHG-standaard: Angst (2019): ...................................................................................................................................................... 3
Nervositeit/spanning .................................................................................................................................................................... 7
Examen- of podiumvrees .............................................................................................................................................................. 7
Slaapproblemen ....................................................................................................................................................................... 8
NHG-standaard: Slaapproblemen en slaapmiddelen (2014): ........................................................................................................ 8
Depressie ................................................................................................................................................................................10
NHG-standaard: Depressie (2019) ............................................................................................................................................... 10
Neuropathische pijn ................................................................................................................................................................15
NHG-standaard: Pijn (2021)......................................................................................................................................................... 15
Diabetes Mellitus type 2 .........................................................................................................................................................16
NHG-standaard: Diabetes mellitus type 2 (2021) ........................................................................................................................ 16
NHG-standaard: CVRM (2019) ................................................................................................................................................ 20
Hypertensie ............................................................................................................................................................................21
NHG-standaard: CVRM (2019) ..................................................................................................................................................... 21
TIA ..........................................................................................................................................................................................28
NHG-standaard: Beroerte (2018)................................................................................................................................................. 28
CVRM ...................................................................................................................................................................................... 28
Diep veneuze trombose (DVT) .................................................................................................................................................30
NHG-standaard: Diep veneuze trombose en longembolie (2017) ............................................................................................... 30
Angina pectoris (AP)................................................................................................................................................................32
NHG-standaard: Stabiele angina pectoris (2019) ........................................................................................................................ 32
Hartinfarct met PCI en stentplaatsing ......................................................................................................................................33
NHG-standaard: Acuut coronair syndroom (ACS) (2012)............................................................................................................. 33
Hartfalen.................................................................................................................................................................................34
NHG-standaard: Hartfalen (2021) ............................................................................................................................................... 34
Ritmestoornissen bij HF: Atriumfibrilleren............................................................................................................................ 37
Paroxismaal atriumfibrilleren..................................................................................................................................................38
NHG-standaard: Atriumfibrilleren (2017) .................................................................................................................................... 38
Maagklachten .........................................................................................................................................................................43
NHG-standaard: Maagklachten (2021): ...................................................................................................................................... 43
Maagbescherming...................................................................................................................................................................45
1
, NHG-standaard: Preventie van maagcomplicaties door geneesmiddelgebruik (2021) ............................................................... 45
Fractuurpreventie ...................................................................................................................................................................46
NHG-standaard: Fractuurpreventie (2012) .................................................................................................................................. 46
Obstipatie ...............................................................................................................................................................................50
NHG-standaard: Obstipatie (2010) .............................................................................................................................................. 50
Aambeien ...............................................................................................................................................................................52
NHG-standaard: Rectaal bloedverlies (2017) .............................................................................................................................. 52
Astma .....................................................................................................................................................................................53
NHG-standaard: Astma (2020) .................................................................................................................................................... 53
COPD ......................................................................................................................................................................................58
NHG-standaard: COPD (2021) ..................................................................................................................................................... 58
Jicht ........................................................................................................................................................................................63
NHG-standaard: Artritis (2017).................................................................................................................................................... 63
Orale schimmelinfectie ...........................................................................................................................................................66
Farmacotherapeutisch Kompas: Orofaryngeale candidiasis ....................................................................................................... 66
Eczeem....................................................................................................................................................................................67
NHG-standaard: Eczeem (2014): ................................................................................................................................................. 67
Droge ogen .............................................................................................................................................................................71
NHG-standaard: Rood oog en oogtrauma (2017)........................................................................................................................ 71
Ziekte van Parkinson ...............................................................................................................................................................72
NHG-standaard: Ziekte van Parkinson (2011) ............................................................................................................................. 72
Ziekte van Crohn .....................................................................................................................................................................76
Richtlijn: Diagnostiek en behandeling van inflammatoire darmziekten bij volwassenen (2009) ................................................. 76
Hypothyreoïdie .......................................................................................................................................................................82
NHG-standaard: Schildklieraandoeningen (2013) ....................................................................................................................... 82
Hyperthyreoïdie ......................................................................................................................................................................84
NHG-standaard: Schildklieraandoeningen (2013) ....................................................................................................................... 84
Incontinentie ..........................................................................................................................................................................85
NHG-standaard: Incontinentie voor urine bij vrouwen (2015)..................................................................................................... 85
Urineweginfecties ...................................................................................................................................................................86
NHG-standaard: Urineweginfecties (2020) .................................................................................................................................. 86
IJzergebreksanemie & Vitamine B12-deficiëntie ......................................................................................................................88
NHG-standaard: Anemie (2014) .................................................................................................................................................. 88
Hoofdpijn ................................................................................................................................................................................89
NHG-standaard: Hoofdpijn (2021) ............................................................................................................................................... 89
2
,Angststoornis
NHG-standaard: Angst (2019):
Behandeldoel = verminderen van de angstklachten en zo het verbeteren van de kwaliteit van leven.
SSRI’s zijn geneesmiddelen van 1e keus bij angststoornissen, vanwege de gunstigere bijwerkingenprofiel en ene
positieve voordeel-risicobalans.
• Late werking: het optimale anxiolytisch effect treedt pas na 2-4 weken op en in sommige gevallen tot 6 weken.
• Tijdens de eerste 2 weken kunnen de bijwerkingen erger zijn:
o Meest voorkomende zijn:
§ Misselijkheid, diarree, obstipatie
§ Seksuele stoornis
§ Slaapstoornis
o Initiële nervositeit of toename angstsymptomen.
§ Dosering kan worden verlaagd om de bijwerkingen te doen afnemen.
§ Benzodiazepinen kunnen hierbij als overbrugging dienen.
à Overweeg bij de start van een AD om initiële angsttoename te ondervangen:
Oxazepam 30 mg in 3 giften (maximaal 150 mg/dag) gedurende maximaal 2-4 weken.
TCA’s hebben een minder gunstig bijwerkingenprofiel vanwege de affiniteit voor meerder receptoren (M3-, H1-, alfa1-
en 5HT2c-receptoren). Ze staan bekend om de anticholinerge bijwerkingen (droge mond, obstipatie, wazig zicht,
urineretentie, verminderde cognitie, tachycardie). Deze middelen moeten langzaam worden afgebouwd, anders
treedt anticholinerge rebound op.
• Clomipramine is de zuiverste TCA die sterk serotonerg is. Daarnaast heeft het ook hoge affiniteit voor alfa1-
receptoren en milde affiniteit voor M3-receptoren (anticholinerg).
Halfwaardetijden van laag naar hoog: CYP2D6- CYP1A2- en QT-verlengers
remmers CYP2C19-
remmer
1. Fluoxamine 13-15 uur (enkelvoudige dosis) Fluoxetine Fluoxamine (Es)citalopram
17-22 uur (meervoudige Paroxetine
dosissen) Citalopram bevat 2
2. Paroxetine 24 uur enatiomeren (R- en S-
3. Sertraline 26 uur enatiomeer). Hierdoor
4. Escitalopram 30 uur heeft het meer
5. Citalopram 36 uur bijwerkingen dan
6. Fluoxetine 4-6 dagen escitalopram.
Norfluoxetine 4-16 dagen
Escitalopram bevat enkel
de actieve S-enatiomeer.
Beleid:
1. SSRI: citalopram, escitalopram, paroxetine, sertraline.
2. TCA: clomipramine (voorkeur), imipramine.
Start en opbouw SSRI’s:
• Start sertraline met en lage dosering (25 mg/dag):
o Als bijwerkingen verwacht worden
o Bij jongvolwassenen (kans suïcidaal gedrag verlagen)
o Bij ouderen.
• Start paroxetine en citalopram met 10 mg/dag.
• Na 1-2 weken de dosis verhogen.
• 4-6 weken na instelling het effect evalueren.
o Bij onvoldoende effect kan de dosering omhoog tot de maximumdosering (tabel 3).
3
, Start en opbouw TCA’s:
• Start TCA’s met een lagere dosering om de bijwerkingen te beperken.
• Verhoog daarna geleidelijk:
o 25 mg voor de nacht
o Dosis per 2-3 dagen ophogen met 25-100 mg/dag
• Bij ouderen is het raadzaam om een nog lagere startdosering (10 mg) te hanteren en de dosering langzaam
op te bouwen.
• 4-6 weken na instelling het effect evalueren.
o Bij onvoldoende effect kan de dosering omhoog tot de maximumdosering.
4
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