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Samenvatting farmacotherapie en farmaceutische zorg II
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Samenvatting farmacotherapie en farmaceutische zorg 2, gedoceerd in de tweede master farmaceutische wetenschappen te Universiteit Gent.
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Farmaceutische zorg en farmacotherapie 2 2024 – 20251. Algemeen ........................................................................................................................................................................................................................................... 5
1.1. WHAM-structuur .......................................................................................................................................................................................................................................................5
1.2. 5 questions !!..............................................................................................................................................................................................................................................................5
1.3. Eerste uitgiftebegeleiding ............................................................................................................................................................................................................................... 6
1.4. Herhaalde uitgiftebegeleiding .............................................................................................................................................................................................................. 6
1.5. QT-verlenging ............................................................................................................................................................................................................................................................ 7
1.6. Bloedingsrisico .................................................................................................................................................................................................................................................. 7
1.7. Serotoninesyndroom ............................................................................................................................................................................................................................................ 8
1.8. Interactiemechanismen.............................................................................................................................................................................................................................. 9
1.8.1. Interacties t.h.v. absorptie ................................................................................................................................................................................................................. 9
1.8.2. Interacties t.h.v. het metabolisme ............................................................................................................................................................................................. 10
1.8.3. Interacties t.h.v. de excretie ........................................................................................................................................................................................................... 10
2. Gastro-intestinaal stelsel ........................................................................................................................................................................................................ 11
2.1. Gastro-intestinale klachten bij kinderen. ..............................................................................................................................................................................................11
2.1.1. Reflux ..............................................................................................................................................................................................................................................................11
2.1.2. Darmkrampen...........................................................................................................................................................................................................................................14
2.1.3. Diarree .......................................................................................................................................................................................................................................................... 16
2.1.4. Peuterdiarree ........................................................................................................................................................................................................................................... 19
2.1.5. Obstipatie bij kinderen ...................................................................................................................................................................................................................... 19
2.1.6. Buikpijn bij kinderen .......................................................................................................................................................................................................................... 20
2.1.7. Spruw.............................................................................................................................................................................................................................................................. 21
2.2. Gastro-intestinale klachten bij zwangere vrouwen. ............................................................................................................................................................. 23
2.2.1. Nausea en braken tijdens de zwangerschap ...................................................................................................................................................................... 23
2.2.2. Obstipatie tijdens de zwangerschap ........................................................................................................................................................................................24
2.2.3. Refluxklachten tijdens de zwangerschap ............................................................................................................................................................................. 25
3. Osteo-articulair stelsel ............................................................................................................................................................................................................ 26
3.1. Zelfzorg bij spier- en gewrichtspijn .........................................................................................................................................................................................................26
3.1.1. Doorverwijscriteria...............................................................................................................................................................................................................................26
3.1.2. Niet medicamenteus advies........................................................................................................................................................................................................... 27
3.1.3. Medicamenteus advies ...................................................................................................................................................................................................................... 27
3.1.4. Casussen spierpijn ............................................................................................................................................................................................................................... 28
4. Zenuwstelsel ...................................................................................................................................................................................................................................31
4.1. Epilepsie...............................................................................................................................................................................................................................................................31
4.1.1. Achtergrond – fysiologie – pathologie ....................................................................................................................................................................................31
4.1.2. Faramacotherapie bij Epilepsie ....................................................................................................................................................................................................31
4.1.3. Bijwerkingenprofiel van anti-epileptica ................................................................................................................................................................................33
4.1.4. Aflevering van anti-epileptica ......................................................................................................................................................................................................33
4.1.5. Interacties met anti-epileptica .................................................................................................................................................................................................... 35
4.1.6. Medicatietoediening via sonde ................................................................................................................................................................................................... 36
4.1.7. Epilepsie en zwangerschap ........................................................................................................................................................................................................... 36
4.1.8. Substitutie van anti-epileptica..................................................................................................................................................................................................... 37
4.1.9. Omgaan met een epilepsie-aanval in de apotheek ...................................................................................................................................................... 38
4.2. Hoofdpijn........................................................................................................................................................................................................................................................... 38
4.2.1. Classificatie .............................................................................................................................................................................................................................................. 38
4.2.2. Spanningshoofdpijn ............................................................................................................................................................................................................................ 39
4.2.3. Migraine...................................................................................................................................................................................................................................................... 40
4.2.4. Medication overuse headache (MOH) ......................................................................................................................................................................................43
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,Farmaceutische zorg en farmacotherapie 2 2024 – 2025
4.2.5. Clusterhoofdpijn ................................................................................................................................................................................................................................... 44
4.2.6. Trigeminusneuralgie .......................................................................................................................................................................................................................... 44
4.2.7. Medicatiebegeleiding en -bewaking bij triptanen..........................................................................................................................................................45
4.2.8. Zelfzorg bij hoofdpijn ........................................................................................................................................................................................................................ 46
4.3. Depressie ............................................................................................................................................................................................................................................................ 47
4.3.1. Inleiding ...................................................................................................................................................................................................................................................... 47
4.3.2. Achtergrond depressie...................................................................................................................................................................................................................... 48
4.3.3. Antidepressiva.......................................................................................................................................................................................................................................... 51
4.3.4. Sint-janskruid........................................................................................................................................................................................................................................... 52
4.3.5. Farmacotherapie bij depressie..................................................................................................................................................................................................... 52
4.3.6. Depressieve stemming als bijwerking .................................................................................................................................................................................... 55
4.4. Bipolaire en psychotische stoornissen ........................................................................................................................................................................................... 55
4.4.1. Bipolaire stoornis .................................................................................................................................................................................................................................. 55
4.4.2. Lithium ......................................................................................................................................................................................................................................................... 57
4.4.3. Psychose en schizofrenie ................................................................................................................................................................................................................ 58
4.4.4. Behandeling psychosegevoeligheid .........................................................................................................................................................................................59
4.4.5. Gedragsproblemen bij dementie ............................................................................................................................................................................................... 63
4.5. Hypnotica, sedativa, anxiolytica .........................................................................................................................................................................................................65
4.5.1. Slapeloosheid...........................................................................................................................................................................................................................................65
4.5.2. Angststoornissen ...................................................................................................................................................................................................................................67
4.5.3. Benzodiazepines ....................................................................................................................................................................................................................................67
4.6. Ziekte van Parkinson ..................................................................................................................................................................................................................................70
4.6.1. Achtergrond ..............................................................................................................................................................................................................................................70
4.6.2. Behandeling ............................................................................................................................................................................................................................................... 71
4.6.3. Medicatiebegeleiding ......................................................................................................................................................................................................................... 73
4.6.4. Medicatiebewaking ..............................................................................................................................................................................................................................76
4.7. Rookstop ............................................................................................................................................................................................................................................................. 77
4.7.1. Inleiding ...................................................................................................................................................................................................................................................... 77
4.7.2. Gevolgen van roken ............................................................................................................................................................................................................................. 77
4.7.3. Rol van de apotheker..........................................................................................................................................................................................................................78
4.7.4. Farmacologische hulpmiddelen ................................................................................................................................................................................................. 80
4.7.5. Eerste uitgiftebegeleiding bupropion bij rookstop .........................................................................Fout! Bladwijzer niet gedefinieerd.
5. Dermatologie ................................................................................................................................................................................................................................ 83
5.1. Acne .............................................................................................................................................................................................................................................................................. 83
5.1.1. Farmacotherapie .................................................................................................................................................................................................................................. 83
5.1.2. Farmaceutische zorg .......................................................................................................................................................................................................................... 85
5.2. Eczeem ................................................................................................................................................................................................................................................................ 90
5.2.1. Pathofysiologie...................................................................................................................................................................................................................................... 90
5.2.2. Farmacotherapie ................................................................................................................................................................................................................................... 91
5.2.3. Farmaceutische zorg ...........................................................................................................................................................................................................................92
5.3. Psoriasis ..............................................................................................................................................................................................................................................................95
5.4. Urticaria (netelroos) ...................................................................................................................................................................................................................................95
5.4.1. Achtergrond ..............................................................................................................................................................................................................................................95
5.4.2. Farmacotherapie .................................................................................................................................................................................................................................. 96
5.5. Schurft (scabiës)........................................................................................................................................................................................................................................... 96
5.5.1. Farmacotherapie .................................................................................................................................................................................................................................. 96
5.5.2. Farmaceutische zorg .......................................................................................................................................................................................................................... 96
5.6. Luizen................................................................................................................................................................................................................................................................... 96
5.7. Zwemmerseczeem .......................................................................................................................................................................................................................................97
5.7.1. Achtergrond ..............................................................................................................................................................................................................................................97
5.7.2. Zelfzorg ........................................................................................................................................................................................................................................................97
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5.8. Wratten ............................................................................................................................................................................................................................................................... 98
5.8.1. Achtergrond ............................................................................................................................................................................................................................................. 98
5.8.2. Zelfzorg ....................................................................................................................................................................................................................................................... 98
5.9. Koortsblaas ...................................................................................................................................................................................................................................................... 99
5.9.1. Achtergrond ............................................................................................................................................................................................................................................. 99
5.9.2. Zelfzorg ....................................................................................................................................................................................................................................................... 99
5.10. Periorale dermatitis ................................................................................................................................................................................................................................. 100
5.10.1. Achtergrond ........................................................................................................................................................................................................................................... 100
5.10.2. Zelfzorg ..................................................................................................................................................................................................................................................... 100
5.11. Huidkanker ...................................................................................................................................................................................................................................................... 101
6. Oogproblemen .............................................................................................................................................................................................................................102
6.1. Doorverwijscriteria ................................................................................................................................................................................................................................... 102
6.2. Oogdroogte .................................................................................................................................................................................................................................................... 102
6.2.1. Pathofysiologie.................................................................................................................................................................................................................................... 102
6.2.2. Farmacotherapie ................................................................................................................................................................................................................................ 102
6.3. Conjunctivitis ................................................................................................................................................................................................................................................ 103
6.3.1. Allergische conjunctivitis .............................................................................................................................................................................................................. 103
6.3.2. Infectieuze conjunctivitis .............................................................................................................................................................................................................. 104
6.4. Hordeolum...................................................................................................................................................................................................................................................... 104
6.4.1. Pathofysiologie.................................................................................................................................................................................................................................... 104
6.4.2. Farmacotherapie ................................................................................................................................................................................................................................ 104
6.5. Blefaritis .......................................................................................................................................................................................................................................................... 105
6.5.1. Pathofysiologie.................................................................................................................................................................................................................................... 105
6.5.2. Farmacotherapie ................................................................................................................................................................................................................................ 105
6.6. Subconjunctivale bloeding .................................................................................................................................................................................................................. 105
6.6.1. Pathofysiologie.................................................................................................................................................................................................................................... 105
6.6.2. Farmacotherapie ................................................................................................................................................................................................................................ 105
6.7. Corpus alienum, etsing, lasogen en sneeuwblindheid...................................................................................................................................................... 106
6.7.1. Pathofysiologie.................................................................................................................................................................................................................................... 106
6.7.2. Farmacotherapie ................................................................................................................................................................................................................................ 106
6.8. Cataract (grijze staar)............................................................................................................................................................................................................................. 106
6.9. Toediening oogdruppels ........................................................................................................................................................................................................................107
6.10. Wat NIET te doen bij oogproblemen in zelfzorg? ................................................................................................................................................................. 108
6.11. Ernstige aandoeningen, waar geen zelfzorg thuishoort ................................................................................................................................................. 109
7. NKO + verkoudheid en griep ................................................................................................................................................................................................... 111
7.1. Rhinitis ........................................................................................................................................................................................................................................................................ 111
7.1.1. Allergische rhinitis (AR) .................................................................................................................................................................................................................... 111
7.1.2. Niet-allergische infectieuze rhinitis ........................................................................................................................................................................................ 115
7.1.3. Geneesmiddel geïnduceerde rhinitis (Rhinitis medicamentosa)......................................................................................................................... 117
7.2. Zelfzorg bij verkoudheid, griep en hoest ..................................................................................................................................................................................... 117
7.2.1. Achtergrond ............................................................................................................................................................................................................................................. 117
7.2.2. WHAM analyse ...................................................................................................................................................................................................................................... 120
7.2.3. Niet medicamenteuze adviezen ............................................................................................................................................................................................... 120
7.2.4. Algemeen advies bij verkoudheid en griep......................................................................................................................................................................... 121
7.2.5. Aanmeldingsklachten ........................................................................................................................................................................................................................ 121
7.2.6. Af te raden geneesmiddelen bij verkoudheid/griep/oorpijn .................................................................................................................................. 127
Samenvatting behandeling verkoudheid/griep/oorpijn ...................................................................................................................................................................128
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7.3. Farmaceutische zorg bij rhinitis medicatie ...............................................................................................................................................................................128
7.3.1. Mometasone neusspray ..................................................................................................................................................................................................................128
7.3.2. Levocetirizine........................................................................................................................................................................................................................................ 130
7.3.3. Magistrale bereiding: levocetirizine + dexamethason ................................................................................................................................................ 131
7.3.4. Aanpak rhinitis medicamentosa................................................................................................................................................................................................ 132
7.3.5. Zelfzorg bij allergische rhinitis .................................................................................................................................................................................................. 133
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