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Samenvatting Schema's geneesmiddelen
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Deze documenten geven een mooi overzicht van de verschillende geneesmiddelen per soort (analgetica, antipsychotica, antibiotica...)
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ANTIDEPRESSIVANiet-selectieve reuptake TCA
inhibitoren
Algemeen 1ste generatie (samen met MAO-I)
Prototype: clomipramine (Anafranil)
Werking - Inhibitie van:
- noradrenaline re-uptake transporter (NET)
- serotonine re-uptake transporter (SERT)
Farmacokinetiek - Absorptie: onvolledig door first-pass metabolisme
- Distributie: lipofiele moleculen
- eiwitbinding
- groot distributievolume
- Klaring: metabool; vaak CYP2D6 afhankelijk
- tricyclische kern (oxidatie, glucuronidatie)
- invloed van farmacogenetica…
- soms actieve metabolieten:
- imipramine → desipramine
- amitriptyline → nortriptyline
- Inname:
- meestal éénmaal daags (lange t1/2)
TDM weinig zinvol
Bijwerkingen - Anticholinerg (M): e.g. amitriptyline
- xerostomie, obstipatie, tachycardie, mydriasis / glaucoom, mictiestoornissen
- Anti-histaminerg (H1): sedatie (inname ‘s avonds; nortriptyline is activerend)
- Anti-adrenerg (α1): (orthostatische) hypotensie, (miosis)
- Cardiotoxiciteit: QTc verlenging, aritmieën
- Varia:
- gewichtstoename
- sexuele stoornissen (ejaculatie, erectie, libido, orgasme)
- excessief zweten
- allergische reacties
=>dirty drug interacties
Contra-indicaties - Hoge kans op zelfdoding
- Cardiaal: artimieën, (recent) myocardinfarct
- Urogenitaal:
- urineretentie
, ANTIDEPRESSIVA
- Benigne Prostaat Hypertrofie (BPH)
- Oftalmologisch: glaucoom
- CZS: epilepsie (verlaging van de convulsiedrempel)
- Refluxoesofagitis
Interacties - Verdringingsinteracties
- Sedatie: cave hypnotica, alcohol, anxiolytica, …
- Sterker effect van sympathomimetica (e.g. fenylefrine)
- CYP2D6 substraten/inhibitoren/inductoren
Zwangerschap - amitriptyline lijkt veilig
- cave clomipramine
Serotonine- en NA reuptake inhibitoren (SNRI)
- dual re-uptake inhibitoren
- betere tolerantie dan TCA’s
- Cave: geven CYP2D6 inhibitie (minder dan SSRIs)
Vb. venlafaxine (~misbruik) en duloxetine
NA- en dopamine reuptake inhibitoren
Bupropion (syn. amfebutamon)
- Werking:
- NA en D re-uptake inhibitie
- Cave:
- convulsies
- vermagering (associatie naltrexon+bupropion: niet eerste keus behandeling
obesitas)
- Cf. rookstop
- Inhibitor CYP2D6
Selectieve reuptake SSRI
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