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Samenvatting farmacotherapie bij ouderen
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Samenvatting van hoofdstuk 8 farmacotherapie bij ouderen uit het boek, Leerboek Geriatrie, probleemgeoriënteerd werken met ouderen.
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By: pascalvandentempel • 3 year ago
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Samenvatting farmacotherapie bij ouderenInhoud
Welke aspecten van het ouder worden zijn belangrijk voor de farmacotherapie bij ouderen?.............3
Innameproblemen..................................................................................................................................3
farmacokinetische veranderingen..........................................................................................................3
absorptie............................................................................................................................................3
Verdeling............................................................................................................................................3
Eiwitbinding........................................................................................................................................4
eliminatie door lever..........................................................................................................................4
eliminatie door nieren........................................................................................................................4
Geneesmiddelen waarvan de dosering moet worden aangepast aan de nierfunctie.............................5
Start low, go slow...............................................................................................................................5
farmacodynamische veranderingen.......................................................................................................5
Evenwicht en valrisico........................................................................................................................6
Bloeddruk...........................................................................................................................................6
Temperatuur......................................................................................................................................6
Delier en andere anticholinerge effecten...........................................................................................6
Geneesmiddelen met sterk anticholinerge effecten.......................................................................7
Immuunsysteem.................................................................................................................................7
geneesmiddelgebonden bijwerkingen....................................................................................................7
Rationeel voorschrijven bij ouderen.......................................................................................................8
Polyfarmacie en geneesmiddelgerelateerde problemen........................................................................8
Ongeschikt geneesmiddel...................................................................................................................8
Onderbehandeling..............................................................................................................................8
Criteria om al dan niet te behandelen................................................................................................8
Deprescribing.....................................................................................................................................8
Risicogeneesmiddelen........................................................................................................................9
Nierfunctie........................................................................................................................................10
Therapietrouw..................................................................................................................................10
Medicatiebeoordeling......................................................................................................................10
STRIP.............................................................................................................................................10
Screeningsinstrumenten...................................................................................................................11
Medicatieoverdracht (Richtlijn overdracht van medicatiegegevens in de keten).............................11
Klinisch relevant voorschrijven.........................................................................................................12
Stopzetten van farmacotherapie in het kader van palliatieve zorg......................................................12
, Hart en vaten....................................................................................................................................12
1. Nitraten....................................................................................................................................12
2. Diuretica...................................................................................................................................12
3. Antihypertensiva.......................................................................................................................12
4. Digoxin......................................................................................................................................13
5. Cholesterolverlagende middelen..............................................................................................13
6. Acetylsalicylzuur.......................................................................................................................13
Zenuwstelsel.....................................................................................................................................13
7. Antipsychotica..........................................................................................................................13
8. Benzodiazepinen.......................................................................................................................13
9. Antidepressiva..........................................................................................................................13
10. Cholinesteraseremmers..........................................................................................................14
Maag-darmkanaal en endocrien stelsel............................................................................................14
11. Laxativa...................................................................................................................................14
12. Protonpompremmers.............................................................................................................14
13. Glucoseverlagende middelen en insuline...............................................................................14
Skelet................................................................................................................................................14
14. Bisfosfonaten..........................................................................................................................14
Opstarten van comforttherapie in het kader van palliatieve zorg........................................................14
Zenuwstelsel.........................................................................................................................................14
Delier................................................................................................................................................14
Angst.................................................................................................................................................14
Pijn....................................................................................................................................................15
Insomnia...........................................................................................................................................15
Maag-darmkanaal.................................................................................................................................15
Nausea en braken.............................................................................................................................15
Obstipatie.........................................................................................................................................15
Luchtwegen..........................................................................................................................................16
Dyspnoe............................................................................................................................................16
Excessief respiratoir secreet (doodsreutel)......................................................................................16
Medicatie in de laatste levensfase.......................................................................................................16
, Welke aspecten van het ouder worden zijn
belangrijk voor de farmacotherapie bij ouderen?
- Farmacokinetiek en farmacodynamiek verandert door verouderingsproces
- Individueel grote verschillen.
Innameproblemen
- Verminderde motiliteit slokdarm en maag grote dragees kunnen blijven steken
ontstaan perforatie, ulceratie of piloesofagitis.
o Vooral bij;
Tetracyclines, kinidinesulfaat, kaliumdragees, acetylsalicylzuur en orale
bisfosfonaten.
o Daardoor hebben vloeibare toedieningsvormen voorkeur.
- Strips als verpakking zijn soms lastig moeilijk eruit te krijgen, of mee innemen aluminium
- Bij cognitieve problemen en medicatie te lang in de mond houden ulcus in de mondholte.
farmacokinetische veranderingen
absorptie
o vaker achloorhydrie; in de maag geen zoutzuur waardoor verhoogde pH in de maag.
ook protonpompremmers verhogen ph in de maag
geneesmiddelen die pH-afhankelijke absorptie hebben kunnen daardoor
een ander absorptieprofiel krijgen
sommige medicatie wordt beter opgenomen in een zure maag
sommige antischimmelmiddelen, zoals itraconazol en ketoconazol.
Deze medicatie innemen met zure vloeistof (bijv Cola) lukt dat niet
inname met vetrijke maaltijd aanbevolen.
Bij inname in drankvorm zijn bovenstaande voorzorgen niet nodig.
Verdeling
o Percentage vetweefsel in verhouding tot totale hoeveelheid lichaamswater neemt
toe en Lean body mass neemt af verdeling van vet- en wateroplosbare
geneesmiddelen wordt anders.
Lipofiele middelen groter (fictief) verdelingsvolume dan bij jongere
volwassenen ivm toename vetcompartiment.
Diazepam bijv cumuleert in vetweefsel en de halveringstijd neemt
sterk toe werking houdt langer aan.
Hydrofiele middelen oplaaddosis zal lager worden gekozen door afname
watercompartiment
Extra alertheid bij geneesmiddelen die geringe therapeutische
breedte hebben
o Lithium, digoxine en gentamicine.
o Start low, go slow!!
monitoren bloedspiegels geeft inzicht in cumulatie en evt. noodzaak tot
dosisaanpassing.
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