Summary

Samenvatting toegepaste farmacologie

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Course
Toegepaste Farmacologie (OG6003)

Institution
Odisee Hogeschool (Odisee)

Volledige samenvatting van het vak toegepaste farmacologie in het 3de jaar farmaceutische en biomedische laboratoriumtechnologie. Bevat ook de opdracht over fysiologische ziekten (epilepsie, atsma, borstkanker, diabetes type 2 en multiple sclerosis)

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Uploaded on January 12, 2021
Number of pages 102
Written in 2020/2021
Type Summary

antimicrobiële middelen
antimycotica
parasieten
astma
epilepsie
diabetes type 2
borstkanker
multiple sclerosis

Institution
Odisee Hogeschool (Odisee)
Education
Farmaceutische En Biomedische Wetenschappen
Course
Toegepaste Farmacologie (OG6003)

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Toegepaste farmacologie
Overzichtstabel antibiotica ........................................................................................................... 6
Antimicrobiële stoffen.................................................................................................................. 7
Keuze antibiotica (AB) ................................................................................................................... 7
1 Invloedsfactoren op de werking van een antimicrobiële stof ..................................................... 7
1.1 Gevoeligheid van het micro-organisme .............................................................................. 7
1.2 Groeifase van een micro-organisme .................................................................................. 8
1.3 Natuurlijk afweermechanisme .......................................................................................... 8
1.4 Andere factoren ............................................................................................................... 8
2 Keuze van het antibioticum ..................................................................................................... 8
2.1 Gevoeligheid van de kiem! ................................................................................................ 8
2.2 Toxiciteit van het AB......................................................................................................... 8
2.3 Distributie van het AB....................................................................................................... 8
2.4 Toestand patiënt .............................................................................................................. 9
2.5 Interacties tussen AB ........................................................................................................ 9
2.5.1 Doel van gebruik van meerdere AB ............................................................................. 9
2.5.2 Algemene regel:........................................................................................................10
2.5.3 OEFENINGEN: ...........................................................................................................10
2.6 Bijwerkingen ...................................................................................................................12
2.7 Posologie ........................................................................................................................12
2.8 Eliminatie van GM ...........................................................................................................13
Resistentiemechanismen ..............................................................................................................14
1. Mogelijke resistentiemechanismen........................................................................................14
2. Natuurlijk >< verworven resistentie .......................................................................................14
3. Mutationele resistentie .........................................................................................................14
4. Transfereerbare resistentie ...................................................................................................15
Werkingsmechanisme antibiotica..................................................................................................17
Overzicht werking van antibiotica..............................................................................................17
Groep 1: inhibitoren van de celwandsynthese ............................................................................18
1. Βèta-lactam antibiotica: werkingsmechanisme....................................................................18
2. Βèta-lactam antibiotica: resistentiemechanismen ...............................................................20
3. Soorten bèta-lactam antibiotica: Penicillines.......................................................................20
4. Andere bèta-lactam antibiotica: bij resistentie te gebruiken ................................................21
4.1 Cefalosporines............................................................................................................21
4.2 Carbapenems ..............................................................................................................21
4.3 Monobactams .............................................................................................................21
5. toepassingen: streptokokkeninfecties.................................................................................22

1

, 5.1 Staphylococcus aureus .................................................................................................22
5.2 Staphylococcus aureus – Folliculitis & furonkel..............................................................22
5.3 Staphylococcus aureus – Paronychium..........................................................................22
5.4 Streptococcus pyogenes – Angina pultacea (“witte angine”) ..........................................23
5.3 Streptococcus pyogenes – Peritonsillair abces ...............................................................23
5.4 Streptococcus pyogenes / Staphylococcus aureus – Impetigo.........................................23
5.5 Streptococcus pyogenes/ Streptococcus pneumoniae: Otitis media acuta.......................23
5.6 Staphylococcus aureus / Streptococcus pneumoniae – Conjuctivitis ...............................24
5.7 Staphylococcus aureus / Streptococcus pneumonia: Sinusitis .........................................24
5.8 Streptococcus pneumonia (“pneumokok”) ....................................................................24
5.9 Streptococcus pneumoniae – Meningitis.......................................................................25
5.10 Streptococcus pneumoniae – Pneumonie....................................................................25
5.11 Streptococcus pneumoniae: Vaccinatie .......................................................................26
5.12 Pseudomonas aeruginosa...........................................................................................26
6 Resistentie .........................................................................................................................27
6.1 Resistentie: MRSA .......................................................................................................27
6.2 Resistentie-ontwikkeling bij β-lactam AB.......................................................................28
6.3 Penicillinase of β-lactamasen........................................................................................29
6.4 Breedspectrum β-lactamasen.......................................................................................29
6.5 Extended spectrum β-lactamasen (ESBL).......................................................................29
6.6 Metallo-β-lactamasen of carbapenemasen....................................................................29
6.7 NDM-1: soort van metallo-β-lactamase.........................................................................29
6.8 Behandeling multiresistente gram- bacterie ..................................................................30
6.9 Consequenties, opties, toekomst ..................................................................................30
7 Glycopeptiden ...................................................................................................................30
CASUS: .................................................................................................................................31
Groep 2: Inhibitoren van de eiwitsynthese .................................................................................31
1 Aminoglycosiden................................................................................................................32
2 Tetracyclines......................................................................................................................32
3 Macroliden ........................................................................................................................33
CASUS: .................................................................................................................................34
Groep 3: AB die de membraanintegriteit verstoren ....................................................................34
1 Polymyxines.......................................................................................................................34
Groep 4: Competitieve inhibitie.................................................................................................34
Groep 5: Inhibitie DNA en RNA synthese....................................................................................35
1 Activiteiten ter hoogte van de DNA-structuur ......................................................................35
1.1 Inhibitoren van DNA gyrase ..........................................................................................35
1.2 Neisseria meningitidis: Meningokokkenmeningitis.........................................................37

2

, 2 activiteiten ter hoogte van de RNA-synthese .......................................................................37
2.1 inhibitoren van DNA transcriptie ..................................................................................37
Tuberculose .............................................................................................................................37
Tuberculostatica ...................................................................................................................38
Tuberculose: voorkomen.......................................................................................................38
Tuberculose opsporen...........................................................................................................38
CASUS: .................................................................................................................................39
Gevoeligheidsbehandelingen en bepaling van resistentie ...............................................................40
1 gevoeligheidsbepalingen ........................................................................................................40
1.1 Keuze antibiotica.............................................................................................................40
1.2 In vitro-testen: Labo MIC-bepaling & dosering ..................................................................40
1.2 Dilutiemethode ...............................................................................................................41
1.2.1 Klassieke MIC bepaling..............................................................................................41
1.2.2 ATB methode............................................................................................................41
1.3 Diffusiemethode .............................................................................................................42
1.3.1 Kirby-Bauer ..............................................................................................................44
1.3.2 Neo-sensitabs-methode (Rosco) ................................................................................44
1.4 Epsilon-test (E-test) .........................................................................................................45
2 Screening en confirmatie ESBL’s .............................................................................................45
2.1 Opsporen ESBL met DDST ................................................................................................46
2.2 Opsporen ESBL met CDDST ..............................................................................................47
2.3 Opsporen ESBL met E-test................................................................................................47
2.4 Cica beta test ..................................................................................................................48
2.5 Sensitiviteit en specificiteit...............................................................................................48
3 ESBL testen van opdracht.......................................................................................................48
3.1 Overzicht β-lactamasen ...................................................................................................48
3.2 VTEK 2 test......................................................................................................................49
3.3 DDS20 & DDS30 ..............................................................................................................50
3.4 ESBL E-test ......................................................................................................................50
Antimycotica ...............................................................................................................................52
1 Soorten mycosen (= schimmelinfecties) ..................................................................................52
2 Werkingsmechanismen antimycotica......................................................................................52
2.1 Polyenen.........................................................................................................................53
2.2 Echinocandinen...............................................................................................................53
2.3 Azoolderivaten................................................................................................................53
2.3.1 Orale candidiosis (spruw) ..........................................................................................53
2.3.2 Luierdermatitis .........................................................................................................54
2.4 Terbinafine .....................................................................................................................54

3

, 2.4.1 Tinea (ringworm) ......................................................................................................54
Antiparasitaire middelen .............................................................................................................55
Introductie...................................................................................................................................55
1 Varkenszweepworm bij IBD....................................................................................................57
2 Kuren met een lintworm? ......................................................................................................57
2.1 Therapie voor lintwormen ...............................................................................................57
3 Vlooienbom...........................................................................................................................58
3.1 Behandeling....................................................................................................................58
3.2 Voorkomen.....................................................................................................................58
4 Helminthen in de strijd tegen auto-immuunziekten (vb MS)/allergieën en chronische
inflammaties............................................................................................................................59
4.1 Multiple sclerosis (MS).....................................................................................................59
4.2 Astma en allergieën.........................................................................................................59
Overzicht parasieten en hun behandeling ......................................................................................60
1 Giardia lamblia = Giardiasis ....................................................................................................60
1.1 Bergen outbreak, 2004 (Noorwegen) ................................................................................60
1.2 Symptomen ....................................................................................................................61
1.3 Preventie ........................................................................................................................61
1.4 Behandeling....................................................................................................................61
1.5 Interacties.......................................................................................................................62
2 Entamoeba histolytica = amoebiasis .......................................................................................62
2.1 Behandeling....................................................................................................................63
3 Trypanosoma sp = slaapziekte ................................................................................................63
3.1 Trypanosoma brucei gambiense en rhodensiense ..............................................................63
3.2 Trypanosoma brucei gambiense .......................................................................................63
3.3 Verloop ziekte .................................................................................................................64
3.4 Preventie ........................................................................................................................64
3.5 Behandeling....................................................................................................................64
4 Toxoplasma gondii = toxoplasmose ........................................................................................64
4.1 Symptomen ....................................................................................................................65
4.2 Preventie ........................................................................................................................65
4.3 Behandeling....................................................................................................................65
4.4 Toxoplasma als stille manipulator.....................................................................................66
5 Enterobius vermicularis = aarsmade ........................................................................................66
5.1 Symptomen en preventie.................................................................................................67
5.2 Behandeling....................................................................................................................67
5.3 Interacties & voorzorgen .................................................................................................67
6 Cryptosporidium parvum = Cryptosporidiose ...........................................................................68

4

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