Deze samenvatting bevat de volledige lesinhoud van het vak praktische psychofarmacologie. De info uit de slides werden geïntegreerd met de eigen persoonlijke notities. Alle afbeeldingen uit de slides worden uitgelegd. Voor mezelf heb ik ook enkele begrippen die niet geduid werden in de les opgezoc...
Inhoudsopgave
INLEIDING DEEL 1: ANATOMIE EN FUNCTIE VAN DE HERSENEN .......................................................................5
CEREBRUM (GROTE HERSENEN) ..................................................................................................................................5
CORTEX CEREBRI ......................................................................................................................................................5
PREFRONTALE CORTEX ..............................................................................................................................................5
PRIMAIRE MOTORISCHE CORTEX ..................................................................................................................................6
SECUNDAIRE MOTORISCHE SCHORS ..............................................................................................................................6
PRIMAIRE SENSORISCHE CORTEX..................................................................................................................................6
SECUNDAIRE SENSORISCHE SCHORS ..............................................................................................................................6
VISUELE CORTEX ......................................................................................................................................................7
AUDITIEVE CORTEX ...................................................................................................................................................7
GNOSTISCH CENTRUM ...............................................................................................................................................7
CEREBRUM .............................................................................................................................................................7
DIENCEPHALON .......................................................................................................................................................8
HERSENSTAM ..........................................................................................................................................................8
CEREBELLUM ...........................................................................................................................................................8
SENSIBEL SYSTEEM VOOR ZINTUIGLIJKE WAARNEMINGEN..................................................................................................9
MOTORISCH SYSTEEM VOOR BEWEGING .......................................................................................................................9
LIMBISCH SYSTEEM VOOR EMOTIONEEL GEDRAG .............................................................................................................9
NUCLEUS ACCUMBENS OF VENTRAAL STRIATUM ...........................................................................................................10
INLEIDING DEEL 2: NEUROTRANSMISSIE........................................................................................................ 10
KLASSIEKE ANTEROGRADE NEUROTRANSMISSIE ............................................................................................................10
HOE COMMUNICEREN ZENUWCELLEN .........................................................................................................................10
DE ACTIEPOTENTIAAL ..............................................................................................................................................11
SYNAPTISCHE NEUROTRANSMISSIE .............................................................................................................................12
RETROGRADE NEUROTRANSMISSIE (E.G. ENDOCANNABINOÏDEN) .....................................................................................12
EXTRASYNAPTISCHE NEUROTRANSMISSIE ....................................................................................................................12
INLEIDING DEEL 3: ......................................................................................................................................... 13
AANGRIJPINGSPUNTEN PSYCHOFARMACA ................................................................................................... 13
RECEPTOREN .........................................................................................................................................................14
IONKANALEN .........................................................................................................................................................16
ENZYMEN .............................................................................................................................................................17
CARRIERS OF TRANSPORTERS ....................................................................................................................................17
INLEIDING DEEL 4: MECHANISMEN VAN NEUROMODULATIE ........................................................................ 17
DESENSITISATIE .....................................................................................................................................................18
DOWN-REGULATIE .................................................................................................................................................18
UP-REGULATIE ......................................................................................................................................................18
SUPERSENSITIVITEIT ................................................................................................................................................19
ANTIDEPRESSIVA .......................................................................................................................................... 19
SYMPTOMEN MAJEURE DEPRESSIE .............................................................................................................................19
MAJEURE DEPRESSIE ...............................................................................................................................................19
BIOSYNTHESE CATECHOLAMINES (CA) ........................................................................................................................20
NORADRENALINE (NAD), BIOSYNTHESE, RECEPTOREN, TRANSPORTERS.............................................................................20
ADRENERGE RECEPTOREN = GPCRS ..........................................................................................................................21
NAD & ADRENALINE METABOLISATIE .........................................................................................................................21
BEËINDIGING VAN DE EFFECTEN VAN NAD & ADRENALINE – METABOLISATIE ....................................................................21
NADERGE BANEN VANAF DE LOCUS COERULEUS ...........................................................................................................22
1
, SEROTONINE 5HT ..................................................................................................................................................22
SEROTONINERGE NEUROTRANSMISSIE ........................................................................................................................22
SEROTONINE RECEPTOREN .......................................................................................................................................22
5HTERGE BANEN VANAF DE RAPHE NUCLEUS ...............................................................................................................23
NEUROBIOLOGIE VAN MAJEURE DEPRESSIE ..................................................................................................................24
BEHANDELING VAN EEN DEPRESSIE ............................................................................................................................26
HEROPNAMEREMMERS ...........................................................................................................................................27
NIET-SELECTIEVE HEROPNAMEREMMERS.....................................................................................................................27
Neveneffecten TCAD & verwante reuptake inhibitoren ...............................................................................28
SNRI’s = serotonine noradrenaline reuptake inhibitoren .............................................................................28
Dopamine reuptake inhibitor + zwakkere NAD reuptake inhibitor + nicotine receptor antagonist .............28
SELECTIEVE HEROPNAMEREMMERS VOOR SEROTONINE ..................................................................................................29
SSRIs werkingsmechanisme..........................................................................................................................29
Neveneffecten eigen aan SSRI’s ...................................................................................................................29
NEVENEFFECTEN VOOR ALLE REUPTAKE INHIBITOREN .....................................................................................................30
SEROTONINESYNDROOM .........................................................................................................................................30
NRI’S = SELECTIEVE NORADRENALINE REUPTAKE INHIBITOR ............................................................................................31
EFFECTEN EN INDICATIES VAN REUPTAKE INHIBITOREN ...................................................................................................31
ANTIDEPRESSIVA DIRECT WERKEND OP DE RECEPTOREN .................................................................................................32
TRAZODON NESTROLAN® ........................................................................................................................................32
MIRTAZAPINE, MIANSERINE .....................................................................................................................................32
AGOMELATINE VALDOXAN® .....................................................................................................................................33
AGOMELATINE VALDOXAN® .....................................................................................................................................33
MAO-INHIBITOREN ................................................................................................................................................34
ANDERE ANTIDEPRESSIVA BIJ MAJEURE DEPRESSIE .........................................................................................................35
SINT-JANSKRUID ....................................................................................................................................................36
PLAATSBEPALING ANTIDEPRESSIVA.............................................................................................................................36
ZWANGERSCHAP ....................................................................................................................................................37
ANTIPSYCHOTICA (MAJEURE TRANQUILISERS) .............................................................................................. 37
SCHIZOFRENIE SYMPTOOMDIMENSIES ........................................................................................................................38
SCHIZOFRENIE .......................................................................................................................................................38
NEUROBIOLOGIE VAN SCHIZOFRENIE ..........................................................................................................................38
CENTRALE DOPAMINERGE BANEN & DOPAMINERGE NEUROTRANSMISSIE ..........................................................................38
GLUTAMATERGE NEUROTRANSMISSIE.........................................................................................................................39
GLUTAMAAT RECEPTORTYPES & RECEPTORSUBTYPES.....................................................................................................40
NEUROBIOLOGIE VAN SCHIZOFRENIE POSITIEVE SYMPTOMEN ..........................................................................................41
NEUROBIOLOGIE VAN SCHIZOFRENIE NEGATIEVE SYMPTOMEN .........................................................................................41
CONVENTIONELE VERSUS ATYPISCHE ANTIPSYCHOTICA ...................................................................................................42
CONVENTIONELE OF TYPISCHE ANTIPSYCHOTICA ...........................................................................................................42
D2 receptor antagonisme: de effecten en neveneffecten ............................................................................42
Andere neveneffecten antipsychotica ..........................................................................................................43
Antipsychotica met verlengde werking ........................................................................................................43
ATYPISCHE OF NIEUWERE ANTIPSYCHOTICA .................................................................................................................44
Serotonine-dopamine antagonist.................................................................................................................44
Andere atypische mechanismen leidend tot verbeterde klinische therapeutische effecten .........................47
Atypische antipsychotica en verbetering van negatieve symptomen: mogelijke werkingsmechanismen ...47
Atypische antipsychotica doeltreffendheid ..................................................................................................47
Atypische antipsychotica ongewenste effecten ...........................................................................................48
INDICATIES ANTIPSYCHOTICA ....................................................................................................................................49
CONTRA-INDICATIES ...............................................................................................................................................49
HYPNOTICA (MINEURE TRANQUILIZERS) ....................................................................................................... 50
NEUROBIOLOGIE VAN SLAAPSTOORNISSEN ..................................................................................................................50
Alertheid .......................................................................................................................................................50
Slaap-waak switch........................................................................................................................................51
Slapeloosheid ...............................................................................................................................................52
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, GABAERGE NEUROTRANSMISSIE ...............................................................................................................................52
Synthese en metabolisatie van het aminozuur GABA ..................................................................................52
BENZODIAZEPINES ..................................................................................................................................................53
Benzodiazepinebindingsplaats van de GABA-A receptor subtypes ..............................................................54
Benzodiazepine effecten ..............................................................................................................................54
Benzodiazepines farmacokinetiek ................................................................................................................55
Benzodiazepine full agonisten Indicaties......................................................................................................55
Benzodiazepines indicaties ...........................................................................................................................55
Benzodiazepines neveneffecten ...................................................................................................................56
Zwangerschap en borstvoeding ...................................................................................................................57
Contra-indicaties & interacties .....................................................................................................................57
Addendum - Benzodiazepine antagonist ......................................................................................................57
ANDERE GABA-A POSITIEVE ALLOSTERISCHE MODULATOREN: Z DRUGS............................................................................57
Binding van GABA-A PAMs aan alfa 1 subunit van de GABA-A receptor .....................................................58
Z drugs neveneffecten ..................................................................................................................................58
MELATONINE ........................................................................................................................................................59
VALERIAANEXTRACTEN ............................................................................................................................................60
DIVERSEN .............................................................................................................................................................60
AANPAK VAN SLAPELOOSHEID KERNBOODSCHAPPEN .....................................................................................................60
ANXIOLYTICA ................................................................................................................................................ 61
NEUROBIOLOGIE VAN ANGST- EN STRESSSTOORNISSEN ..................................................................................................61
ANXIOLYSE DOOR BENZODIAZEPINES ..........................................................................................................................62
ANXIOLYSE DOOR ANTIDEPRESSIVA ............................................................................................................................63
DIVERSEN .............................................................................................................................................................63
AANPAK VAN GEGENERALISEERDE ANGSTSTOORNISSEN(GAS) .........................................................................................63
AANPAK VAN PANIEKSTOORNISSEN ............................................................................................................................63
AANPAK VAN FOBIE ................................................................................................................................................64
AANPAK VAN SOCIALE ANGSTSTOORNISSEN .................................................................................................................64
AANPAK VAN OCS .................................................................................................................................................64
MOOD STABILISERS (STEMMINGSSTABILISATOREN) ..................................................................................... 64
BIPOLAIRE STOORNIS ..............................................................................................................................................65
Symptomen van manie .................................................................................................................................65
BEHANDELING VAN BIPOLAIRE STOORNISSEN ...............................................................................................................65
LITHIUMZOUTEN ....................................................................................................................................................66
ANDERE MOOD STABILISERS = BEPAALDE ANTI-EPILEPTICA ..............................................................................................67
ANDERE MOOD STABILISERS = ATYPISCHE ANTIPSYCHOTICA BIJ MANIE ...............................................................................67
ANTIEPILEPTICA ............................................................................................................................................ 68
WAT IS EPILEPSIE? .................................................................................................................................................68
SOORTEN EPILEPTISCHE AANVALLEN ...........................................................................................................................69
STATUS EPILEPTICUS ...............................................................................................................................................69
EPILEPSIESYNDROMEN ............................................................................................................................................70
EPILEPSIE INCIDENTIE, OORZAKEN ..............................................................................................................................70
EPILEPSY SPECTRUM DISORDER .................................................................................................................................70
EPILEPSIE BEHANDELING ..........................................................................................................................................70
PLAATSBEPALING ...................................................................................................................................................71
PATHOFYSIOLOGIE VAN EPILEPSIE ..............................................................................................................................71
INDELING AEDS VOLGENS WERKINGSMECHANISMEN.....................................................................................................72
INACTIVATIE VAN EEN NATRIUMKANAAL ......................................................................................................................73
INDELING AED VOLGENS WERKINGSSPECTRUM ............................................................................................................74
Valproïnezuur- Natriumvalproaat ................................................................................................................74
Lamotrigine ..................................................................................................................................................75
Levetiracetam en analogen ..........................................................................................................................76
Topiramaat...................................................................................................................................................76
Perampanel ..................................................................................................................................................77
3
, Carbamazepine en Oxcarbazepine ...............................................................................................................77
Gabapentine en Pregabaline ........................................................................................................................78
Fenobarbital en Primidon .............................................................................................................................79
Fenytoïne en Natriumfenytoïne....................................................................................................................80
Lacosamide...................................................................................................................................................80
STOPPEN VAN DE ANTI-EPILEPTISCHE BEHANDELING ......................................................................................................81
BEHANDELING VAN VROUWELIJKE EPILEPSIEPATIË NTEN ..................................................................................................81
TAKE HOME MESSAGES (!) .......................................................................................................................................81
AAN MIDDELEN GEBONDEN STOORNISSEN EN HUN BEHANDELING .............................................................. 82
MESOLIMBISCHE DOPAMINERGE BAAN MEDIEERT “REWARDING” ....................................................................................82
OPIOÏDEN EN MIDDELEN BIJ OPIOÏDVERSLAVING ...........................................................................................................83
OPIOID̈ EN .............................................................................................................................................................83
MEDICATIE BIJ OPIOID̈ VERSLAVING ............................................................................................................................84
ALCOHOL EN MIDDELEN BIJ ALCOHOLMISBRUIK ............................................................................................................85
ALCOHOLVERSLAVING .............................................................................................................................................85
Middelen bij alcoholmisbruik - Alcoholontwenning .....................................................................................86
Middelen bij alcoholmisbruik - Terugvalpreventie .......................................................................................86
INTERACTIES TUSSEN GENEESMIDDELEN EN ALCOHOL.....................................................................................................87
NICOTINE EN MIDDELEN BIJ TABAKSMISBRUIK ..............................................................................................................88
CANNABINOID̈ EN ...................................................................................................................................................90
DISSOCIATIEVE ANESTHETICA ....................................................................................................................................91
CP, KETAMINE EN DEXTROMETHORPHAN ....................................................................................................................91
CENTRALE STIMULANTIA ..........................................................................................................................................92
Amfetamines effecten algemeen .................................................................................................................92
Amfetamines neveneffecten ........................................................................................................................93
Cocaïne = centraal stimulerend ....................................................................................................................93
Middelen bij verslaving aan centrale stimulantia ........................................................................................93
HALLUCINOGENEN (VERWANT MET MONOAMINES) ......................................................................................................94
ADHD EN NARCOLEPSIE................................................................................................................................. 94
MIDDELEN BIJ ADHD .............................................................................................................................................94
ADHD aandacht ............................................................................................................................................95
ADHD hyperactiviteit en impulsiviteit ..........................................................................................................95
ADHD bij volwassenen..................................................................................................................................97
Behandeling van ADHD ................................................................................................................................97
MIDDELEN BIJ NARCOLEPSIE .................................................................................................................................. 100
Modafinil (100 mg).................................................................................................................................... 100
Pitolisant ................................................................................................................................................... 101
Oxybaat ..................................................................................................................................................... 102
Behandeling van narcolepsie: addendum ................................................................................................. 102
EXAMEN: VOORBEELDVRAGEN ............................................................................................................................... 103
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