Inhoudsopgave
A. Pijnmedicatie......................................................................................................................................3
PCM....................................................................................................................................................4
NSAIDs/Prostaglandinesynthetaseremmers.......................................................................................5
Opioïden.............................................................................................................................................7
Overview............................................................................................................................................9
B. Antistolling.......................................................................................................................................11
Tromboyctenaggregatieremmers.....................................................................................................13
Vitamine K-antagonisten/cumarinederivaten..................................................................................15
Heparines.........................................................................................................................................17
DOAC’s..............................................................................................................................................18
Overview..........................................................................................................................................19
C. Cardiovasculaire middelen...............................................................................................................21
Diuretica...........................................................................................................................................21
β-receptorblokkerende sympathicolytica.........................................................................................24
Calcium-antagonisten.......................................................................................................................26
RAS-Remmers...................................................................................................................................26
ACE remmers................................................................................................................................27
Angiotensine II – antagonisten.....................................................................................................29
Hartglycosiden (digoxine).................................................................................................................29
Nitraten............................................................................................................................................29
Overview..........................................................................................................................................30
D. Antidiabetica....................................................................................................................................32
Orale bloedglucose verlagende middelen........................................................................................33
Insuline.............................................................................................................................................35
Overview..........................................................................................................................................36
E. Antidepressiva..................................................................................................................................37
Antidepressiva..................................................................................................................................37
Lithium..............................................................................................................................................39
Overview..........................................................................................................................................39
F. Benzodiazepines...............................................................................................................................41
Overview..........................................................................................................................................42
G. Antibiotica........................................................................................................................................42
β-lactam-antibiotica.........................................................................................................................44
Tetracyclinen (doxycyline)................................................................................................................45
, Aminoglycosiden (gentamicine).......................................................................................................46
Macroliden (azitromycine)................................................................................................................46
Sulfonamiden/trimethoprim (co-trimoxazol)...................................................................................46
Chinolonen (ciprofloxacine)..............................................................................................................47
Middelen bij UWI (nitrofurantoïne, fosfomycine)............................................................................47
Midddelen bij anaerobe infecties (metronidazol)............................................................................48
Overview..........................................................................................................................................49
H. Farmacokinetiek...............................................................................................................................49
Absorptie..........................................................................................................................................49
Distributie.........................................................................................................................................50
Metabolisme.....................................................................................................................................50
Eliminatie..........................................................................................................................................50
Overview..........................................................................................................................................51
I. Geneesmiddelenallergie....................................................................................................................51
Anafylaxie (immunologisch/niet-immunologisch)............................................................................52
Trombocytopenie/hemolytische anemie..........................................................................................53
Ernstige huidreacties (severe cutaneous adverse reactions (SCAR))................................................54
Overview..........................................................................................................................................55
J. Wet- en regelgeving..........................................................................................................................55
K. Goed geneesmiddelengebruik..........................................................................................................56
L. Zwangerschap en lactatie.................................................................................................................58
Zwangerschap...................................................................................................................................58
Lactatie.............................................................................................................................................58
Te kennen geneesmiddelen..................................................................................................................59
,A. Pijnmedicatie
Analgetica
- Niet-opioïden PCM of Prostaglandinesynthetaseremmers
- Opioïden
Pathofysiologie van de pijn
Prostaglandines maken nociceptoren gevoeliger
Via vezels:
- C-vezels: gaan trager, geven doffe diepe pijn
- Aδ-vezels: gaan sneller, geven scherpe pijn
, WHO pijnladder
Fase 1 Paracetamol: 500 – 1000 mg 3-4 dd
Indien onvoldoende effect:
prostaglandinesynthethaseremmer
- Ibuprofen max 2400 mg in 4 – 6 doses
- Diclofenac 50 mg 2 – 4 dd
- Naproxen 250 – 500 mg 2 dd
Fase 2 Vervanging of toevoeging niet-opioïd fase 1 door/met zwak Deze stap wordt bij
werkend opioïd nociceptieve pijn bij kanker
- Codeïne 30 – 60 mg per keer, max 200 mg per dag meestal overgeslagen ivm
- Tramadol 50 – 100 mg 3 – 4 dd - Geringe pijn afname
(Codeïne en
tramadol)
- Bijwerkingen zoals
misselijkheid,
duizeligheid,
obstipatie (tramadol)
Fase 3 Onvoldoende werkzaamheid: Middel uit fase 3 wordt over
Sterker opioïd het algemeen gecombineerd
- Morfine retard 1 -2dd 10 – 30 mg met een middel uit fase 1
Max dosering bepaald door gewicht, leeftijd en vanwege de verschillende
eventueel optredende bijwerkingen aangrijpingspunten in het
- Fentanylpleister -> bij patiënten met stabiele pijnmechanisme
opioïdbehoefte en slikproblemen/braken
Nadeel fentanylpleister =
Opioïdrotatie: indien pijnstilling onvoldoende of bijwerkingen trage inwerkingtreding
onacceptabel kan van morfinepreparaat gewisseld worden
Fase 4 Indien andere toedieningswegen onvoldoende pijnstilling
geven: parentereale toediening
WHO pijnladder
PCM
Werking PCM
- Analgetisch
- Antipyretisch
- NIET anti-inflammatoir
Bijwerking: leverbeschadiging treedt op bij > 150 mg/kg per dag obv overbelasting metabole
verwerkingscapaciteit
Risicofactoren/risicogroepen:
Alcoholisme Max 2 g / dag
Pre-existent leverfalen
Slechte voedingstoestand
A. Pijnmedicatie......................................................................................................................................3
PCM....................................................................................................................................................4
NSAIDs/Prostaglandinesynthetaseremmers.......................................................................................5
Opioïden.............................................................................................................................................7
Overview............................................................................................................................................9
B. Antistolling.......................................................................................................................................11
Tromboyctenaggregatieremmers.....................................................................................................13
Vitamine K-antagonisten/cumarinederivaten..................................................................................15
Heparines.........................................................................................................................................17
DOAC’s..............................................................................................................................................18
Overview..........................................................................................................................................19
C. Cardiovasculaire middelen...............................................................................................................21
Diuretica...........................................................................................................................................21
β-receptorblokkerende sympathicolytica.........................................................................................24
Calcium-antagonisten.......................................................................................................................26
RAS-Remmers...................................................................................................................................26
ACE remmers................................................................................................................................27
Angiotensine II – antagonisten.....................................................................................................29
Hartglycosiden (digoxine).................................................................................................................29
Nitraten............................................................................................................................................29
Overview..........................................................................................................................................30
D. Antidiabetica....................................................................................................................................32
Orale bloedglucose verlagende middelen........................................................................................33
Insuline.............................................................................................................................................35
Overview..........................................................................................................................................36
E. Antidepressiva..................................................................................................................................37
Antidepressiva..................................................................................................................................37
Lithium..............................................................................................................................................39
Overview..........................................................................................................................................39
F. Benzodiazepines...............................................................................................................................41
Overview..........................................................................................................................................42
G. Antibiotica........................................................................................................................................42
β-lactam-antibiotica.........................................................................................................................44
Tetracyclinen (doxycyline)................................................................................................................45
, Aminoglycosiden (gentamicine).......................................................................................................46
Macroliden (azitromycine)................................................................................................................46
Sulfonamiden/trimethoprim (co-trimoxazol)...................................................................................46
Chinolonen (ciprofloxacine)..............................................................................................................47
Middelen bij UWI (nitrofurantoïne, fosfomycine)............................................................................47
Midddelen bij anaerobe infecties (metronidazol)............................................................................48
Overview..........................................................................................................................................49
H. Farmacokinetiek...............................................................................................................................49
Absorptie..........................................................................................................................................49
Distributie.........................................................................................................................................50
Metabolisme.....................................................................................................................................50
Eliminatie..........................................................................................................................................50
Overview..........................................................................................................................................51
I. Geneesmiddelenallergie....................................................................................................................51
Anafylaxie (immunologisch/niet-immunologisch)............................................................................52
Trombocytopenie/hemolytische anemie..........................................................................................53
Ernstige huidreacties (severe cutaneous adverse reactions (SCAR))................................................54
Overview..........................................................................................................................................55
J. Wet- en regelgeving..........................................................................................................................55
K. Goed geneesmiddelengebruik..........................................................................................................56
L. Zwangerschap en lactatie.................................................................................................................58
Zwangerschap...................................................................................................................................58
Lactatie.............................................................................................................................................58
Te kennen geneesmiddelen..................................................................................................................59
,A. Pijnmedicatie
Analgetica
- Niet-opioïden PCM of Prostaglandinesynthetaseremmers
- Opioïden
Pathofysiologie van de pijn
Prostaglandines maken nociceptoren gevoeliger
Via vezels:
- C-vezels: gaan trager, geven doffe diepe pijn
- Aδ-vezels: gaan sneller, geven scherpe pijn
, WHO pijnladder
Fase 1 Paracetamol: 500 – 1000 mg 3-4 dd
Indien onvoldoende effect:
prostaglandinesynthethaseremmer
- Ibuprofen max 2400 mg in 4 – 6 doses
- Diclofenac 50 mg 2 – 4 dd
- Naproxen 250 – 500 mg 2 dd
Fase 2 Vervanging of toevoeging niet-opioïd fase 1 door/met zwak Deze stap wordt bij
werkend opioïd nociceptieve pijn bij kanker
- Codeïne 30 – 60 mg per keer, max 200 mg per dag meestal overgeslagen ivm
- Tramadol 50 – 100 mg 3 – 4 dd - Geringe pijn afname
(Codeïne en
tramadol)
- Bijwerkingen zoals
misselijkheid,
duizeligheid,
obstipatie (tramadol)
Fase 3 Onvoldoende werkzaamheid: Middel uit fase 3 wordt over
Sterker opioïd het algemeen gecombineerd
- Morfine retard 1 -2dd 10 – 30 mg met een middel uit fase 1
Max dosering bepaald door gewicht, leeftijd en vanwege de verschillende
eventueel optredende bijwerkingen aangrijpingspunten in het
- Fentanylpleister -> bij patiënten met stabiele pijnmechanisme
opioïdbehoefte en slikproblemen/braken
Nadeel fentanylpleister =
Opioïdrotatie: indien pijnstilling onvoldoende of bijwerkingen trage inwerkingtreding
onacceptabel kan van morfinepreparaat gewisseld worden
Fase 4 Indien andere toedieningswegen onvoldoende pijnstilling
geven: parentereale toediening
WHO pijnladder
PCM
Werking PCM
- Analgetisch
- Antipyretisch
- NIET anti-inflammatoir
Bijwerking: leverbeschadiging treedt op bij > 150 mg/kg per dag obv overbelasting metabole
verwerkingscapaciteit
Risicofactoren/risicogroepen:
Alcoholisme Max 2 g / dag
Pre-existent leverfalen
Slechte voedingstoestand
