FA-MA101
Chronische aandoeningen
Samenvatting
,FA-MA101 Chronische aandoeningen M. de Leeuw
Inhoudsopgave
Inleiding FA-MA101 Chronische aandoeningen .....................................................................................7
Doelstelling.................................................................................................................................................. 7
Leerdoelen................................................................................................................................................... 7
Benodigde voorkennis ................................................................................................................................. 7
Nierfunctie............................................................................................................................................... 8
Natrium en Kalium waardes .................................................................................................................. 11
Begrippenlijst .................................................................................................................................... 19
Migraine ........................................................................................................................................... 20
Definitie; Migraine..................................................................................................................................... 20
Risicofactoren; Migraine ........................................................................................................................... 20
Pathofysiologie; Migraine ......................................................................................................................... 20
Anatomie hersenen, van belang bij de pathofysiologie van migraine .................................................. 23
Symptomen; Migraine ............................................................................................................................... 23
Migraine Vs. spanningshoofdpijn .......................................................................................................... 23
Prodromale verschijnselen .................................................................................................................... 24
Migraine met aura ................................................................................................................................. 25
Beleid; Migraine ........................................................................................................................................ 26
Aanvalsbehandeling .............................................................................................................................. 26
Profylaxe van migraine .......................................................................................................................... 27
Geneesmiddelen; Migraine ....................................................................................................................... 28
Paracetamol .......................................................................................................................................... 28
NSAID’s .................................................................................................................................................. 28
Triptanen ............................................................................................................................................... 29
Bètablokkers .......................................................................................................................................... 31
Valproïnezuur ........................................................................................................................................ 33
Topiramaat ............................................................................................................................................ 34
De ziekte van Parkinson ..................................................................................................................... 35
Definitie; De ziekte van Parkinson............................................................................................................. 35
Pathofysiologie; De ziekte van Parkinson ................................................................................................. 35
Dopamine basics ................................................................................................................................... 35
Basale Ganglia; Directe route ................................................................................................................ 36
Basale Ganglia; Indirecte route ............................................................................................................. 36
De ziekte van Parkinson ........................................................................................................................ 37
Beloop & Prognose; de Ziekte van Parkinson ....................................................................................... 40
Symptomen; De ziekte van Parkinson ....................................................................................................... 41
Universiteit Utrecht Pagina 2 van 136
,FA-MA101 Chronische aandoeningen M. de Leeuw
Motorische symptomen ........................................................................................................................ 41
Niet-motorische symptomen ................................................................................................................ 41
Beleid; De ziekte van Parkinson ................................................................................................................ 42
De vroege/ ongecompliceerde fase ...................................................................................................... 42
Gecompliceerde fase ............................................................................................................................. 42
Beleid; niet-motorische symptomen ..................................................................................................... 43
Impulscontrolestoornissen bij de ziekte van Parkinson ........................................................................ 44
Geneesmiddelen; De ziekte van Parkinson ............................................................................................... 44
Levodopa + decarboxylaseremmer ....................................................................................................... 44
Dopamine-agonisten: pramipexol, ropinirol ......................................................................................... 45
Bijwerkingen levodopa/ dopamineagonisten verklaren ....................................................................... 46
Catechol-O-methyl-transferase-(COMT)-remmers: entacapone, tolcapon .......................................... 47
Amantadine ........................................................................................................................................... 47
MAOB-remmers: selegiline .................................................................................................................... 48
Apomorfine (ook een dopamineagonist) .............................................................................................. 48
Diabetes Mellitus .............................................................................................................................. 50
Definitie; Diabetes Mellitus ....................................................................................................................... 50
Risicofactoren; Diabetes Mellitus type 2................................................................................................... 50
Pathofysiologie; Diabetes Mellitus type 2 ................................................................................................. 50
De opname/ uitscheiding van glucose .................................................................................................. 51
Bloedglucose concentratie & HbA1C-gehalte......................................................................................... 52
Symptomen; Diabetes Mellitus type 2 ...................................................................................................... 52
Beleid; Diabetes Mellitus type 2 ............................................................................................................... 53
Behandeldoel + streefwaardes om beleid te beoordelen en gnm in te zetten .................................... 53
Medicamenteuze stappen..................................................................................................................... 54
Geneesmiddelen; Diabetes Mellitus type 2 .............................................................................................. 55
Metformine ........................................................................................................................................... 55
Sulfonylureumderivaten........................................................................................................................ 56
Repaglinide ............................................................................................................................................ 56
Insuline .................................................................................................................................................. 57
GLP-1-analoga ....................................................................................................................................... 58
Dipetideylpeptidase-4-remmers (DPP4-remmers)................................................................................ 59
SGLT2-remmers (natirum-glucose-cotransporter-2-remmers) ............................................................. 60
Thiazolidinedionen ................................................................................................................................ 61
Hartfalen........................................................................................................................................... 62
Definitie; hartfalen .................................................................................................................................... 62
Universiteit Utrecht Pagina 3 van 136
, FA-MA101 Chronische aandoeningen M. de Leeuw
Risicofactoren; hartfalen ........................................................................................................................... 62
Pathofysiologie; hartfalen ......................................................................................................................... 62
Links hartfalen ....................................................................................................................................... 62
Rechts hartfalen .................................................................................................................................... 63
Systolisch hartfalen (HF-REF)................................................................................................................. 63
Diastolisch hartfalen (HF-PEF) ............................................................................................................... 65
Remodeling ........................................................................................................................................... 67
RAAS ...................................................................................................................................................... 68
B-type natriuretische peptiden (BNP) ................................................................................................... 68
Symptomen; hartfalen .............................................................................................................................. 68
Classificatie; hartfalen ............................................................................................................................... 69
Beleid; hartfalen ........................................................................................................................................ 69
Beleid; systolisch hartfalen.................................................................................................................... 69
Beleid; diastolisch hartfalen .................................................................................................................. 70
Beleid; Acuut hartfalen.......................................................................................................................... 70
Overige medicamenteuze behandeling bij hartfalen ............................................................................ 71
Geneesmiddelen; hartfalen....................................................................................................................... 72
ACE-remmers......................................................................................................................................... 72
Angiotensine II-antagonisten (ARB’s) .................................................................................................... 74
Lisdiuretica ............................................................................................................................................ 75
Selectieve bètablokkers......................................................................................................................... 76
Aldosteronantagonisten ........................................................................................................................ 77
Digoxine ................................................................................................................................................. 78
Chronic Obstructive Pulmonary Disease (COPD) ................................................................................. 81
Definitie; COPD .......................................................................................................................................... 81
Risicofactoren; COPD ................................................................................................................................ 81
Pathofysiologie; COPD............................................................................................................................... 81
Longparameters .................................................................................................................................... 81
COPD ..................................................................................................................................................... 82
Beloop & prognose COPD...................................................................................................................... 87
Vergelijking van COPD met Astma ........................................................................................................ 88
Symptomen; COPD .................................................................................................................................... 89
Classificatie; COPD..................................................................................................................................... 90
Beleid; COPD ............................................................................................................................................. 90
Onderhoudsmedicatie........................................................................................................................... 91
Beleid bij exacerbaties........................................................................................................................... 93
Universiteit Utrecht Pagina 4 van 136
Chronische aandoeningen
Samenvatting
,FA-MA101 Chronische aandoeningen M. de Leeuw
Inhoudsopgave
Inleiding FA-MA101 Chronische aandoeningen .....................................................................................7
Doelstelling.................................................................................................................................................. 7
Leerdoelen................................................................................................................................................... 7
Benodigde voorkennis ................................................................................................................................. 7
Nierfunctie............................................................................................................................................... 8
Natrium en Kalium waardes .................................................................................................................. 11
Begrippenlijst .................................................................................................................................... 19
Migraine ........................................................................................................................................... 20
Definitie; Migraine..................................................................................................................................... 20
Risicofactoren; Migraine ........................................................................................................................... 20
Pathofysiologie; Migraine ......................................................................................................................... 20
Anatomie hersenen, van belang bij de pathofysiologie van migraine .................................................. 23
Symptomen; Migraine ............................................................................................................................... 23
Migraine Vs. spanningshoofdpijn .......................................................................................................... 23
Prodromale verschijnselen .................................................................................................................... 24
Migraine met aura ................................................................................................................................. 25
Beleid; Migraine ........................................................................................................................................ 26
Aanvalsbehandeling .............................................................................................................................. 26
Profylaxe van migraine .......................................................................................................................... 27
Geneesmiddelen; Migraine ....................................................................................................................... 28
Paracetamol .......................................................................................................................................... 28
NSAID’s .................................................................................................................................................. 28
Triptanen ............................................................................................................................................... 29
Bètablokkers .......................................................................................................................................... 31
Valproïnezuur ........................................................................................................................................ 33
Topiramaat ............................................................................................................................................ 34
De ziekte van Parkinson ..................................................................................................................... 35
Definitie; De ziekte van Parkinson............................................................................................................. 35
Pathofysiologie; De ziekte van Parkinson ................................................................................................. 35
Dopamine basics ................................................................................................................................... 35
Basale Ganglia; Directe route ................................................................................................................ 36
Basale Ganglia; Indirecte route ............................................................................................................. 36
De ziekte van Parkinson ........................................................................................................................ 37
Beloop & Prognose; de Ziekte van Parkinson ....................................................................................... 40
Symptomen; De ziekte van Parkinson ....................................................................................................... 41
Universiteit Utrecht Pagina 2 van 136
,FA-MA101 Chronische aandoeningen M. de Leeuw
Motorische symptomen ........................................................................................................................ 41
Niet-motorische symptomen ................................................................................................................ 41
Beleid; De ziekte van Parkinson ................................................................................................................ 42
De vroege/ ongecompliceerde fase ...................................................................................................... 42
Gecompliceerde fase ............................................................................................................................. 42
Beleid; niet-motorische symptomen ..................................................................................................... 43
Impulscontrolestoornissen bij de ziekte van Parkinson ........................................................................ 44
Geneesmiddelen; De ziekte van Parkinson ............................................................................................... 44
Levodopa + decarboxylaseremmer ....................................................................................................... 44
Dopamine-agonisten: pramipexol, ropinirol ......................................................................................... 45
Bijwerkingen levodopa/ dopamineagonisten verklaren ....................................................................... 46
Catechol-O-methyl-transferase-(COMT)-remmers: entacapone, tolcapon .......................................... 47
Amantadine ........................................................................................................................................... 47
MAOB-remmers: selegiline .................................................................................................................... 48
Apomorfine (ook een dopamineagonist) .............................................................................................. 48
Diabetes Mellitus .............................................................................................................................. 50
Definitie; Diabetes Mellitus ....................................................................................................................... 50
Risicofactoren; Diabetes Mellitus type 2................................................................................................... 50
Pathofysiologie; Diabetes Mellitus type 2 ................................................................................................. 50
De opname/ uitscheiding van glucose .................................................................................................. 51
Bloedglucose concentratie & HbA1C-gehalte......................................................................................... 52
Symptomen; Diabetes Mellitus type 2 ...................................................................................................... 52
Beleid; Diabetes Mellitus type 2 ............................................................................................................... 53
Behandeldoel + streefwaardes om beleid te beoordelen en gnm in te zetten .................................... 53
Medicamenteuze stappen..................................................................................................................... 54
Geneesmiddelen; Diabetes Mellitus type 2 .............................................................................................. 55
Metformine ........................................................................................................................................... 55
Sulfonylureumderivaten........................................................................................................................ 56
Repaglinide ............................................................................................................................................ 56
Insuline .................................................................................................................................................. 57
GLP-1-analoga ....................................................................................................................................... 58
Dipetideylpeptidase-4-remmers (DPP4-remmers)................................................................................ 59
SGLT2-remmers (natirum-glucose-cotransporter-2-remmers) ............................................................. 60
Thiazolidinedionen ................................................................................................................................ 61
Hartfalen........................................................................................................................................... 62
Definitie; hartfalen .................................................................................................................................... 62
Universiteit Utrecht Pagina 3 van 136
, FA-MA101 Chronische aandoeningen M. de Leeuw
Risicofactoren; hartfalen ........................................................................................................................... 62
Pathofysiologie; hartfalen ......................................................................................................................... 62
Links hartfalen ....................................................................................................................................... 62
Rechts hartfalen .................................................................................................................................... 63
Systolisch hartfalen (HF-REF)................................................................................................................. 63
Diastolisch hartfalen (HF-PEF) ............................................................................................................... 65
Remodeling ........................................................................................................................................... 67
RAAS ...................................................................................................................................................... 68
B-type natriuretische peptiden (BNP) ................................................................................................... 68
Symptomen; hartfalen .............................................................................................................................. 68
Classificatie; hartfalen ............................................................................................................................... 69
Beleid; hartfalen ........................................................................................................................................ 69
Beleid; systolisch hartfalen.................................................................................................................... 69
Beleid; diastolisch hartfalen .................................................................................................................. 70
Beleid; Acuut hartfalen.......................................................................................................................... 70
Overige medicamenteuze behandeling bij hartfalen ............................................................................ 71
Geneesmiddelen; hartfalen....................................................................................................................... 72
ACE-remmers......................................................................................................................................... 72
Angiotensine II-antagonisten (ARB’s) .................................................................................................... 74
Lisdiuretica ............................................................................................................................................ 75
Selectieve bètablokkers......................................................................................................................... 76
Aldosteronantagonisten ........................................................................................................................ 77
Digoxine ................................................................................................................................................. 78
Chronic Obstructive Pulmonary Disease (COPD) ................................................................................. 81
Definitie; COPD .......................................................................................................................................... 81
Risicofactoren; COPD ................................................................................................................................ 81
Pathofysiologie; COPD............................................................................................................................... 81
Longparameters .................................................................................................................................... 81
COPD ..................................................................................................................................................... 82
Beloop & prognose COPD...................................................................................................................... 87
Vergelijking van COPD met Astma ........................................................................................................ 88
Symptomen; COPD .................................................................................................................................... 89
Classificatie; COPD..................................................................................................................................... 90
Beleid; COPD ............................................................................................................................................. 90
Onderhoudsmedicatie........................................................................................................................... 91
Beleid bij exacerbaties........................................................................................................................... 93
Universiteit Utrecht Pagina 4 van 136
