Farmaceutische zorg en farmacotherapie 1 2023 – 2024
Inhoudsopgave
Hoofdstuk 1.................................................................................................................................................... 4
1. Algemene inleiding .................................................................................................................................... 4
Wat is farmacotherapie? ................................................................................................................................ 4
Wat is farmaceu3sche zorg? ........................................................................................................................ 10
Zelfzorgadvies............................................................................................................................................... 12
Vermijden van medica3efouten – medica3ebewaking ................................................................................ 13
2. Therapietrouw ......................................................................................................................................... 13
Types niet-therapietrouw ............................................................................................................................. 14
3. Interac:es en geneesmiddelen ................................................................................................................ 15
Interac3emechanismen ............................................................................................................................... 15
Gevolgen van interac3es .............................................................................................................................. 16
Interac3es aLandelen ................................................................................................................................. 16
Arts contacteren ........................................................................................................................................... 17
4. Farmacokine:sche interac:es ................................................................................................................. 18
Interac3es ter hoogte van de absorp3e ....................................................................................................... 18
Interac3es ter hoogte van de distribu3e ...................................................................................................... 18
Interac3es ter hoogte van de metabolisa3e ................................................................................................ 18
Interac3es ter hoogte van de excre3e.......................................................................................................... 20
Interac3es ter hoogte van de PgP’s .............................................................................................................. 20
5. Farmacodynamische interac:es .............................................................................................................. 20
Hyperkaliëmie .............................................................................................................................................. 20
Bloedingsrisico ............................................................................................................................................. 21
Serotonine syndroom ................................................................................................................................... 22
QT interval .................................................................................................................................................... 22
Farmacologische antagonismen ................................................................................................................... 23
6. Farmacotherapie bij speciale popula:es ................................................................................................. 24
Zwangere vrouwen ....................................................................................................................................... 24
Vrouwen met kinderwens ............................................................................................................................ 25
Vrouwen die borstvoeding geven................................................................................................................. 25
Kinderen ....................................................................................................................................................... 26
Ouderen ....................................................................................................................................................... 26
Cardiovasculair stelsel .................................................................................................................................. 28
1. Cardiovasculair risicobeheer .................................................................................................................... 28
Apparently healthy people – risicobeheer ................................................................................................... 28
Pa3ënten met vastgesteld ASCVD ................................................................................................................ 29
Specifieke risico-condi3es ............................................................................................................................ 29
Risicobeheer: aanpak risicofactoren ............................................................................................................ 29
2. Diure:ca................................................................................................................................................... 33
3. ß-blokkers ................................................................................................................................................ 36
4. Calciumantagonisten ............................................................................................................................... 40
5. ACE-inhibitoren en sartanen .................................................................................................................... 41
ACE-inhibitoren ............................................................................................................................................ 41
Sartanen ....................................................................................................................................................... 45
6. ARNI: sacubitril/valsartan complex .......................................................................................................... 45
7. An:-ar:mica ............................................................................................................................................ 46
,Farmaceutische zorg en farmacotherapie 1 2023 – 2024
8. Nitraten.................................................................................................................................................... 49
9. Hypolipemiërende middelen .................................................................................................................... 51
Sta3nes......................................................................................................................................................... 51
PCSK9-inhibitoren ........................................................................................................................................ 55
10. An:trombo:ca .................................................................................................................................... 56
An3-aggregan3a ........................................................................................................................................... 57
An3coagulan3a ............................................................................................................................................ 58
Aandachtspunten an3trombo3ca ................................................................................................................ 62
11. Digoxine ............................................................................................................................................... 63
Gastro-intes:naal stelsel .............................................................................................................................. 64
1. Medica:ebegeleiding bij PPI’s ................................................................................................................. 64
Farmacologie van de PPI’s ............................................................................................................................ 64
Uitgicebegeleiding ....................................................................................................................................... 64
Problema3ek rond onnodig PPI gebruik ...................................................................................................... 65
2. Medica:ebewaking bij PPI’s .................................................................................................................... 66
CYP2C19 ....................................................................................................................................................... 66
GM waarvan BB aLankelijk is van de gastro-intes3nale pH ........................................................................ 66
3. Medica:ebegeleiding bij aminosalicylaten.............................................................................................. 66
4. Maagklachten bij NSAID-gebruikers ........................................................................................................ 67
5. Zelfzorg .................................................................................................................................................... 68
Refluxklachten & brandend maagzuur ......................................................................................................... 68
Dyspepsie ..................................................................................................................................................... 70
Nausea & braken .......................................................................................................................................... 70
Diarree ......................................................................................................................................................... 72
Cons3pa3e ................................................................................................................................................... 74
Proctologische aandoeningen, Aambeien en anale fissuren........................................................................ 78
Diarree/GI klachten bij colchicine toxiciteit ................................................................................................. 79
Preven3e opiaat – obs3pa3e ....................................................................................................................... 79
Astma en COPD ............................................................................................................................................ 80
1. Astma vs COPD......................................................................................................................................... 80
2. Therapeu:sche klassen van inhala:emedica:e ...................................................................................... 81
ß2 agonisten (BA) ......................................................................................................................................... 81
Inhala3ecor3costeroïden ............................................................................................................................. 81
ICS + ß2 combina3e ...................................................................................................................................... 81
An3cholinergica: muscarine antagonisten (MA) .......................................................................................... 81
SABA + SAMA combina3e ............................................................................................................................ 82
LABA + LAMA combina3e ............................................................................................................................. 82
ICS + LABA + LAMA: single inhaler triple therapy ......................................................................................... 82
3. Behandelingsplan ASTMA ........................................................................................................................ 82
Monoklonale an3lichamen in astma behandeling ....................................................................................... 82
4. Behandelingsplan COPD .......................................................................................................................... 83
Behandeling GOLD groep B .......................................................................................................................... 83
Behandeling GOLD groep D .......................................................................................................................... 83
Behandeling acute exacerba3e COPD .......................................................................................................... 83
5. Medica:ebegeleiding .............................................................................................................................. 84
Astma ........................................................................................................................................................... 84
COPD ............................................................................................................................................................ 84
6. Medica:ebewaking ................................................................................................................................. 88
,Farmaceutische zorg en farmacotherapie 1 2023 – 2024
Geneesmiddelinterac3es ............................................................................................................................. 88
Contra-indica3es .......................................................................................................................................... 89
Zwangerschap en borstvoeding ................................................................................................................... 90
Andere aandachtspunten ............................................................................................................................. 90
7. Zelfzorg bij astma en COPD pa:ënten ..................................................................................................... 91
Astma ........................................................................................................................................................... 91
COPD ............................................................................................................................................................ 91
Diabetes ....................................................................................................................................................... 92
Insuline – begeleiding .................................................................................................................................. 92
Orale an3diabe3ca – begeleiding................................................................................................................. 94
Pre-opera3ef beleid bij an3diabe3ca ........................................................................................................... 97
Extra informa3e............................................................................................................................................ 97
Medica3ebewaking ...................................................................................................................................... 98
Zelfzorg bij diabe3ci ..................................................................................................................................... 99
Schildklierpathologie ...................................................................................................................................101
Medica3ebegeleiding ................................................................................................................................. 102
Medica3ebewaking .................................................................................................................................... 103
Systemische cor:costeroïden ......................................................................................................................105
Medica3ebegeleiding ................................................................................................................................. 105
Medica3ebewaking .................................................................................................................................... 107
An:concep:e ..............................................................................................................................................108
1. Homonale an:concep:e – indeling ....................................................................................................... 108
Oestroprogestagene associa3es................................................................................................................. 108
Progestagenen ........................................................................................................................................... 109
IUD ............................................................................................................................................................. 109
Andere........................................................................................................................................................ 109
2. Menopauzale klachten ........................................................................................................................... 109
3. Farmaceu:sche zorg bij an:concep:e en menopauzale klachten ......................................................... 110
Medica3ebegeleiding ................................................................................................................................. 110
Medica3ebewaking .................................................................................................................................... 113
Noodan3concep3e ..................................................................................................................................... 115
4. Zelfzorg bij menstrua:epijn ................................................................................................................... 116
Niet medicamenteus advies ....................................................................................................................... 117
Medicamenteus advies .............................................................................................................................. 117
Urogenitale problemen en urineweginfec:es ..............................................................................................118
1. Urogenitale problemen .......................................................................................................................... 118
Blaasfunc3estoornissen ............................................................................................................................. 118
Benigne prostaathypertrofie/mic3eklachten bij mannen .......................................................................... 119
Vaginale klachten ....................................................................................................................................... 120
Impoten3e.................................................................................................................................................. 121
Bedplassen ................................................................................................................................................. 122
2. Farmacotherapie bij urineweginfec:es (UWI) ....................................................................................... 122
Acute cys33s/blaasontsteking.................................................................................................................... 122
Recidiverende cys33s ................................................................................................................................. 123
Acute pyelonefri3s ..................................................................................................................................... 123
Asymptoma3sche bacteriurie .................................................................................................................... 124
, Farmaceutische zorg en farmacotherapie 1 2023 – 2024
Pijn en koorts ..............................................................................................................................................125
1. Achtergrond ........................................................................................................................................... 125
Types pijn ................................................................................................................................................... 125
Biopsychosociaal model ............................................................................................................................. 125
Behandeldoel ............................................................................................................................................. 125
2. Behandeling van pijn ............................................................................................................................. 126
Niet medicamenteus .................................................................................................................................. 126
Medicamenteus ......................................................................................................................................... 127
Cannabis/cannabinoïden ........................................................................................................................... 129
Opioïdencrisis in USA ................................................................................................................................. 129
Opioïdrota3e .............................................................................................................................................. 130
3. Farmaceu:sche zorg bij pijn .................................................................................................................. 130
Paracetamol ............................................................................................................................................... 130
Opioïden..................................................................................................................................................... 131
4. Farmaceu:sche zorg bij koorts .............................................................................................................. 135
Achtergrond ............................................................................................................................................... 135
Niet-medicamenteus advies ....................................................................................................................... 136
Medicamenteus advies .............................................................................................................................. 136
Osteo-ar:culaire aandoeningen ..................................................................................................................138
1. Systemische NSAID’s .............................................................................................................................. 139
Medica3ebegeleiding ................................................................................................................................. 139
Medica3ebewaking .................................................................................................................................... 145
2. Farmaceu:sche zorg bij osteoar:culaire aandoeningen ....................................................................... 146
Reumatoïde artri3s .................................................................................................................................... 146
Jicht ............................................................................................................................................................ 149
Artrose: slijtagereuma ................................................................................................................................ 151
3. Farmaceu:sche zorg bij osteoporose ..................................................................................................... 152
Achtergond ................................................................................................................................................. 152
Behandeling osteoporose .......................................................................................................................... 152
Farmaceu3sche zorg bij osteoporose ......................................................................................................... 154
Hoofdstuk 1
1. Algemene inleiding
Wa t i s f a r m a c o t h e r a p i e?
Doel: optimale behandeling van patiënten met geneesmiddelen.
GM = essentiële tool om klachten of aandoeningen te behandelen of te voorkomen.
à geneesmiddelengebruik, moet altijd rationeel gebeuren.
Maar:
- GM kunnen (ernstige) problemen veroozaken
- Door slecht gebruik à ineffectiviteit
- Kostelijk
- Als apotheker is het belangrijk te realiseren welke patiënten baat hebben aan een geneesmiddelen en welke
hier juist een risico oplopen.
Wees steeds in staat om medicatie als een deel van behandelingsstrategiën te zien, vaak of soms is de niet-
medicamenteuze behandeling belangrijker.
Inhoudsopgave
Hoofdstuk 1.................................................................................................................................................... 4
1. Algemene inleiding .................................................................................................................................... 4
Wat is farmacotherapie? ................................................................................................................................ 4
Wat is farmaceu3sche zorg? ........................................................................................................................ 10
Zelfzorgadvies............................................................................................................................................... 12
Vermijden van medica3efouten – medica3ebewaking ................................................................................ 13
2. Therapietrouw ......................................................................................................................................... 13
Types niet-therapietrouw ............................................................................................................................. 14
3. Interac:es en geneesmiddelen ................................................................................................................ 15
Interac3emechanismen ............................................................................................................................... 15
Gevolgen van interac3es .............................................................................................................................. 16
Interac3es aLandelen ................................................................................................................................. 16
Arts contacteren ........................................................................................................................................... 17
4. Farmacokine:sche interac:es ................................................................................................................. 18
Interac3es ter hoogte van de absorp3e ....................................................................................................... 18
Interac3es ter hoogte van de distribu3e ...................................................................................................... 18
Interac3es ter hoogte van de metabolisa3e ................................................................................................ 18
Interac3es ter hoogte van de excre3e.......................................................................................................... 20
Interac3es ter hoogte van de PgP’s .............................................................................................................. 20
5. Farmacodynamische interac:es .............................................................................................................. 20
Hyperkaliëmie .............................................................................................................................................. 20
Bloedingsrisico ............................................................................................................................................. 21
Serotonine syndroom ................................................................................................................................... 22
QT interval .................................................................................................................................................... 22
Farmacologische antagonismen ................................................................................................................... 23
6. Farmacotherapie bij speciale popula:es ................................................................................................. 24
Zwangere vrouwen ....................................................................................................................................... 24
Vrouwen met kinderwens ............................................................................................................................ 25
Vrouwen die borstvoeding geven................................................................................................................. 25
Kinderen ....................................................................................................................................................... 26
Ouderen ....................................................................................................................................................... 26
Cardiovasculair stelsel .................................................................................................................................. 28
1. Cardiovasculair risicobeheer .................................................................................................................... 28
Apparently healthy people – risicobeheer ................................................................................................... 28
Pa3ënten met vastgesteld ASCVD ................................................................................................................ 29
Specifieke risico-condi3es ............................................................................................................................ 29
Risicobeheer: aanpak risicofactoren ............................................................................................................ 29
2. Diure:ca................................................................................................................................................... 33
3. ß-blokkers ................................................................................................................................................ 36
4. Calciumantagonisten ............................................................................................................................... 40
5. ACE-inhibitoren en sartanen .................................................................................................................... 41
ACE-inhibitoren ............................................................................................................................................ 41
Sartanen ....................................................................................................................................................... 45
6. ARNI: sacubitril/valsartan complex .......................................................................................................... 45
7. An:-ar:mica ............................................................................................................................................ 46
,Farmaceutische zorg en farmacotherapie 1 2023 – 2024
8. Nitraten.................................................................................................................................................... 49
9. Hypolipemiërende middelen .................................................................................................................... 51
Sta3nes......................................................................................................................................................... 51
PCSK9-inhibitoren ........................................................................................................................................ 55
10. An:trombo:ca .................................................................................................................................... 56
An3-aggregan3a ........................................................................................................................................... 57
An3coagulan3a ............................................................................................................................................ 58
Aandachtspunten an3trombo3ca ................................................................................................................ 62
11. Digoxine ............................................................................................................................................... 63
Gastro-intes:naal stelsel .............................................................................................................................. 64
1. Medica:ebegeleiding bij PPI’s ................................................................................................................. 64
Farmacologie van de PPI’s ............................................................................................................................ 64
Uitgicebegeleiding ....................................................................................................................................... 64
Problema3ek rond onnodig PPI gebruik ...................................................................................................... 65
2. Medica:ebewaking bij PPI’s .................................................................................................................... 66
CYP2C19 ....................................................................................................................................................... 66
GM waarvan BB aLankelijk is van de gastro-intes3nale pH ........................................................................ 66
3. Medica:ebegeleiding bij aminosalicylaten.............................................................................................. 66
4. Maagklachten bij NSAID-gebruikers ........................................................................................................ 67
5. Zelfzorg .................................................................................................................................................... 68
Refluxklachten & brandend maagzuur ......................................................................................................... 68
Dyspepsie ..................................................................................................................................................... 70
Nausea & braken .......................................................................................................................................... 70
Diarree ......................................................................................................................................................... 72
Cons3pa3e ................................................................................................................................................... 74
Proctologische aandoeningen, Aambeien en anale fissuren........................................................................ 78
Diarree/GI klachten bij colchicine toxiciteit ................................................................................................. 79
Preven3e opiaat – obs3pa3e ....................................................................................................................... 79
Astma en COPD ............................................................................................................................................ 80
1. Astma vs COPD......................................................................................................................................... 80
2. Therapeu:sche klassen van inhala:emedica:e ...................................................................................... 81
ß2 agonisten (BA) ......................................................................................................................................... 81
Inhala3ecor3costeroïden ............................................................................................................................. 81
ICS + ß2 combina3e ...................................................................................................................................... 81
An3cholinergica: muscarine antagonisten (MA) .......................................................................................... 81
SABA + SAMA combina3e ............................................................................................................................ 82
LABA + LAMA combina3e ............................................................................................................................. 82
ICS + LABA + LAMA: single inhaler triple therapy ......................................................................................... 82
3. Behandelingsplan ASTMA ........................................................................................................................ 82
Monoklonale an3lichamen in astma behandeling ....................................................................................... 82
4. Behandelingsplan COPD .......................................................................................................................... 83
Behandeling GOLD groep B .......................................................................................................................... 83
Behandeling GOLD groep D .......................................................................................................................... 83
Behandeling acute exacerba3e COPD .......................................................................................................... 83
5. Medica:ebegeleiding .............................................................................................................................. 84
Astma ........................................................................................................................................................... 84
COPD ............................................................................................................................................................ 84
6. Medica:ebewaking ................................................................................................................................. 88
,Farmaceutische zorg en farmacotherapie 1 2023 – 2024
Geneesmiddelinterac3es ............................................................................................................................. 88
Contra-indica3es .......................................................................................................................................... 89
Zwangerschap en borstvoeding ................................................................................................................... 90
Andere aandachtspunten ............................................................................................................................. 90
7. Zelfzorg bij astma en COPD pa:ënten ..................................................................................................... 91
Astma ........................................................................................................................................................... 91
COPD ............................................................................................................................................................ 91
Diabetes ....................................................................................................................................................... 92
Insuline – begeleiding .................................................................................................................................. 92
Orale an3diabe3ca – begeleiding................................................................................................................. 94
Pre-opera3ef beleid bij an3diabe3ca ........................................................................................................... 97
Extra informa3e............................................................................................................................................ 97
Medica3ebewaking ...................................................................................................................................... 98
Zelfzorg bij diabe3ci ..................................................................................................................................... 99
Schildklierpathologie ...................................................................................................................................101
Medica3ebegeleiding ................................................................................................................................. 102
Medica3ebewaking .................................................................................................................................... 103
Systemische cor:costeroïden ......................................................................................................................105
Medica3ebegeleiding ................................................................................................................................. 105
Medica3ebewaking .................................................................................................................................... 107
An:concep:e ..............................................................................................................................................108
1. Homonale an:concep:e – indeling ....................................................................................................... 108
Oestroprogestagene associa3es................................................................................................................. 108
Progestagenen ........................................................................................................................................... 109
IUD ............................................................................................................................................................. 109
Andere........................................................................................................................................................ 109
2. Menopauzale klachten ........................................................................................................................... 109
3. Farmaceu:sche zorg bij an:concep:e en menopauzale klachten ......................................................... 110
Medica3ebegeleiding ................................................................................................................................. 110
Medica3ebewaking .................................................................................................................................... 113
Noodan3concep3e ..................................................................................................................................... 115
4. Zelfzorg bij menstrua:epijn ................................................................................................................... 116
Niet medicamenteus advies ....................................................................................................................... 117
Medicamenteus advies .............................................................................................................................. 117
Urogenitale problemen en urineweginfec:es ..............................................................................................118
1. Urogenitale problemen .......................................................................................................................... 118
Blaasfunc3estoornissen ............................................................................................................................. 118
Benigne prostaathypertrofie/mic3eklachten bij mannen .......................................................................... 119
Vaginale klachten ....................................................................................................................................... 120
Impoten3e.................................................................................................................................................. 121
Bedplassen ................................................................................................................................................. 122
2. Farmacotherapie bij urineweginfec:es (UWI) ....................................................................................... 122
Acute cys33s/blaasontsteking.................................................................................................................... 122
Recidiverende cys33s ................................................................................................................................. 123
Acute pyelonefri3s ..................................................................................................................................... 123
Asymptoma3sche bacteriurie .................................................................................................................... 124
, Farmaceutische zorg en farmacotherapie 1 2023 – 2024
Pijn en koorts ..............................................................................................................................................125
1. Achtergrond ........................................................................................................................................... 125
Types pijn ................................................................................................................................................... 125
Biopsychosociaal model ............................................................................................................................. 125
Behandeldoel ............................................................................................................................................. 125
2. Behandeling van pijn ............................................................................................................................. 126
Niet medicamenteus .................................................................................................................................. 126
Medicamenteus ......................................................................................................................................... 127
Cannabis/cannabinoïden ........................................................................................................................... 129
Opioïdencrisis in USA ................................................................................................................................. 129
Opioïdrota3e .............................................................................................................................................. 130
3. Farmaceu:sche zorg bij pijn .................................................................................................................. 130
Paracetamol ............................................................................................................................................... 130
Opioïden..................................................................................................................................................... 131
4. Farmaceu:sche zorg bij koorts .............................................................................................................. 135
Achtergrond ............................................................................................................................................... 135
Niet-medicamenteus advies ....................................................................................................................... 136
Medicamenteus advies .............................................................................................................................. 136
Osteo-ar:culaire aandoeningen ..................................................................................................................138
1. Systemische NSAID’s .............................................................................................................................. 139
Medica3ebegeleiding ................................................................................................................................. 139
Medica3ebewaking .................................................................................................................................... 145
2. Farmaceu:sche zorg bij osteoar:culaire aandoeningen ....................................................................... 146
Reumatoïde artri3s .................................................................................................................................... 146
Jicht ............................................................................................................................................................ 149
Artrose: slijtagereuma ................................................................................................................................ 151
3. Farmaceu:sche zorg bij osteoporose ..................................................................................................... 152
Achtergond ................................................................................................................................................. 152
Behandeling osteoporose .......................................................................................................................... 152
Farmaceu3sche zorg bij osteoporose ......................................................................................................... 154
Hoofdstuk 1
1. Algemene inleiding
Wa t i s f a r m a c o t h e r a p i e?
Doel: optimale behandeling van patiënten met geneesmiddelen.
GM = essentiële tool om klachten of aandoeningen te behandelen of te voorkomen.
à geneesmiddelengebruik, moet altijd rationeel gebeuren.
Maar:
- GM kunnen (ernstige) problemen veroozaken
- Door slecht gebruik à ineffectiviteit
- Kostelijk
- Als apotheker is het belangrijk te realiseren welke patiënten baat hebben aan een geneesmiddelen en welke
hier juist een risico oplopen.
Wees steeds in staat om medicatie als een deel van behandelingsstrategiën te zien, vaak of soms is de niet-
medicamenteuze behandeling belangrijker.
