Medicatie, invasieve handelingen
en diabetes
Inhoud
1 Wat is medicatie?................................................................................................................................8
1.1 Definitie........................................................................................................................................8
1.2 Benaming......................................................................................................................................8
2 Geschiedenis van medicatie................................................................................................................8
2.1 Van overlevering tot wetenschap.................................................................................................8
2.2 Alternatieve geneesmiddelen.......................................................................................................8
2.3 Geneesmiddelenonderzoek..........................................................................................................8
2.4 Farmacovigilantie FAGG...............................................................................................................8
3 Indeling van medicatie.........................................................................................................................8
3.1 Causale therapie...........................................................................................................................8
3.2 Symptomatische therapie.............................................................................................................8
3.3 Substitutie of vervanging..............................................................................................................9
3.4 Profylactisch.................................................................................................................................9
3.5 Placebo.........................................................................................................................................9
3.6 Diagnostisch..................................................................................................................................9
4 Farmacologie.......................................................................................................................................9
4.1 Farmacokinetiek: compartimentenmodel....................................................................................9
4.1.1 Absorptie.............................................................................................................................11
4.1.2 Het centrale compartiment.................................................................................................11
4.1.3 Het targetorgaan.................................................................................................................12
4.1.4 Depotfunctie........................................................................................................................12
4.1.5 Metabolisme........................................................................................................................12
4.1.6 Excretie................................................................................................................................12
4.1.7 Streven naar evenwicht.......................................................................................................12
4.2 Farmacodynamiek......................................................................................................................13
4.2.1 Receptoren..........................................................................................................................13
4.2.2 Ionkanalen...........................................................................................................................14
4.2.3 Transporteiwitten................................................................................................................14
4.2.4 Enzymen...............................................................................................................................15
..........................................................................................................................................................16
1
, 4.3 Het first-pass effect.....................................................................................................................16
4.4 Farmacotherapeutische begrippen.............................................................................................17
4.4.1 Bloedspiegel en biologische beschikbaarheid......................................................................17
4.4.2 Halfwaardetijd en klaring.....................................................................................................17
4.4.3 Optimale effectieve spiegel of steady state concentratie....................................................18
4.4.4 Therapeutische venster en therapeutische breedte............................................................18
4.4.5 Toxische- en subtherapeutische dosis.................................................................................19
4.4.6 Cumulatie.............................................................................................................................19
4.4.7 Opstart- en/of onderhoudsdosis..........................................................................................20
4.5 Nevenwerkingen van geneesmiddelen.......................................................................................20
4.6 Beïnvloedende factoren van geneesmiddelen............................................................................20
4.6.1 Ziekte...................................................................................................................................20
4.6.2 Genetische factoren.............................................................................................................21
4.6.3 Interactie.............................................................................................................................21
4.6.4 Lichaamsgewicht..................................................................................................................21
4.6.5 Omgevingsfactoren..............................................................................................................21
4.6.6 Voeding................................................................................................................................21
5 Lokale of systemisch werking van medicatie.....................................................................................21
6 Enteraal toediening...........................................................................................................................22
6.1 De mondholte.............................................................................................................................22
6.1.1 Sublinguaal..........................................................................................................................22
6.1.2 Orodispersibel......................................................................................................................22
6.2 Het rectum..................................................................................................................................22
7 Inspuitingen.......................................................................................................................................22
7.1 Omschrijving van een injectie.....................................................................................................22
7.2 Indeling van injecties..................................................................................................................23
7.2.1 Intradermaal........................................................................................................................23
7.2.2 Subcutaan............................................................................................................................23
7.2.3 Intramusculair......................................................................................................................24
7.2.4 Intraveneus..........................................................................................................................27
7.2.5 Andere injecties...................................................................................................................27
7.3 Verpleegkundige aandachtspunten............................................................................................27
8 Toediening via huid en subcutaan weefsel........................................................................................27
8.1 Dermaal......................................................................................................................................28
8.2 Transdermaal..............................................................................................................................28
8.3 Implantaten................................................................................................................................28
2
,9 Toediening via ademhaling................................................................................................................28
9.1 Zuurstof......................................................................................................................................28
9.1.1 Omschrijving........................................................................................................................28
9.1.2 Zuurstoftekort: acuut versus chronisch...............................................................................29
9.1.3 Zuurstofbronnen..................................................................................................................30
9.1.4 Toedieningsmethoden:........................................................................................................31
9.1.5 Complicaties bij zuurstoftoediening:...................................................................................31
9.1.6 Verpleegkundige aandachtspunten bij zuurstoftherapie:....................................................32
9.2 Andere mediactievormen via ademhaling..................................................................................32
9.2.1 Dampen...............................................................................................................................32
9.2.2 Dosisaerosol.........................................................................................................................32
9.2.3 Droogpoederinhalatoren.....................................................................................................32
9.2.4 Verneveling..........................................................................................................................32
10 Andere lokale toedieningsvormen...................................................................................................32
10.1 Vaginaal....................................................................................................................................32
10.2 Neus..........................................................................................................................................33
10.3 Oor............................................................................................................................................33
10.4 Oog...........................................................................................................................................33
11 Gevaren verbonden aan het gebruik van geneesmiddelen.............................................................33
11.1 Allergie......................................................................................................................................33
11.2 Idiosyncrasie.............................................................................................................................33
11.3 Intolerantie...............................................................................................................................33
11.4 Seksuele dysfunctie..................................................................................................................33
11.5 Toxicomanie.............................................................................................................................33
11.6 Intoxicatie of vergiftiging..........................................................................................................34
12 Verpleegkundige en medicatie........................................................................................................34
12.1 De regel van 5...........................................................................................................................34
12.2 Verantwoordelijkheid van de arts van de verpleegkundige......................................................34
12.3 Kennis.......................................................................................................................................34
12.4 Verpleegkundige aandachtspunten bij medicatietoediening...................................................34
13 Verpakking en bewaren van geneesmiddelen.................................................................................34
13.1 Verpakking van geneesmiddelen..............................................................................................34
13.1.1 Buitenverpakking...............................................................................................................34
13.1.2 Primaire verpakking...........................................................................................................35
13.2 Bewaring van geneesmiddelen.................................................................................................35
13.2.1 Temperatuur......................................................................................................................35
3
, 13.2.2 Tijd.....................................................................................................................................35
13.2.3 Vochtigheid........................................................................................................................35
13.2.4 Licht...................................................................................................................................35
13.2.5 Risico medicatie.................................................................................................................35
14 Patiënten en medicatie....................................................................................................................35
14.1 Therapietrouw..........................................................................................................................35
14.2 Bijzonder patiëntengroepen.....................................................................................................35
1 Bloedafname.....................................................................................................................................36
1.1 Bepaling......................................................................................................................................36
1.2 Doel............................................................................................................................................36
1.2.1 Proefpunctie: bloedonderzoek............................................................................................36
1.2.2 Evacuerende punctie; donor, aderlating, wisseltransfusie..................................................36
1.3 Soorten bloedonderzoeken........................................................................................................36
1.4 Perifere venapunctie..................................................................................................................38
1.4.1 Vershchillende systemen.....................................................................................................39
1.4.2 Verpleegkundige aandachtspunten.....................................................................................39
1.4.3 Bijzondere patiëntengroepen..............................................................................................40
2 Het infuus..........................................................................................................................................41
2.1 Bepaling......................................................................................................................................41
2.2 Doel............................................................................................................................................41
2.2.1 Volume en samenstelling van het lichaam behouden of herstellen....................................41
2.2.2 Normale voedingsbehoeften verzekeren.............................................................................42
2.2.3 Desintoxicatie:.....................................................................................................................42
2.2.4 Medicatietoediening:...........................................................................................................42
2.2.5 Waakinfuus, preventief........................................................................................................42
2.2.6 Diagnostisch hulpmiddel......................................................................................................42
2.3 Soorten infuusoplossingen.........................................................................................................42
2.3.1 Volgens osmotische druk.....................................................................................................42
2.3.2 Volgens samenstelling.........................................................................................................43
2.4 Het plaatsen van een perifeer infuus..........................................................................................45
2.4.1 Materiaal.............................................................................................................................45
2.4.2 De aderkeuze.......................................................................................................................46
2.4.3 De technische handelingen..................................................................................................46
2.4.4 Inloopsnelheid regelen........................................................................................................46
2.4.5 Verpleegkundige aandachtspunten.....................................................................................47
2.4.6 Complicaties........................................................................................................................47
4
en diabetes
Inhoud
1 Wat is medicatie?................................................................................................................................8
1.1 Definitie........................................................................................................................................8
1.2 Benaming......................................................................................................................................8
2 Geschiedenis van medicatie................................................................................................................8
2.1 Van overlevering tot wetenschap.................................................................................................8
2.2 Alternatieve geneesmiddelen.......................................................................................................8
2.3 Geneesmiddelenonderzoek..........................................................................................................8
2.4 Farmacovigilantie FAGG...............................................................................................................8
3 Indeling van medicatie.........................................................................................................................8
3.1 Causale therapie...........................................................................................................................8
3.2 Symptomatische therapie.............................................................................................................8
3.3 Substitutie of vervanging..............................................................................................................9
3.4 Profylactisch.................................................................................................................................9
3.5 Placebo.........................................................................................................................................9
3.6 Diagnostisch..................................................................................................................................9
4 Farmacologie.......................................................................................................................................9
4.1 Farmacokinetiek: compartimentenmodel....................................................................................9
4.1.1 Absorptie.............................................................................................................................11
4.1.2 Het centrale compartiment.................................................................................................11
4.1.3 Het targetorgaan.................................................................................................................12
4.1.4 Depotfunctie........................................................................................................................12
4.1.5 Metabolisme........................................................................................................................12
4.1.6 Excretie................................................................................................................................12
4.1.7 Streven naar evenwicht.......................................................................................................12
4.2 Farmacodynamiek......................................................................................................................13
4.2.1 Receptoren..........................................................................................................................13
4.2.2 Ionkanalen...........................................................................................................................14
4.2.3 Transporteiwitten................................................................................................................14
4.2.4 Enzymen...............................................................................................................................15
..........................................................................................................................................................16
1
, 4.3 Het first-pass effect.....................................................................................................................16
4.4 Farmacotherapeutische begrippen.............................................................................................17
4.4.1 Bloedspiegel en biologische beschikbaarheid......................................................................17
4.4.2 Halfwaardetijd en klaring.....................................................................................................17
4.4.3 Optimale effectieve spiegel of steady state concentratie....................................................18
4.4.4 Therapeutische venster en therapeutische breedte............................................................18
4.4.5 Toxische- en subtherapeutische dosis.................................................................................19
4.4.6 Cumulatie.............................................................................................................................19
4.4.7 Opstart- en/of onderhoudsdosis..........................................................................................20
4.5 Nevenwerkingen van geneesmiddelen.......................................................................................20
4.6 Beïnvloedende factoren van geneesmiddelen............................................................................20
4.6.1 Ziekte...................................................................................................................................20
4.6.2 Genetische factoren.............................................................................................................21
4.6.3 Interactie.............................................................................................................................21
4.6.4 Lichaamsgewicht..................................................................................................................21
4.6.5 Omgevingsfactoren..............................................................................................................21
4.6.6 Voeding................................................................................................................................21
5 Lokale of systemisch werking van medicatie.....................................................................................21
6 Enteraal toediening...........................................................................................................................22
6.1 De mondholte.............................................................................................................................22
6.1.1 Sublinguaal..........................................................................................................................22
6.1.2 Orodispersibel......................................................................................................................22
6.2 Het rectum..................................................................................................................................22
7 Inspuitingen.......................................................................................................................................22
7.1 Omschrijving van een injectie.....................................................................................................22
7.2 Indeling van injecties..................................................................................................................23
7.2.1 Intradermaal........................................................................................................................23
7.2.2 Subcutaan............................................................................................................................23
7.2.3 Intramusculair......................................................................................................................24
7.2.4 Intraveneus..........................................................................................................................27
7.2.5 Andere injecties...................................................................................................................27
7.3 Verpleegkundige aandachtspunten............................................................................................27
8 Toediening via huid en subcutaan weefsel........................................................................................27
8.1 Dermaal......................................................................................................................................28
8.2 Transdermaal..............................................................................................................................28
8.3 Implantaten................................................................................................................................28
2
,9 Toediening via ademhaling................................................................................................................28
9.1 Zuurstof......................................................................................................................................28
9.1.1 Omschrijving........................................................................................................................28
9.1.2 Zuurstoftekort: acuut versus chronisch...............................................................................29
9.1.3 Zuurstofbronnen..................................................................................................................30
9.1.4 Toedieningsmethoden:........................................................................................................31
9.1.5 Complicaties bij zuurstoftoediening:...................................................................................31
9.1.6 Verpleegkundige aandachtspunten bij zuurstoftherapie:....................................................32
9.2 Andere mediactievormen via ademhaling..................................................................................32
9.2.1 Dampen...............................................................................................................................32
9.2.2 Dosisaerosol.........................................................................................................................32
9.2.3 Droogpoederinhalatoren.....................................................................................................32
9.2.4 Verneveling..........................................................................................................................32
10 Andere lokale toedieningsvormen...................................................................................................32
10.1 Vaginaal....................................................................................................................................32
10.2 Neus..........................................................................................................................................33
10.3 Oor............................................................................................................................................33
10.4 Oog...........................................................................................................................................33
11 Gevaren verbonden aan het gebruik van geneesmiddelen.............................................................33
11.1 Allergie......................................................................................................................................33
11.2 Idiosyncrasie.............................................................................................................................33
11.3 Intolerantie...............................................................................................................................33
11.4 Seksuele dysfunctie..................................................................................................................33
11.5 Toxicomanie.............................................................................................................................33
11.6 Intoxicatie of vergiftiging..........................................................................................................34
12 Verpleegkundige en medicatie........................................................................................................34
12.1 De regel van 5...........................................................................................................................34
12.2 Verantwoordelijkheid van de arts van de verpleegkundige......................................................34
12.3 Kennis.......................................................................................................................................34
12.4 Verpleegkundige aandachtspunten bij medicatietoediening...................................................34
13 Verpakking en bewaren van geneesmiddelen.................................................................................34
13.1 Verpakking van geneesmiddelen..............................................................................................34
13.1.1 Buitenverpakking...............................................................................................................34
13.1.2 Primaire verpakking...........................................................................................................35
13.2 Bewaring van geneesmiddelen.................................................................................................35
13.2.1 Temperatuur......................................................................................................................35
3
, 13.2.2 Tijd.....................................................................................................................................35
13.2.3 Vochtigheid........................................................................................................................35
13.2.4 Licht...................................................................................................................................35
13.2.5 Risico medicatie.................................................................................................................35
14 Patiënten en medicatie....................................................................................................................35
14.1 Therapietrouw..........................................................................................................................35
14.2 Bijzonder patiëntengroepen.....................................................................................................35
1 Bloedafname.....................................................................................................................................36
1.1 Bepaling......................................................................................................................................36
1.2 Doel............................................................................................................................................36
1.2.1 Proefpunctie: bloedonderzoek............................................................................................36
1.2.2 Evacuerende punctie; donor, aderlating, wisseltransfusie..................................................36
1.3 Soorten bloedonderzoeken........................................................................................................36
1.4 Perifere venapunctie..................................................................................................................38
1.4.1 Vershchillende systemen.....................................................................................................39
1.4.2 Verpleegkundige aandachtspunten.....................................................................................39
1.4.3 Bijzondere patiëntengroepen..............................................................................................40
2 Het infuus..........................................................................................................................................41
2.1 Bepaling......................................................................................................................................41
2.2 Doel............................................................................................................................................41
2.2.1 Volume en samenstelling van het lichaam behouden of herstellen....................................41
2.2.2 Normale voedingsbehoeften verzekeren.............................................................................42
2.2.3 Desintoxicatie:.....................................................................................................................42
2.2.4 Medicatietoediening:...........................................................................................................42
2.2.5 Waakinfuus, preventief........................................................................................................42
2.2.6 Diagnostisch hulpmiddel......................................................................................................42
2.3 Soorten infuusoplossingen.........................................................................................................42
2.3.1 Volgens osmotische druk.....................................................................................................42
2.3.2 Volgens samenstelling.........................................................................................................43
2.4 Het plaatsen van een perifeer infuus..........................................................................................45
2.4.1 Materiaal.............................................................................................................................45
2.4.2 De aderkeuze.......................................................................................................................46
2.4.3 De technische handelingen..................................................................................................46
2.4.4 Inloopsnelheid regelen........................................................................................................46
2.4.5 Verpleegkundige aandachtspunten.....................................................................................47
2.4.6 Complicaties........................................................................................................................47
4
