FA-MA202
Klinische Farmacie
Samenvatting
,FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Inhoud
Leerdoelen ..........................................................................................................................................5
Thema 1; Bioanalyse & Medicatiebewaking .......................................................................................... 6
Clinical Rules................................................................................................................................................ 6
Nierfunctie............................................................................................................................................... 6
Kalium...................................................................................................................................................... 6
Natrium ................................................................................................................................................... 7
INR ........................................................................................................................................................... 7
QTc-verlenging ........................................................................................................................................ 7
Antistolling .................................................................................................................................................. 8
Pathofysiologie trombose ....................................................................................................................... 8
Groepen antistolling .............................................................................................................................. 11
Antitrombotische therapie .................................................................................................................... 16
Casussen uit HC-antistolling & operatie ................................................................................................ 17
Farmacogenetica ....................................................................................................................................... 20
Begrippen .............................................................................................................................................. 20
Naamgeving allelen ............................................................................................................................... 21
Type metabolisers ................................................................................................................................. 21
Farmacogenetische test ........................................................................................................................ 23
Casus clopidogrel................................................................................................................................... 23
Thema 2; TDM & Toxicologie ............................................................................................................. 25
Farmacokinetiek ........................................................................................................................................ 25
Therapeutic Drug Monitoring.................................................................................................................... 26
TDM anti-epileptica: Valproïnezuur ...................................................................................................... 27
TDM Antibiotica .................................................................................................................................... 28
TDM Voriconazol ................................................................................................................................... 30
TDM immunosuppressiva...................................................................................................................... 30
Toxicologie ................................................................................................................................................ 31
Voorbeelden intoxicaties ...................................................................................................................... 31
Intoxicaties algemeen ........................................................................................................................... 31
Toxidromen ........................................................................................................................................... 32
Screening ............................................................................................................................................... 34
Behandeling van intoxicaties................................................................................................................. 34
Paracetamol intoxicatie......................................................................................................................... 35
Benzodiazepinen intoxicatie ................................................................................................................. 36
Tricyclische antidepressiva intoxicatie .................................................................................................. 37
Alcoholen intoxicatie ............................................................................................................................. 37
Thema 3; Medicatieoverdracht in de keten......................................................................................... 40
Medicatieverificatie vs. Medicatiebeoordeling......................................................................................... 40
Pagina 2 van 87
,FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Medicatieoverdracht ................................................................................................................................. 41
Risico-inschatting ...................................................................................................................................... 41
LSP ............................................................................................................................................................. 42
Opname en ontslag gesprek...................................................................................................................... 42
Conclusie ................................................................................................................................................... 42
Thema 4; Infectieziekten.................................................................................................................... 43
Bacteriën ................................................................................................................................................... 43
Antibiotica ................................................................................................................................................. 43
Beta-lactam antibiotica ......................................................................................................................... 45
Aminoglycosiden ................................................................................................................................... 47
Tetracyclines.......................................................................................................................................... 47
Macroliden ............................................................................................................................................ 47
Sulfonamiden (+trimethoprim) ............................................................................................................. 48
Chinolonen ............................................................................................................................................ 48
Glycopeptiden ....................................................................................................................................... 48
Metronidazol ......................................................................................................................................... 48
Tubercolose-middelen (tuberculostatica) ............................................................................................. 48
Antimycotica ............................................................................................................................................. 49
Indeling en toepassing........................................................................................................................... 49
Virussen & antivirale middelen ................................................................................................................. 49
Resistentie ................................................................................................................................................. 50
Mechanismen van resistentie ............................................................................................................... 51
Algemene strategie antibioticumbeleid .................................................................................................... 52
Reserve antibiotica .................................................................................................................................... 53
Pneumonie beleid SWAB........................................................................................................................... 53
Definitie ................................................................................................................................................. 53
Oorzaak ................................................................................................................................................. 53
Classificatie ............................................................................................................................................ 53
Diagnostiek ............................................................................................................................................ 53
Behandeling........................................................................................................................................... 54
Urineweginfectie beleid NHG .................................................................................................................... 59
Thema 5; Radiofarmacie & Cytostatica ............................................................................................... 61
Radiofarmaca ............................................................................................................................................ 61
Radioactiviteit basics ................................................................................................................................. 61
Radiofarmaca bij onderzoeken ................................................................................................................. 61
Single photon emission CT (SPECT) ....................................................................................................... 62
Positron emissive tomografie (PET ) ..................................................................................................... 63
Therapeutische radiofarmaca ................................................................................................................... 63
Verantwoordelijkheden radiofarmaceut .................................................................................................. 64
Pagina 3 van 87
, FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Radiochemie .............................................................................................................................................. 64
Radiochemie technetium ...................................................................................................................... 64
Tc-99m generator en labeling farmacon ............................................................................................... 64
Cyclotron ............................................................................................................................................... 65
Fluor-18 / FDG ....................................................................................................................................... 66
Gallium-68 (Ga-68) ................................................................................................................................ 66
Bereiding radiofarmaca vs. Cytostatica ..................................................................................................... 67
Radiofarmaca ........................................................................................................................................ 67
Cytostatica ........................................................................................ Fout! Bladwijzer niet gedefinieerd.
Thema 6; Voeding en geneesmiddelen + toediening-systemen ............................................................ 68
Soorten sondes.......................................................................................................................................... 69
Sondevoeding ............................................................................................................................................ 69
Geneesmiddelen over de sonde................................................................................................................ 70
Medicatiereview bij een patiënt met een sonde ...................................................................................... 71
Totaal parenterale voeding ....................................................................................................................... 75
Koolhydraten ......................................................................................................................................... 75
Eiwitten ................................................................................................................................................. 75
Vetten .................................................................................................................................................... 76
Wie, Wanneer, Welke TPV ........................................................................................................................ 77
Refeeding syndrome ............................................................................................................................. 77
Perifere lijnen en lokale complicaties ....................................................................................................... 78
Extravasatie ........................................................................................................................................... 78
Centrale-veneuze lijnen (CVC) ................................................................................................................... 80
Soorten centrale lijnen .......................................................................................................................... 81
Complicaties centrale lijnen .................................................................................................................. 81
Thema 7; Klinische Geneesmiddelenonderzoek & ethiek .................................................................... 82
Historie ...................................................................................................................................................... 82
Toetsing medisch-wetenschappelijk onderzoek ....................................................................................... 82
De organisatie van toetsing ....................................................................................................................... 83
Definitie geneesmiddelenonderzoek ........................................................................................................ 84
IMP vs non-IMP ......................................................................................................................................... 84
Regelgeving KGO ....................................................................................................................................... 84
Medicatiebewaking ................................................................................................................................... 85
Drug accountability ................................................................................................................................... 85
Vragen werkcollege ................................................................................................................................... 85
Pagina 4 van 87
Klinische Farmacie
Samenvatting
,FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Inhoud
Leerdoelen ..........................................................................................................................................5
Thema 1; Bioanalyse & Medicatiebewaking .......................................................................................... 6
Clinical Rules................................................................................................................................................ 6
Nierfunctie............................................................................................................................................... 6
Kalium...................................................................................................................................................... 6
Natrium ................................................................................................................................................... 7
INR ........................................................................................................................................................... 7
QTc-verlenging ........................................................................................................................................ 7
Antistolling .................................................................................................................................................. 8
Pathofysiologie trombose ....................................................................................................................... 8
Groepen antistolling .............................................................................................................................. 11
Antitrombotische therapie .................................................................................................................... 16
Casussen uit HC-antistolling & operatie ................................................................................................ 17
Farmacogenetica ....................................................................................................................................... 20
Begrippen .............................................................................................................................................. 20
Naamgeving allelen ............................................................................................................................... 21
Type metabolisers ................................................................................................................................. 21
Farmacogenetische test ........................................................................................................................ 23
Casus clopidogrel................................................................................................................................... 23
Thema 2; TDM & Toxicologie ............................................................................................................. 25
Farmacokinetiek ........................................................................................................................................ 25
Therapeutic Drug Monitoring.................................................................................................................... 26
TDM anti-epileptica: Valproïnezuur ...................................................................................................... 27
TDM Antibiotica .................................................................................................................................... 28
TDM Voriconazol ................................................................................................................................... 30
TDM immunosuppressiva...................................................................................................................... 30
Toxicologie ................................................................................................................................................ 31
Voorbeelden intoxicaties ...................................................................................................................... 31
Intoxicaties algemeen ........................................................................................................................... 31
Toxidromen ........................................................................................................................................... 32
Screening ............................................................................................................................................... 34
Behandeling van intoxicaties................................................................................................................. 34
Paracetamol intoxicatie......................................................................................................................... 35
Benzodiazepinen intoxicatie ................................................................................................................. 36
Tricyclische antidepressiva intoxicatie .................................................................................................. 37
Alcoholen intoxicatie ............................................................................................................................. 37
Thema 3; Medicatieoverdracht in de keten......................................................................................... 40
Medicatieverificatie vs. Medicatiebeoordeling......................................................................................... 40
Pagina 2 van 87
,FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Medicatieoverdracht ................................................................................................................................. 41
Risico-inschatting ...................................................................................................................................... 41
LSP ............................................................................................................................................................. 42
Opname en ontslag gesprek...................................................................................................................... 42
Conclusie ................................................................................................................................................... 42
Thema 4; Infectieziekten.................................................................................................................... 43
Bacteriën ................................................................................................................................................... 43
Antibiotica ................................................................................................................................................. 43
Beta-lactam antibiotica ......................................................................................................................... 45
Aminoglycosiden ................................................................................................................................... 47
Tetracyclines.......................................................................................................................................... 47
Macroliden ............................................................................................................................................ 47
Sulfonamiden (+trimethoprim) ............................................................................................................. 48
Chinolonen ............................................................................................................................................ 48
Glycopeptiden ....................................................................................................................................... 48
Metronidazol ......................................................................................................................................... 48
Tubercolose-middelen (tuberculostatica) ............................................................................................. 48
Antimycotica ............................................................................................................................................. 49
Indeling en toepassing........................................................................................................................... 49
Virussen & antivirale middelen ................................................................................................................. 49
Resistentie ................................................................................................................................................. 50
Mechanismen van resistentie ............................................................................................................... 51
Algemene strategie antibioticumbeleid .................................................................................................... 52
Reserve antibiotica .................................................................................................................................... 53
Pneumonie beleid SWAB........................................................................................................................... 53
Definitie ................................................................................................................................................. 53
Oorzaak ................................................................................................................................................. 53
Classificatie ............................................................................................................................................ 53
Diagnostiek ............................................................................................................................................ 53
Behandeling........................................................................................................................................... 54
Urineweginfectie beleid NHG .................................................................................................................... 59
Thema 5; Radiofarmacie & Cytostatica ............................................................................................... 61
Radiofarmaca ............................................................................................................................................ 61
Radioactiviteit basics ................................................................................................................................. 61
Radiofarmaca bij onderzoeken ................................................................................................................. 61
Single photon emission CT (SPECT) ....................................................................................................... 62
Positron emissive tomografie (PET ) ..................................................................................................... 63
Therapeutische radiofarmaca ................................................................................................................... 63
Verantwoordelijkheden radiofarmaceut .................................................................................................. 64
Pagina 3 van 87
, FA-MA202 Klinische Farmacie, Samenvatting M. de Leeuw
Radiochemie .............................................................................................................................................. 64
Radiochemie technetium ...................................................................................................................... 64
Tc-99m generator en labeling farmacon ............................................................................................... 64
Cyclotron ............................................................................................................................................... 65
Fluor-18 / FDG ....................................................................................................................................... 66
Gallium-68 (Ga-68) ................................................................................................................................ 66
Bereiding radiofarmaca vs. Cytostatica ..................................................................................................... 67
Radiofarmaca ........................................................................................................................................ 67
Cytostatica ........................................................................................ Fout! Bladwijzer niet gedefinieerd.
Thema 6; Voeding en geneesmiddelen + toediening-systemen ............................................................ 68
Soorten sondes.......................................................................................................................................... 69
Sondevoeding ............................................................................................................................................ 69
Geneesmiddelen over de sonde................................................................................................................ 70
Medicatiereview bij een patiënt met een sonde ...................................................................................... 71
Totaal parenterale voeding ....................................................................................................................... 75
Koolhydraten ......................................................................................................................................... 75
Eiwitten ................................................................................................................................................. 75
Vetten .................................................................................................................................................... 76
Wie, Wanneer, Welke TPV ........................................................................................................................ 77
Refeeding syndrome ............................................................................................................................. 77
Perifere lijnen en lokale complicaties ....................................................................................................... 78
Extravasatie ........................................................................................................................................... 78
Centrale-veneuze lijnen (CVC) ................................................................................................................... 80
Soorten centrale lijnen .......................................................................................................................... 81
Complicaties centrale lijnen .................................................................................................................. 81
Thema 7; Klinische Geneesmiddelenonderzoek & ethiek .................................................................... 82
Historie ...................................................................................................................................................... 82
Toetsing medisch-wetenschappelijk onderzoek ....................................................................................... 82
De organisatie van toetsing ....................................................................................................................... 83
Definitie geneesmiddelenonderzoek ........................................................................................................ 84
IMP vs non-IMP ......................................................................................................................................... 84
Regelgeving KGO ....................................................................................................................................... 84
Medicatiebewaking ................................................................................................................................... 85
Drug accountability ................................................................................................................................... 85
Vragen werkcollege ................................................................................................................................... 85
Pagina 4 van 87
