GESPECIALISEERDE TOEGEPASTE
FARMACOLOGIE
INHOUD
1. Farmacokinetiek ..............................................................................................................................7
1.1 Inleiding .....................................................................................................................................7
1.2 Farmacokinetische veranderingen tijdens zwangerschap ..............................................................7
1.2.1 Absorptie .............................................................................................................................7
1.2.2 Distributie ............................................................................................................................8
1.2.3 Metabolisatie (biotransformatie) ...........................................................................................9
1.2.4 Eliminatie .............................................................................................................................9
1.3 Farmacokinetische kwetsbaarheid ............................................................................................ 10
1.3.1 Kiem (bevruchte eicel) ........................................................................................................ 10
1.3.2 Embryo .............................................................................................................................. 10
1.3.3 Foetus ............................................................................................................................... 10
1.4 Teratogenese ............................................................................................................................ 10
1.5 GM gebruik bij borstvoeding....................................................................................................... 11
2. GM voor bloed, hart- & vaatstelsel ................................................................................................... 12
2.1 Inleiding ................................................................................................................................... 12
2.1.1 Hart- & bloedvatenstelsel staat oiv autonoom zenuwstelsel .................................................. 12
2.2 GM voor hartfalen ..................................................................................................................... 12
2.3 Anti-angina pectoris GM ............................................................................................................ 13
2.4 Anti-aritmica............................................................................................................................. 13
2.5 Antihypertensiva ....................................................................................................................... 13
2.5.1 GM die inwerken op RAAS ................................................................................................... 14
2.5.2 Diuretica ............................................................................................................................ 14
2.6 GM bij hypotensie ..................................................................................................................... 14
2.7 Hypolipemiërende GM .............................................................................................................. 15
2.8 Veno- & capillarotropica ............................................................................................................ 15
2.9 GM die inwerken op bloedstolling .............................................................................................. 15
2.9.1 Antitrombotica ................................................................................................................... 15
2.9.2 Antihemorragica ................................................................................................................. 16
2.10 GM voor hematopoëse ............................................................................................................ 16
3. GM voor gastro-intestinaalstelsel .................................................................................................... 17
3.1 Inleiding ................................................................................................................................... 17
1
Gespecialiseerde toegepaste farmacologie
, 3.2 GM voor maag- & duodenum pathologie ..................................................................................... 17
3.2.1 Maagzuursecretie-inhibitoren.............................................................................................. 17
3.2.2 Antacida ............................................................................................................................ 17
3.2.3 AB bij helicobacter pylori ..................................................................................................... 17
3.3 Spasmolytica ............................................................................................................................ 17
3.4 GM voor lever, galblaas & pancreas............................................................................................ 18
3.5 Anti-emetica ............................................................................................................................. 18
3.5.1 Gastroprokinetica ............................................................................................................... 18
3.5.2 Serotonine antagonisten ..................................................................................................... 18
3.6 Laxativa .................................................................................................................................... 19
3.7 Anti-diarreïca ............................................................................................................................ 19
3.8 GM bij inflammatoir darmlijden .................................................................................................. 19
3.9 Darm ontsmettende GM ............................................................................................................ 19
3.10 GM bij hemorroïden ................................................................................................................. 19
4. GM voor hormonaal stelsel & anticonceptie ..................................................................................... 20
4.1 Inleiding ................................................................................................................................... 20
4.1.1 Hormonen .......................................................................................................................... 20
4.1.2 Contraceptie ...................................................................................................................... 20
4.2 combinatie preparaten .............................................................................................................. 20
4.2.1 Combinatie pil (COC) .......................................................................................................... 20
4.2.2 Combinatie preparaten: andere ........................................................................................... 20
4.2.3 Combinatie preparaten: indicaties ...................................................................................... 21
4.2.4 Combinatie preparaten: contra-indicaties ........................................................................... 21
4.2.5 Combinatie preparaten: neveneffecten ................................................................................ 21
4.3 Progesteron only pill (POP) ........................................................................................................ 21
4.3.1 Progesteron only pill: voordelen........................................................................................... 22
4.4 Intra-uteriene contraceptie ........................................................................................................ 22
4.4.1 Levonorgestrel spiralen ....................................................................................................... 22
4.4.2 Koperspiralen ..................................................................................................................... 22
4.4.3 Welke spiraal? .................................................................................................................... 22
4.4.4 Plaatsing spiraal ................................................................................................................. 22
4.5 Noodanticonceptie ................................................................................................................... 23
4.6 Anti-progestageen..................................................................................................................... 23
4.7 Gonadotrofine-releasing hormoon ............................................................................................. 23
4.7.1 Gn-RH: indicaties ............................................................................................................... 23
4.8 Dopamine-agonisten................................................................................................................. 23
4.9 Hormoon substitutie therapie .................................................................................................... 24
2
Gespecialiseerde toegepaste farmacologie
, 4.9.1 Hormoontherapie: mogelijke nadelen .................................................................................. 24
4.9.2 Hormoontherapie: voordelen .............................................................................................. 24
5. GM voor AH-stelsel......................................................................................................................... 25
5.1 Inleiding ................................................................................................................................... 25
5.2 GM bij astma & COPD ............................................................................................................... 25
5.2.1 Astmabehandelin tijdens zwangerschap .............................................................................. 26
5.3 Antitussiva, mucolytica & expectorantia ..................................................................................... 26
5.4 GM voor rhinitis & sinusitis ........................................................................................................ 26
5.5 GM bij allergie ........................................................................................................................... 26
6. Algemene anesthesie tijdens zwangerschap .................................................................................... 27
6.1 Inleiding ................................................................................................................................... 27
6.1.1 Geschiedenis ..................................................................................................................... 27
6.1.2 Algemene houding algemene anesthesie tijdens zwangerschap ............................................ 27
6.2 Anesthesie ............................................................................................................................... 27
6.2.1 Medicatie algemene anesthesie .......................................................................................... 27
6.2.2 Intubatie & beademing ........................................................................................................ 29
6.2.3 Regionale anesthesie .......................................................................................................... 30
6.2.4 Noodmedicatie .................................................................................................................. 30
6.3 Aandachtspunten tijdens zwangerschap .................................................................................... 31
6.3.1 Fysiologische veranderingen tijdens zwangerschap .............................................................. 31
6.3.2 Pre-operatieve voorbereiding .............................................................................................. 32
6.3.3 Aanpassingen algemene anesthesie .................................................................................... 32
6.3.4 Post-operatieve aandachtspunten ....................................................................................... 34
7. Pijnstillers & ontstekingsremmende middelen ................................................................................. 35
7.1 Inleiding ................................................................................................................................... 35
7.1.1 Ontstekingsreactie ............................................................................................................. 35
7.1.2 Pijn .................................................................................................................................... 35
7.2 Ontstekingsremmende middelen ............................................................................................... 36
7.3 Pijnbehandeling ........................................................................................................................ 36
7.3.1 Niet-medicamenteuze middelen ......................................................................................... 36
7.3.2 Analgetica .......................................................................................................................... 36
8. GM voor zenuwstelsel..................................................................................................................... 38
8.1 Inleiding ................................................................................................................................... 38
8.2 Psychofarmaca ......................................................................................................................... 38
8.2.1 Algemeen ........................................................................................................................... 38
8.2.2 Hypnotica, anxiolytica, sedativa .......................................................................................... 39
8.2.3 Antidepressiva ................................................................................................................... 40
3
Gespecialiseerde toegepaste farmacologie
, 8.2.4 ECT .................................................................................................................................... 40
8.2.5 Antipsychotica ................................................................................................................... 41
8.2.6 Lithium .............................................................................................................................. 42
8.2.7 Centrale stimulantia ........................................................................................................... 42
8.3 Specifieke aandoeningen van het zenuwstelsel .......................................................................... 42
8.3.1 Epilepsie ............................................................................................................................ 42
8.3.2 Migraine ............................................................................................................................. 43
8.3.3 Ziekte van Parkinson ........................................................................................................... 43
8.3.4 MS ..................................................................................................................................... 43
9. Juridische aspecten van voorschrijfrecht ......................................................................................... 44
9.1 Gezondheidsrecht .................................................................................................................... 44
9.1.1 WUG .................................................................................................................................. 44
9.1.2 Koninklijk besluit ................................................................................................................ 44
9.1.3 Kwaliteitswet ...................................................................................................................... 44
9.2 Sociale zekerheid ...................................................................................................................... 45
9.3 Aansprakelijkheid ..................................................................................................................... 45
9.3.1 Strafrechtelijke aansprakelijkheid ........................................................................................ 45
9.3.2 Burgerrechtelijke aansprakelijkheid ..................................................................................... 45
10. Medicatiegebruik tijdens de lactatieperiode ................................................................................... 46
10.1 Pijnstilling ............................................................................................................................... 46
10.2 Antibiotica .............................................................................................................................. 46
10.3 Bloedverdunners..................................................................................................................... 46
10.4 Bloeddrukverlagende middelen ............................................................................................... 46
10.5 Medicatie ivm diabetes & suikerspiegel .................................................................................... 46
10.6 Maagzuur, diarree & constipatie ............................................................................................... 46
10.7 Lokale preparaten ................................................................................................................... 46
10.8 Psychofarmaca ....................................................................................................................... 47
10.8.1 Antidepressiva .................................................................................................................. 47
10.8.2 Benzodiazepines & slaapmiddelen .................................................................................... 47
10.8.3 Anti-epileptica .................................................................................................................. 47
10.8.4 Lithium............................................................................................................................. 47
10.9 Anticonceptie ......................................................................................................................... 47
10.10 Varia ..................................................................................................................................... 47
11. Modulatoren van de uteriene contractie......................................................................................... 48
11.1 Inleiding ................................................................................................................................. 48
11.2 Oxytocica ............................................................................................................................... 48
11.3 Tocolytica ............................................................................................................................... 49
4
Gespecialiseerde toegepaste farmacologie
FARMACOLOGIE
INHOUD
1. Farmacokinetiek ..............................................................................................................................7
1.1 Inleiding .....................................................................................................................................7
1.2 Farmacokinetische veranderingen tijdens zwangerschap ..............................................................7
1.2.1 Absorptie .............................................................................................................................7
1.2.2 Distributie ............................................................................................................................8
1.2.3 Metabolisatie (biotransformatie) ...........................................................................................9
1.2.4 Eliminatie .............................................................................................................................9
1.3 Farmacokinetische kwetsbaarheid ............................................................................................ 10
1.3.1 Kiem (bevruchte eicel) ........................................................................................................ 10
1.3.2 Embryo .............................................................................................................................. 10
1.3.3 Foetus ............................................................................................................................... 10
1.4 Teratogenese ............................................................................................................................ 10
1.5 GM gebruik bij borstvoeding....................................................................................................... 11
2. GM voor bloed, hart- & vaatstelsel ................................................................................................... 12
2.1 Inleiding ................................................................................................................................... 12
2.1.1 Hart- & bloedvatenstelsel staat oiv autonoom zenuwstelsel .................................................. 12
2.2 GM voor hartfalen ..................................................................................................................... 12
2.3 Anti-angina pectoris GM ............................................................................................................ 13
2.4 Anti-aritmica............................................................................................................................. 13
2.5 Antihypertensiva ....................................................................................................................... 13
2.5.1 GM die inwerken op RAAS ................................................................................................... 14
2.5.2 Diuretica ............................................................................................................................ 14
2.6 GM bij hypotensie ..................................................................................................................... 14
2.7 Hypolipemiërende GM .............................................................................................................. 15
2.8 Veno- & capillarotropica ............................................................................................................ 15
2.9 GM die inwerken op bloedstolling .............................................................................................. 15
2.9.1 Antitrombotica ................................................................................................................... 15
2.9.2 Antihemorragica ................................................................................................................. 16
2.10 GM voor hematopoëse ............................................................................................................ 16
3. GM voor gastro-intestinaalstelsel .................................................................................................... 17
3.1 Inleiding ................................................................................................................................... 17
1
Gespecialiseerde toegepaste farmacologie
, 3.2 GM voor maag- & duodenum pathologie ..................................................................................... 17
3.2.1 Maagzuursecretie-inhibitoren.............................................................................................. 17
3.2.2 Antacida ............................................................................................................................ 17
3.2.3 AB bij helicobacter pylori ..................................................................................................... 17
3.3 Spasmolytica ............................................................................................................................ 17
3.4 GM voor lever, galblaas & pancreas............................................................................................ 18
3.5 Anti-emetica ............................................................................................................................. 18
3.5.1 Gastroprokinetica ............................................................................................................... 18
3.5.2 Serotonine antagonisten ..................................................................................................... 18
3.6 Laxativa .................................................................................................................................... 19
3.7 Anti-diarreïca ............................................................................................................................ 19
3.8 GM bij inflammatoir darmlijden .................................................................................................. 19
3.9 Darm ontsmettende GM ............................................................................................................ 19
3.10 GM bij hemorroïden ................................................................................................................. 19
4. GM voor hormonaal stelsel & anticonceptie ..................................................................................... 20
4.1 Inleiding ................................................................................................................................... 20
4.1.1 Hormonen .......................................................................................................................... 20
4.1.2 Contraceptie ...................................................................................................................... 20
4.2 combinatie preparaten .............................................................................................................. 20
4.2.1 Combinatie pil (COC) .......................................................................................................... 20
4.2.2 Combinatie preparaten: andere ........................................................................................... 20
4.2.3 Combinatie preparaten: indicaties ...................................................................................... 21
4.2.4 Combinatie preparaten: contra-indicaties ........................................................................... 21
4.2.5 Combinatie preparaten: neveneffecten ................................................................................ 21
4.3 Progesteron only pill (POP) ........................................................................................................ 21
4.3.1 Progesteron only pill: voordelen........................................................................................... 22
4.4 Intra-uteriene contraceptie ........................................................................................................ 22
4.4.1 Levonorgestrel spiralen ....................................................................................................... 22
4.4.2 Koperspiralen ..................................................................................................................... 22
4.4.3 Welke spiraal? .................................................................................................................... 22
4.4.4 Plaatsing spiraal ................................................................................................................. 22
4.5 Noodanticonceptie ................................................................................................................... 23
4.6 Anti-progestageen..................................................................................................................... 23
4.7 Gonadotrofine-releasing hormoon ............................................................................................. 23
4.7.1 Gn-RH: indicaties ............................................................................................................... 23
4.8 Dopamine-agonisten................................................................................................................. 23
4.9 Hormoon substitutie therapie .................................................................................................... 24
2
Gespecialiseerde toegepaste farmacologie
, 4.9.1 Hormoontherapie: mogelijke nadelen .................................................................................. 24
4.9.2 Hormoontherapie: voordelen .............................................................................................. 24
5. GM voor AH-stelsel......................................................................................................................... 25
5.1 Inleiding ................................................................................................................................... 25
5.2 GM bij astma & COPD ............................................................................................................... 25
5.2.1 Astmabehandelin tijdens zwangerschap .............................................................................. 26
5.3 Antitussiva, mucolytica & expectorantia ..................................................................................... 26
5.4 GM voor rhinitis & sinusitis ........................................................................................................ 26
5.5 GM bij allergie ........................................................................................................................... 26
6. Algemene anesthesie tijdens zwangerschap .................................................................................... 27
6.1 Inleiding ................................................................................................................................... 27
6.1.1 Geschiedenis ..................................................................................................................... 27
6.1.2 Algemene houding algemene anesthesie tijdens zwangerschap ............................................ 27
6.2 Anesthesie ............................................................................................................................... 27
6.2.1 Medicatie algemene anesthesie .......................................................................................... 27
6.2.2 Intubatie & beademing ........................................................................................................ 29
6.2.3 Regionale anesthesie .......................................................................................................... 30
6.2.4 Noodmedicatie .................................................................................................................. 30
6.3 Aandachtspunten tijdens zwangerschap .................................................................................... 31
6.3.1 Fysiologische veranderingen tijdens zwangerschap .............................................................. 31
6.3.2 Pre-operatieve voorbereiding .............................................................................................. 32
6.3.3 Aanpassingen algemene anesthesie .................................................................................... 32
6.3.4 Post-operatieve aandachtspunten ....................................................................................... 34
7. Pijnstillers & ontstekingsremmende middelen ................................................................................. 35
7.1 Inleiding ................................................................................................................................... 35
7.1.1 Ontstekingsreactie ............................................................................................................. 35
7.1.2 Pijn .................................................................................................................................... 35
7.2 Ontstekingsremmende middelen ............................................................................................... 36
7.3 Pijnbehandeling ........................................................................................................................ 36
7.3.1 Niet-medicamenteuze middelen ......................................................................................... 36
7.3.2 Analgetica .......................................................................................................................... 36
8. GM voor zenuwstelsel..................................................................................................................... 38
8.1 Inleiding ................................................................................................................................... 38
8.2 Psychofarmaca ......................................................................................................................... 38
8.2.1 Algemeen ........................................................................................................................... 38
8.2.2 Hypnotica, anxiolytica, sedativa .......................................................................................... 39
8.2.3 Antidepressiva ................................................................................................................... 40
3
Gespecialiseerde toegepaste farmacologie
, 8.2.4 ECT .................................................................................................................................... 40
8.2.5 Antipsychotica ................................................................................................................... 41
8.2.6 Lithium .............................................................................................................................. 42
8.2.7 Centrale stimulantia ........................................................................................................... 42
8.3 Specifieke aandoeningen van het zenuwstelsel .......................................................................... 42
8.3.1 Epilepsie ............................................................................................................................ 42
8.3.2 Migraine ............................................................................................................................. 43
8.3.3 Ziekte van Parkinson ........................................................................................................... 43
8.3.4 MS ..................................................................................................................................... 43
9. Juridische aspecten van voorschrijfrecht ......................................................................................... 44
9.1 Gezondheidsrecht .................................................................................................................... 44
9.1.1 WUG .................................................................................................................................. 44
9.1.2 Koninklijk besluit ................................................................................................................ 44
9.1.3 Kwaliteitswet ...................................................................................................................... 44
9.2 Sociale zekerheid ...................................................................................................................... 45
9.3 Aansprakelijkheid ..................................................................................................................... 45
9.3.1 Strafrechtelijke aansprakelijkheid ........................................................................................ 45
9.3.2 Burgerrechtelijke aansprakelijkheid ..................................................................................... 45
10. Medicatiegebruik tijdens de lactatieperiode ................................................................................... 46
10.1 Pijnstilling ............................................................................................................................... 46
10.2 Antibiotica .............................................................................................................................. 46
10.3 Bloedverdunners..................................................................................................................... 46
10.4 Bloeddrukverlagende middelen ............................................................................................... 46
10.5 Medicatie ivm diabetes & suikerspiegel .................................................................................... 46
10.6 Maagzuur, diarree & constipatie ............................................................................................... 46
10.7 Lokale preparaten ................................................................................................................... 46
10.8 Psychofarmaca ....................................................................................................................... 47
10.8.1 Antidepressiva .................................................................................................................. 47
10.8.2 Benzodiazepines & slaapmiddelen .................................................................................... 47
10.8.3 Anti-epileptica .................................................................................................................. 47
10.8.4 Lithium............................................................................................................................. 47
10.9 Anticonceptie ......................................................................................................................... 47
10.10 Varia ..................................................................................................................................... 47
11. Modulatoren van de uteriene contractie......................................................................................... 48
11.1 Inleiding ................................................................................................................................. 48
11.2 Oxytocica ............................................................................................................................... 48
11.3 Tocolytica ............................................................................................................................... 49
4
Gespecialiseerde toegepaste farmacologie
