FARMACOLOGIE
INHOUD
1. Inleiding: het geneesmiddel, herkomst en ontstaan van geneesmiddelen ............................................5
1.1 Ontdekking & herkomst ...............................................................................................................5
1.1.1 Ontdekking ...........................................................................................................................5
1.1.2 Herkomst .............................................................................................................................5
1.2 Ontwikkeling ...............................................................................................................................5
1.2.1 Preklinische fase ..................................................................................................................5
1.2.2 Klinische fasen .....................................................................................................................5
1.3 Placebo ......................................................................................................................................6
1.4 Homeopathie..............................................................................................................................6
1.5 Kruidengeneesmiddelen..............................................................................................................6
1.6 Wettelijke bepaling .....................................................................................................................6
1.7 Voorschriften ..............................................................................................................................6
1.8 Terugbetalingsmodaliteiten .........................................................................................................7
1.9 Werking ......................................................................................................................................7
1.10 Naamgeving ..............................................................................................................................7
1.11 Toedieningsvormen ...................................................................................................................7
1.11.1 Poeder ...............................................................................................................................7
1.11.2 Tablet & comprimé .............................................................................................................8
1.11.3 Capsule .............................................................................................................................8
1.11.4 Oplossing, suspensie & emulsie ..........................................................................................8
1.11.5 Druppels ............................................................................................................................8
1.11.6 Infuus & injectievloeistoffen ................................................................................................8
1.11.7 Zalf, crème, pasta & gel .......................................................................................................8
1.11.8 Transdermaal therapeutisch sysyteem ................................................................................8
1.11.9 Zetpil, ovule & klysma .........................................................................................................8
1.11.10 Implantaten ......................................................................................................................8
1.12 Toedieningswijze .......................................................................................................................8
1.12.1 Voor plaatselijke werking .....................................................................................................8
1.12.2 Voor systematische werking ................................................................................................8
1.12.3 Bijzondere lokale toedieningswijzen .....................................................................................9
2. Werken met het geneesmiddelrepertorium ...................................................................................... 10
2.1 Het BCFI ................................................................................................................................... 10
2.2 Werken met geneesmiddelrepertorium van BCFI ........................................................................ 10
2.2.1 Symbolen ........................................................................................................................... 11
2.2.2 VOS-groepen ...................................................................................................................... 11
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,FARMACOLOGIE
2.2.3 No switch ........................................................................................................................... 11
3. Placenta en gezondheid .................................................................................................................. 12
3.1 Geschiedenis ........................................................................................................................... 12
3.2 Fascinerend orgaan .................................................................................................................. 12
3.2.1 Placentaire barrière ............................................................................................................ 12
3.3 Hypothese over foetale oorsprong ............................................................................................. 12
3.4 Nederlandse hongersnood ........................................................................................................ 12
3.5 Hypothese van thrifty fenotype .................................................................................................. 13
3.6 Ontwikkelingsoorsprong gezondheid & ziekte ............................................................................. 13
3.7 Luchtvervuiling ......................................................................................................................... 13
3.8 ENVIRONAGE Birth Cohort ........................................................................................................ 13
3.8.1 Deel 1 – Set up .................................................................................................................... 13
3.8.2 Deel 2 – Luchtvervuiling & gezondheid pasgeborenen ........................................................... 14
3.8.3 Deel 3 – Luchtvervuiling & gezondheid kinderen .................................................................... 14
3.9 Luchtvervuiling & borstvoeding .................................................................................................. 15
3.10 Tabaksrook & gezondheid pasgeborenen .................................................................................. 15
3.11 Taak van de vroedvrouw .......................................................................................................... 16
4. Toxicologie en teratoloie ................................................................................................................. 17
4.1 Definitie toxicologie .................................................................................................................. 17
4.2 Soorten toxische stoffen ............................................................................................................ 17
4.3 The dosis makes the poison ....................................................................................................... 17
4.4 Andere factoren ........................................................................................................................ 17
4.5 Toxicokinetiek – Toxicodynamiek ............................................................................................... 17
4.6 Toxiciteit................................................................................................................................... 18
4.7 Dosis-respons .......................................................................................................................... 18
4.8 Farmacologie – Teratologie ........................................................................................................ 18
4.8.1 Farmacologie ..................................................................................................................... 18
4.8.2 Teratologie ......................................................................................................................... 18
4.9 Toxicologie van enkele genotsmiddelen ..................................................................................... 18
4.9.1 Alcohol .............................................................................................................................. 19
4.9.2 Roken ................................................................................................................................ 19
4.9.3 Caffeïne ............................................................................................................................. 20
4.9.4 Drugs ................................................................................................................................. 20
5. Farmacologische processen ........................................................................................................... 22
5.1 Definitie farmacologie ............................................................................................................... 22
5.2 Farmaceutiek ........................................................................................................................... 22
5.3 Farmacokinetiek ....................................................................................................................... 22
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,FARMACOLOGIE
5.3.1 Absorptie ........................................................................................................................... 22
5.3.2 Distributie .......................................................................................................................... 23
5.3.3 Metabolisatie ..................................................................................................................... 24
5.3.4 Eliminatie ........................................................................................................................... 24
5.4 Farmacodynamiek .................................................................................................................... 25
5.4.1 Receptoren ........................................................................................................................ 25
5.4.2 Enzymen ............................................................................................................................ 26
5.4.3 Ion kanalen ........................................................................................................................ 26
5.4.4 Overige transporteiwitten .................................................................................................... 26
5.4.5 DNA ................................................................................................................................... 26
5.5 Bijwerkingen – intoxicatieverschijnselen – interacties.................................................................. 26
5.5.1 Specifieke bijwerkingen ...................................................................................................... 26
5.5.2 Aspecifieke bijwerkingen ..................................................................................................... 26
5.5.3 Intoxicatieverschijnselen .................................................................................................... 27
5.5.4 Interacties .......................................................................................................................... 27
6. Toepassing farmacologische processen .......................................................................................... 28
6.1 Toepassingen farmacokinetiek .................................................................................................. 28
6.2 Plasmaconcentratie-tijd curve ................................................................................................... 28
6.2.1 Bij éénmalige PO toediening ................................................................................................ 28
6.2.2 Bij continue toediening ....................................................................................................... 29
6.2.3 Bij herhaalde toediening ...................................................................................................... 29
6.2.4 Formularium ...................................................................................................................... 30
6.3 Geneesmiddel interactie – metabolisatie ................................................................................... 30
7. Medicatie en borstvoeding .............................................................................................................. 31
7.1 Farmacokinetiek & farmacodynamiek ........................................................................................ 31
7.1.1 Farmacokinetiek ................................................................................................................. 31
7.1.2 Farmacodynamiek .............................................................................................................. 31
7.2 Invloed van middelen op melkproductie ..................................................................................... 31
7.2.1 Dopamine agonisten & antagonisten ................................................................................... 31
7.2.2 Andere geneesmiddelen ..................................................................................................... 32
7.2.3 Medicatie & vaccinatie ........................................................................................................ 32
7.3 Overdracht van middelen naar moedermelk ............................................................................... 32
7.3.1 Epidemiologie medicatiegebruik tijdens lactatie ................................................................... 32
7.3.2 Medicatiegebruik tijdens lactatie ......................................................................................... 32
7.3.3 Overdracht van geneesmiddel naar moedermelk .................................................................. 33
7.3.4 Effect bij zuigeling ............................................................................................................... 33
7.3.5 Samengevat ....................................................................................................................... 34
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, FARMACOLOGIE
7.4 Fytotherapie vs homeopathie .................................................................................................... 34
4
INHOUD
1. Inleiding: het geneesmiddel, herkomst en ontstaan van geneesmiddelen ............................................5
1.1 Ontdekking & herkomst ...............................................................................................................5
1.1.1 Ontdekking ...........................................................................................................................5
1.1.2 Herkomst .............................................................................................................................5
1.2 Ontwikkeling ...............................................................................................................................5
1.2.1 Preklinische fase ..................................................................................................................5
1.2.2 Klinische fasen .....................................................................................................................5
1.3 Placebo ......................................................................................................................................6
1.4 Homeopathie..............................................................................................................................6
1.5 Kruidengeneesmiddelen..............................................................................................................6
1.6 Wettelijke bepaling .....................................................................................................................6
1.7 Voorschriften ..............................................................................................................................6
1.8 Terugbetalingsmodaliteiten .........................................................................................................7
1.9 Werking ......................................................................................................................................7
1.10 Naamgeving ..............................................................................................................................7
1.11 Toedieningsvormen ...................................................................................................................7
1.11.1 Poeder ...............................................................................................................................7
1.11.2 Tablet & comprimé .............................................................................................................8
1.11.3 Capsule .............................................................................................................................8
1.11.4 Oplossing, suspensie & emulsie ..........................................................................................8
1.11.5 Druppels ............................................................................................................................8
1.11.6 Infuus & injectievloeistoffen ................................................................................................8
1.11.7 Zalf, crème, pasta & gel .......................................................................................................8
1.11.8 Transdermaal therapeutisch sysyteem ................................................................................8
1.11.9 Zetpil, ovule & klysma .........................................................................................................8
1.11.10 Implantaten ......................................................................................................................8
1.12 Toedieningswijze .......................................................................................................................8
1.12.1 Voor plaatselijke werking .....................................................................................................8
1.12.2 Voor systematische werking ................................................................................................8
1.12.3 Bijzondere lokale toedieningswijzen .....................................................................................9
2. Werken met het geneesmiddelrepertorium ...................................................................................... 10
2.1 Het BCFI ................................................................................................................................... 10
2.2 Werken met geneesmiddelrepertorium van BCFI ........................................................................ 10
2.2.1 Symbolen ........................................................................................................................... 11
2.2.2 VOS-groepen ...................................................................................................................... 11
1
,FARMACOLOGIE
2.2.3 No switch ........................................................................................................................... 11
3. Placenta en gezondheid .................................................................................................................. 12
3.1 Geschiedenis ........................................................................................................................... 12
3.2 Fascinerend orgaan .................................................................................................................. 12
3.2.1 Placentaire barrière ............................................................................................................ 12
3.3 Hypothese over foetale oorsprong ............................................................................................. 12
3.4 Nederlandse hongersnood ........................................................................................................ 12
3.5 Hypothese van thrifty fenotype .................................................................................................. 13
3.6 Ontwikkelingsoorsprong gezondheid & ziekte ............................................................................. 13
3.7 Luchtvervuiling ......................................................................................................................... 13
3.8 ENVIRONAGE Birth Cohort ........................................................................................................ 13
3.8.1 Deel 1 – Set up .................................................................................................................... 13
3.8.2 Deel 2 – Luchtvervuiling & gezondheid pasgeborenen ........................................................... 14
3.8.3 Deel 3 – Luchtvervuiling & gezondheid kinderen .................................................................... 14
3.9 Luchtvervuiling & borstvoeding .................................................................................................. 15
3.10 Tabaksrook & gezondheid pasgeborenen .................................................................................. 15
3.11 Taak van de vroedvrouw .......................................................................................................... 16
4. Toxicologie en teratoloie ................................................................................................................. 17
4.1 Definitie toxicologie .................................................................................................................. 17
4.2 Soorten toxische stoffen ............................................................................................................ 17
4.3 The dosis makes the poison ....................................................................................................... 17
4.4 Andere factoren ........................................................................................................................ 17
4.5 Toxicokinetiek – Toxicodynamiek ............................................................................................... 17
4.6 Toxiciteit................................................................................................................................... 18
4.7 Dosis-respons .......................................................................................................................... 18
4.8 Farmacologie – Teratologie ........................................................................................................ 18
4.8.1 Farmacologie ..................................................................................................................... 18
4.8.2 Teratologie ......................................................................................................................... 18
4.9 Toxicologie van enkele genotsmiddelen ..................................................................................... 18
4.9.1 Alcohol .............................................................................................................................. 19
4.9.2 Roken ................................................................................................................................ 19
4.9.3 Caffeïne ............................................................................................................................. 20
4.9.4 Drugs ................................................................................................................................. 20
5. Farmacologische processen ........................................................................................................... 22
5.1 Definitie farmacologie ............................................................................................................... 22
5.2 Farmaceutiek ........................................................................................................................... 22
5.3 Farmacokinetiek ....................................................................................................................... 22
2
,FARMACOLOGIE
5.3.1 Absorptie ........................................................................................................................... 22
5.3.2 Distributie .......................................................................................................................... 23
5.3.3 Metabolisatie ..................................................................................................................... 24
5.3.4 Eliminatie ........................................................................................................................... 24
5.4 Farmacodynamiek .................................................................................................................... 25
5.4.1 Receptoren ........................................................................................................................ 25
5.4.2 Enzymen ............................................................................................................................ 26
5.4.3 Ion kanalen ........................................................................................................................ 26
5.4.4 Overige transporteiwitten .................................................................................................... 26
5.4.5 DNA ................................................................................................................................... 26
5.5 Bijwerkingen – intoxicatieverschijnselen – interacties.................................................................. 26
5.5.1 Specifieke bijwerkingen ...................................................................................................... 26
5.5.2 Aspecifieke bijwerkingen ..................................................................................................... 26
5.5.3 Intoxicatieverschijnselen .................................................................................................... 27
5.5.4 Interacties .......................................................................................................................... 27
6. Toepassing farmacologische processen .......................................................................................... 28
6.1 Toepassingen farmacokinetiek .................................................................................................. 28
6.2 Plasmaconcentratie-tijd curve ................................................................................................... 28
6.2.1 Bij éénmalige PO toediening ................................................................................................ 28
6.2.2 Bij continue toediening ....................................................................................................... 29
6.2.3 Bij herhaalde toediening ...................................................................................................... 29
6.2.4 Formularium ...................................................................................................................... 30
6.3 Geneesmiddel interactie – metabolisatie ................................................................................... 30
7. Medicatie en borstvoeding .............................................................................................................. 31
7.1 Farmacokinetiek & farmacodynamiek ........................................................................................ 31
7.1.1 Farmacokinetiek ................................................................................................................. 31
7.1.2 Farmacodynamiek .............................................................................................................. 31
7.2 Invloed van middelen op melkproductie ..................................................................................... 31
7.2.1 Dopamine agonisten & antagonisten ................................................................................... 31
7.2.2 Andere geneesmiddelen ..................................................................................................... 32
7.2.3 Medicatie & vaccinatie ........................................................................................................ 32
7.3 Overdracht van middelen naar moedermelk ............................................................................... 32
7.3.1 Epidemiologie medicatiegebruik tijdens lactatie ................................................................... 32
7.3.2 Medicatiegebruik tijdens lactatie ......................................................................................... 32
7.3.3 Overdracht van geneesmiddel naar moedermelk .................................................................. 33
7.3.4 Effect bij zuigeling ............................................................................................................... 33
7.3.5 Samengevat ....................................................................................................................... 34
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, FARMACOLOGIE
7.4 Fytotherapie vs homeopathie .................................................................................................... 34
4
