DEEL II: FARMACOKINETIEK
EN FARMACODYNAMIEK
,INHOUDSOPGAVE
1. ANTIBACTERIËLE MIDDELEN...................................................................................................... 4
a. 𝛽-lactam antibiotica ................................................................................................................. 4
B. macroliden ................................................................................................................................. 4
C. tetracyclines............................................................................................................................... 5
D. clindamycine en lincomycine ...................................................................................................... 5
E. chinolonen (= fluoroquinolones) ................................................................................................... 5
F. sulfonamiden .............................................................................................................................. 6
G. urinaire antibacteriele middelen .................................................................................................. 6
H. tuberculostatica ......................................................................................................................... 6
I. aminoglycosiden .......................................................................................................................... 6
J. glycopeptiden ............................................................................................................................... 7
K. diverse antibiotica ....................................................................................................................... 7
1. definitie ................................................................................................................................ 8
2. PARAMETERS ........................................................................................................................ 8
max concentratie ............................................................................................................................. 8
Halfwaarde tijd ................................................................................................................................ 9
Oppervlakte onder de curve ............................................................................................................. 9
plasma-Proteïne binding .................................................................................................................. 9
Biologische beschikbaarheid (BB)..................................................................................................... 9
3. ADME .................................................................................................................................. 10
A. absorptie ................................................................................................................................10
B. Distributie ...............................................................................................................................11
C. Eliminatie ...............................................................................................................................12
1. Definitie............................................................................................................................... 13
2. Dosis respons curve ............................................................................................................. 13
3. Curve die ons iets zegt over PK en PD .................................................................................... 13
1. van mic naar geschikte ab keuze ........................................................................................... 14
A. gevoeligheidsbepalingen .........................................................................................................14
B. Raportering van de gevoeligheidsbepaling door het klinisch labo ...............................................17
2. begrip breekpunt.................................................................................................................. 18
A. definities ................................................................................................................................18
2
, B. eucast ....................................................................................................................................18
C. Vuistregels bij de interpretatie van een antibiogram ..................................................................20
D. ambulante praktijk ..................................................................................................................22
3. Groepen van antibiotica ingedeeld volgens PK-PD kenmerken ............................................... 22
algemeen .......................................................................................................................................22
A. tijdsafhankelijke AB .................................................................................................................24
B. AUC over MIC met een tijdsafhankelijke factor..........................................................................26
C. concentratie afhankelijke AB (Cmax/MIC) ................................................................................30
D. Tijdsafhankelijk VS concentratie afhankelijk .............................................................................31
4. therapie duur ....................................................................................................................... 32
therapieduur vs posologie ...............................................................................................................32
vroeger vs nu ..................................................................................................................................32
5. casussen ............................................................................................................................. 32
1. intensieve zorg patiënten ..................................................................................................... 33
A. instellen van antibiotherapie ....................................................................................................33
B. wijzigingen in PK/PD ................................................................................................................34
C. Optimaal dosseren bij IZ ..........................................................................................................37
2. Kinderen .............................................................................................................................. 39
A. Achtergrond ............................................................................................................................39
B. Farmacokinetiek bij kinderen ...................................................................................................40
C. oplossen van casussen ...........................................................................................................42
3. Ouderen .............................................................................................................................. 44
A. farmacokinetiek ......................................................................................................................44
B. casussen ................................................................................................................................46
4. CYSTIC FIBROSIS PATIËNTEN ............................................................................................... 47
Achtergrond ...................................................................................................................................47
Behandeling ...................................................................................................................................48
5. Obese patiënten...................................................................................................................... 52
Achtergrond ...................................................................................................................................52
Invloed op farmacokinetiek .............................................................................................................52
Kwantificatie van obesitas ...............................................................................................................53
3
, H1: KLASSEN VAN ANTIBIOTICA
1. ANTIBACTERIËLE MIDDELEN
A. 𝛽-LACTAM ANTIBIOTICA
PENICILLINES
• Benzylpenicilline
• Feneticilline
• Flucloxacilline
• Amoxicilline
• Carboxypenicillines
• Acylureïdopenicillines
CEFALOSPORINES
• Cefadroxil
• Cefalexine
• Cefazoline
• Cefuroxim
• Cefotaxim
• Ceftazidim
• Ceftriaxon
• Cefepim
• Ceftaroline
• Ceftolozaan
CARBAPENEMS
• Meropenem
MONOBACTAMS
• Azactam
• Cayston
B. MACROLIDEN
ERYTHROMYCINE
4
EN FARMACODYNAMIEK
,INHOUDSOPGAVE
1. ANTIBACTERIËLE MIDDELEN...................................................................................................... 4
a. 𝛽-lactam antibiotica ................................................................................................................. 4
B. macroliden ................................................................................................................................. 4
C. tetracyclines............................................................................................................................... 5
D. clindamycine en lincomycine ...................................................................................................... 5
E. chinolonen (= fluoroquinolones) ................................................................................................... 5
F. sulfonamiden .............................................................................................................................. 6
G. urinaire antibacteriele middelen .................................................................................................. 6
H. tuberculostatica ......................................................................................................................... 6
I. aminoglycosiden .......................................................................................................................... 6
J. glycopeptiden ............................................................................................................................... 7
K. diverse antibiotica ....................................................................................................................... 7
1. definitie ................................................................................................................................ 8
2. PARAMETERS ........................................................................................................................ 8
max concentratie ............................................................................................................................. 8
Halfwaarde tijd ................................................................................................................................ 9
Oppervlakte onder de curve ............................................................................................................. 9
plasma-Proteïne binding .................................................................................................................. 9
Biologische beschikbaarheid (BB)..................................................................................................... 9
3. ADME .................................................................................................................................. 10
A. absorptie ................................................................................................................................10
B. Distributie ...............................................................................................................................11
C. Eliminatie ...............................................................................................................................12
1. Definitie............................................................................................................................... 13
2. Dosis respons curve ............................................................................................................. 13
3. Curve die ons iets zegt over PK en PD .................................................................................... 13
1. van mic naar geschikte ab keuze ........................................................................................... 14
A. gevoeligheidsbepalingen .........................................................................................................14
B. Raportering van de gevoeligheidsbepaling door het klinisch labo ...............................................17
2. begrip breekpunt.................................................................................................................. 18
A. definities ................................................................................................................................18
2
, B. eucast ....................................................................................................................................18
C. Vuistregels bij de interpretatie van een antibiogram ..................................................................20
D. ambulante praktijk ..................................................................................................................22
3. Groepen van antibiotica ingedeeld volgens PK-PD kenmerken ............................................... 22
algemeen .......................................................................................................................................22
A. tijdsafhankelijke AB .................................................................................................................24
B. AUC over MIC met een tijdsafhankelijke factor..........................................................................26
C. concentratie afhankelijke AB (Cmax/MIC) ................................................................................30
D. Tijdsafhankelijk VS concentratie afhankelijk .............................................................................31
4. therapie duur ....................................................................................................................... 32
therapieduur vs posologie ...............................................................................................................32
vroeger vs nu ..................................................................................................................................32
5. casussen ............................................................................................................................. 32
1. intensieve zorg patiënten ..................................................................................................... 33
A. instellen van antibiotherapie ....................................................................................................33
B. wijzigingen in PK/PD ................................................................................................................34
C. Optimaal dosseren bij IZ ..........................................................................................................37
2. Kinderen .............................................................................................................................. 39
A. Achtergrond ............................................................................................................................39
B. Farmacokinetiek bij kinderen ...................................................................................................40
C. oplossen van casussen ...........................................................................................................42
3. Ouderen .............................................................................................................................. 44
A. farmacokinetiek ......................................................................................................................44
B. casussen ................................................................................................................................46
4. CYSTIC FIBROSIS PATIËNTEN ............................................................................................... 47
Achtergrond ...................................................................................................................................47
Behandeling ...................................................................................................................................48
5. Obese patiënten...................................................................................................................... 52
Achtergrond ...................................................................................................................................52
Invloed op farmacokinetiek .............................................................................................................52
Kwantificatie van obesitas ...............................................................................................................53
3
, H1: KLASSEN VAN ANTIBIOTICA
1. ANTIBACTERIËLE MIDDELEN
A. 𝛽-LACTAM ANTIBIOTICA
PENICILLINES
• Benzylpenicilline
• Feneticilline
• Flucloxacilline
• Amoxicilline
• Carboxypenicillines
• Acylureïdopenicillines
CEFALOSPORINES
• Cefadroxil
• Cefalexine
• Cefazoline
• Cefuroxim
• Cefotaxim
• Ceftazidim
• Ceftriaxon
• Cefepim
• Ceftaroline
• Ceftolozaan
CARBAPENEMS
• Meropenem
MONOBACTAMS
• Azactam
• Cayston
B. MACROLIDEN
ERYTHROMYCINE
4
