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Samenvatting partim II Farmacologie
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Samenvatting van partim II van Farmacologie, gebaseerd op de powerpoints en hoorcolleges. Gegeven in bachelor 2. Dit bevat NIET partim I.
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Farmacologie: partim IIInhoud
1. Hypolipemiërende farmaca ................................................................................................................. 3
1.1 Inleiding ......................................................................................................................................... 3
1.2 Stoornissen in het lipidenmetabolisme ......................................................................................... 4
1.2.1 Atherosclerose & atherotrombose ........................................................................................ 5
1.3 Hypolipemiërende farmaca ........................................................................................................... 9
1.3.1 Statines (HMG-CoA reductase remmers) ............................................................................... 9
1.3.2 Fibraten (o.a. fenofibraat) .................................................................................................... 11
1.3.3 Harsen die galzuren binden .................................................................................................. 13
1.3.4 Remmers van de cholesteroltransporter in de darm ........................................................... 13
1.3.5 Visderivaten (omega 3 vetzure ethylesters)......................................................................... 14
1.3.6 PCSK9-inhibitoren ................................................................................................................. 14
1.4 Combinatie medicatie ................................................................................................................. 15
2. Farmacologie van het hart ................................................................................................................ 16
2.1 Inleiding ....................................................................................................................................... 16
2.2 Farmaca die de hartfunctie beïnvloeden .................................................................................... 16
2.2.1 Anti-aritmica ......................................................................................................................... 16
2.2.2 Hartglycosiden ...................................................................................................................... 22
2.2.3 Autonome neurotransmitters en verwante stoffen............................................................. 28
2.2.4 Anti-anginosa........................................................................................................................ 28
2.2.5 Calciumantagonisten ............................................................................................................ 34
3. Farmacologie van het vasculair systeem ........................................................................................... 37
3.1 Inleiding ....................................................................................................................................... 37
3.2 Vasoconstrictoren ....................................................................................................................... 38
3.3 Vasodilatoren .............................................................................................................................. 42
3.4 Geneesmiddelen.......................................................................................................................... 45
3.4.1 Geneesmiddelen bij hypertensie.......................................................................................... 45
3.4.2 Geneesmiddelen bij hartfalen met een gereduceerde ejectiefractie (HFrEF) ..................... 47
3.4.3 Geneesmiddelen bij angina pectoris .................................................................................... 49
3.4.4 Geneesmiddelen bij de ziekte van Raynaud......................................................................... 50
3.4.5 Geneesmiddelen bij pulmonaire hypertensie ...................................................................... 50
4. Farmacologie van de nier .................................................................................................................. 51
4.1 Inleiding ....................................................................................................................................... 51
1
, 4.2 Aangrijpingspunten voor medicatie ............................................................................................ 51
4.3 Diuretica ...................................................................................................................................... 54
5. Farmacologie van het respiratoir & GI systeem ................................................................................ 58
5.1 Farmacologie van het ademhalingsstelsel .................................................................................. 58
5.1.1 Regulatie van de luchtwegen ............................................................................................... 58
5.1.2 Astma.................................................................................................................................... 58
5.2 Farmacologie van het maagdarmstelsel...................................................................................... 65
5.2.1 Secretie van maagzuur, mucus & bicarbonaat ..................................................................... 65
5.2.2 Braken................................................................................................................................... 70
5.2.3 Constipatie............................................................................................................................ 74
5.2.4 Diarree: antidiarreïca............................................................................................................ 77
5.2.5 Spasmolytica ......................................................................................................................... 78
6. Farmacologie van het CZS ................................................................................................................. 79
6.1 Inleiding ....................................................................................................................................... 79
6.2 Neurotransmitters ....................................................................................................................... 80
6.2.1 Aminozuren .......................................................................................................................... 80
6.2.2 Noradrenaline in het CZS ...................................................................................................... 84
6.2.3 Dopamine in het CZS ............................................................................................................ 84
6.2.4 5-HT (serotonine) in het CZS ................................................................................................ 86
6.2.5 Acetylcholine in het CZS ....................................................................................................... 87
6.2.6 Histamine.............................................................................................................................. 88
6.2.7 Purines .................................................................................................................................. 88
6.2.8 Melatonine ........................................................................................................................... 89
6.2.9 NO ......................................................................................................................................... 89
6.3 Neurodegeneratieve aandoeningen ........................................................................................... 89
6.3.1 Ziekte van Alzheimer ............................................................................................................ 91
6.3.2 Ziekte van Parkinson............................................................................................................. 93
6.4 Antipsychotica ( = neuroleptica).................................................................................................. 98
6.4.1 Werkingsmechanisme ........................................................................................................ 100
6.4.2 Classificatie ......................................................................................................................... 102
6.5 Antidepressiva ........................................................................................................................... 106
6.5.1 Inleiding .............................................................................................................................. 106
6.5.2 Werkingsmechanismen ...................................................................................................... 107
6.5.3 Stemmingsstabilisatoren .................................................................................................... 114
6.6 Anxiolytica & hypnosedativa ..................................................................................................... 116
6.6.1 Benzodiazepines ................................................................................................................. 117
2
, 6.6.2 Barbituraten ....................................................................................................................... 119
6.7 Anti-eleptica .............................................................................................................................. 119
6.7.1 Epilepsie.............................................................................................................................. 119
6.7.2 Anti-eleptica ....................................................................................................................... 120
6.7.3 Samenvattend .................................................................................................................... 123
7 Opioïden (analgetica) ....................................................................................................................... 124
7.1 Inleiding ..................................................................................................................................... 124
7.2 Nociceptieve pijn ....................................................................................................................... 125
7.3 Analgetica: opioïden .................................................................................................................. 128
7.3.1 Inleiding .............................................................................................................................. 128
7.3.2 Werkingsmechanisme van de opioïden ............................................................................. 129
7.3.3 Indeling opioïde analgetica ................................................................................................ 140
7.3.4 Opioïd antagonisten ........................................................................................................... 143
7.3.5 Interacties met opioïden .................................................................................................... 144
7.4 Samenvattend ........................................................................................................................... 145
8. Lokale anesthetica ........................................................................................................................... 146
8.1 Inleiding ..................................................................................................................................... 146
8.2 Werkingsmechanisme ............................................................................................................... 147
8.3 Gebruik ...................................................................................................................................... 148
8.4 Verschillende types en toedieningswijze .................................................................................. 149
1. Hypolipemiërende farmaca
→ zeer veel gebruikte GM, vnl.: statines (goed kennen!).
1.1 Inleiding
Lipoproteïnetransport in het bloed
Componenten:
• Chylomicronen
o Functie: gaan TG en cholesterol vanuit de GI-tractus naar
de weefsels transporteren.
o Lipoproteïne lipase → zorgt voor de omzetting van TG in
glycerol en vrije vetzuren (bouwstenen).
▪ Vrije vetzuren worden verder opgenomen
(afbeelding: thv de vaatwand)
o Chylomicron remnants = restanten van de chylomicronen wanneer ze hun TG hebben
vrijgegeven.
▪ Worden naar de lever getransporteerd (in hepatocyt), verschillende opties:
• Opgestapeld, gesecreteerd in de gal of geoxideerd tot galzuren
• Op zich geoxideerd
3
, • Omgezet naar VLDL partikels
• VLDL (very low density lipoproteins)
o Bevat:
▪ Heel wat cholesterol
▪ Ook heel wat nieuw gesynthetiseerde TG
o TG in de VLDL → worden ook via lipoproteïne lipase omgezet tot glycerol en vrije
vetzuren → vrije vetzuren opgenomen.
▪ LET OP: daarnaast ook LDL gevormd.
• LDL (low density lipoproteins)
o = ‘slechte cholesterol’
o Bevat
▪ Geen TG
▪ Wel cholesterol esthers (hoog gehalte aan cholesterol)
o Cholesterol esters → wordt opgenomen door weefsels & de lever (via endocytose
m.b.v. specifieke LDL-receptoren)
• HDL (high density lipoproteins)
o = ‘goede cholesterol’
o Functie: nemen cholesterol (celturnover) vanuit de weefsels en de arteriën(!) op →
verder omgezet naar: VLDL & LDL.
Opm.: daarnaast ook IDL (intermediate density lipoproteins).
1.2 Stoornissen in het lipidenmetabolisme
= dyslipidemie
4
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