Ostrava Cvič 1 Základy Biol.l.

7/26/2019 Ostrava Cvi 1 Zklady Biol.l.

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Zklady biologick lby - cvieneskov E.

volba psychofarmaka volba antidepresiva volba antipsychotika


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Psychofarmakoterapie volba obecn!

na "klad! "nalost o lk# t$. %innosti& sn'enlivosti a be"penosti

na "klad! detailnch "nalost o nemocnmklinickm obra"# individ#ln sn'enlivosti

preferenc nemocnhoperspektiva - farmakogenetice

individ#ali"ovan (per"onali"ovan) lba


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Psychofarmakoterapie volbaobecn!

*olba na "klad! "nalost o lk#+innoststar' i nov!$' psychofarmaka se v pr,m!r# v

%innosti neli'

n'enlivot a be"penost

e$v!t' ro"dly ve sn'enlivosti a be"penosti


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*olba antidepresiva


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*olba /0 mechanism#s %ink#

k#pina 1k 2lokda "p!tnhovychytvn

2lokda receptor,

/ 345 0 /6h alfa7 47 3457 3458 3459

56/ :mipramin ;; ;; < ;; ; ; < ;=- : 6italopram < ;;; < < < < < < : 5ra"odon < + < < ;; ;=- < ;; : >ebo?etin ;;; < < < < < < < : *enlafa?in ; ;; ;=- < < < < < : 2#propion ;=- < ;; < < < < < C5ar#'en problmy v se?#ln oblasti& por#chych#ti k $dl#& pokles nlady& "$m#& motivace


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:ndivid#ali"ovan lba volba /0dle klinickho obra"#

Mednotliv depresivn pH"naky $so# spo$ovny sdysf#nkc #ritIch oblast a ne#ronlnch drah&

kter $so# ve v"$emn interakci ane#rotransmitry (hlavn! 3-45& /&0/)volba /0 dle pHevaN#$cch pH"nak,

%tl#mov B 0>: (b#propion) %"kostn B />: (tra"odon) a a/ (mirta"apin) nevyhran!n B >: (citalopram& sertralin)& >:


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:ndivid#ali"ovan lba volba/0 dle sn'enlivosti

*olba dle sn'enlivosti (a preference) kvalitn se? B />:& a/& 0>:

kvalitn spnek B />:& a/ ovlivn!n hmotnosti

- snNen 0>:

- "vI'en a/


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:ndivid#ali"ovan lba volba /0dle be"penosti>i"iko krvcen ->: kas#istiky o krvcen do O:5 risiko pHi kombinaci s Qarfarinem& heparinem&

nesteroidnm proti"n!tlivImi ltkami& acylpirinem

1kov interakce n!kter /0& hlavn! >: s#bstrty i inhibitory $aternch

en"ym, po"or pHi polyfarmaciiRyndrom " vysa"en(hlavn! po >: a venlafa?in#)

"vrat!& ata?ie gastrointestinln pH"naky chHipkov pH"naky sensorick (parest"ie)


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:ndivid#ali"ovan lbavolba /0 dlebe"penostierotoninovI syndrom >: - i po $edn dvce& pHedvkovn (7S-7TU)kombinace /0 (>: ; inhibitoHi 6JP S3


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akati"ie "m!na psych. stav# klon#s ( trvalI) hypertermie

tremor klon#s (navo"enI) m#sk#lrn hypertonicita

NivotohroN#$cto?icita

mrnpH"naky

:ndivid#ali"ovan lba volba /0 dlebe"penosti - serotoninovI syndrom


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:ndivid#ali"ovan lba volba /0 dlebe"penosti - gravidita

*liv na dt! teratogenita P/ syndrom behaviorln to?icita

P/ (poor neonatal adaptation) syndrom shodn nespecifick pro$evy (limitovanI repertor reakc) pHie?po"ici r,"nIm psychofarmak,m

- ne#rologick (neklid& "m!ny svalovho ton#&tremor& problmy se spnkem& astI pl)

- O:5 (problmy s krmenm)& respiran vIskyt do SV hod.& trvn 8-T dn,& v!t'ino# mrn& nevyNad#$

lb#& dosta#$c podp,rn opatHen pHiny - syndrom " odn!t& to?icita& dal' pHiny


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*olba antipsychotika


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*olba /P preferovna /P 8. generace(/P8O& atypick)

0!len dle farmakologickho profil# specifit 08 a 09 antagonist-- amis#lpridantagonist serotonin# a dopamin# (0/)BB

risperidon& "iprasidon& sertindol& paliperidonm#ltireceptorov antagonist (@/>5/)BB

klo"apin& olan"apin& W#etiapin& "otepin

parciln agonist dopaminovIch receptor,(tak na"Ivan dopaminov a serotoninovstabili"tory) B aripipra"ol


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08 antipsychotickI& antimanickI& antiagresivn &EP=akat"ie& prolaktin#

alfa7 post.hypoten"e& "vrat!& synkopa

alfa8 antidepresivn&bd!losti& 5G

47 an?iolytickI& sedace& navo"en spnk#& hmotnosti& anti-EP=ak

@7

(centr.)

por#cha pam!ti a kognice& s#cho v %stech& anti-EP=akat"ie

@8-S(perif.)

ro"ma"an vid!n& "cpa& retence moi& tachykardie&hyperten"e

3-458/ anti EP=akat"ie& Aantipsychot.

3-4568 ch#ti k $dl# a hmotnosti (A)

*olba /P mechanism#s %ink#(%inek blokdy receptor,)


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eNdo#c

%inky

ari ami ris pali "ip sert clo" olan W#e "ot

/kati"ie=EP ;


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:ndivid#ali"ovan lba volba /P dleklinickho obra"# - dynamiky nemoci

Prodromln f"e ro"vo$i nemoci pHedch" r,"n! dlo#h prodromln

obdob charakteristick nespecifickImi pH"nakya=nebo pHechodnImi psychotickImi pH"naky v tto f"i "ko#'eny terape#tick intervence #

vysoce ri"ikovIch $edinc, (ne$ast!$i s po"itivnrodinno# anamn"o# schi"ofrenn por#chy)

# Hady se podaHilo minimln! oddlit pHechod dopsychX"y(@okhtari @ et >a$arethinam >.& 8


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7. epi"oda schi"ofrenie v!t' odpov! na lb# a vy'' nchylnost k

neNdo#cm %ink,m /P ve srovnn s pacientys chronickIm pr,b!hem schi"ofrenie

sta niN' denn dvky /P (9


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>obinson et al. 7[[[

Poetrelaps,

\7


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:ndivid#ali"ovan lba volba /P dle

klinickho obra"# - dynamiky nemociDdrNovac lba - cl "abrnit relaps#0,sledky relaps#6erebroto?ick

mo"kov atrofie

"hor'en pr,b!h#Psychoto?ickvliv psychotickho "Nitk# ("vI'en be"nad!$e)agrese v,i sob! a ostatnm& s#icidia& ri"iko ab%"#

ocioto?ick"trta sociln integrace a "am!stnnvyhoHen& pocity viny& red#kce sociln st!hospitali"ace a nklad,


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:ndivid#ali"ovan lba volba /P dleklinickho obra"# - dynamiky nemociDdrNovac lba B "sady "klad - dlo#hodob kontin#ln farmakoterapie #drNovac lba /P ]ri"iko relaps# 8-9?& ^3U vs 8


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:ndivid#ali"ovan lba volba /P dleklinickho obra"#B pHevaN#$cch pH"nak,

Po"itivn pH"naky kombinace antipsychotik 8. generaceegativn pH"naky /#gmentace /0 (mn! kon"istentn vIsledky s >:& lep'

efekt mirta"apin)& amis#lprid& r5@

0epresivn pH"naky klo"apin& a#gmentace /0 (>:& >:)Gognitivn pH"naky /P8O _/P7O v

a#gmentace /0 (mirta"apin) nefarmakologick pHst#py (kognitivn remediace) psychostim#lancia& 0/ agonist& kognitiva& ovlivn!n

gl#tamtergn transmise


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/gitovanost /P7O a ben"odia"epiny vyka"#$ srovnatelno# %innost

na agresivit# a agitovanost& moNn #Nt v kombinaci. i. m. /P8O (aripipra"ol& olan"apin& "iprasidon)

srovnateln! %inn s haloperidolem "a niN' incidencene#rologickIch neNdo#cch %ink,.

kombinace parenterln aplikace olan"apin# a 2Z0ri"ikov

kombinace klo"apin#=olan"apin# a parenterln!aplikovanIch 2Z0 m,Ne vst k %tl#m# dechovhocentra


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Gatatonn pH"naky elektrokonv#l"ivn lba alternativa moho# bIt vysok dvky 2Z0Farmakore"istence -ne%sp!ch 8 lebnIch k,r

dv!ma r,"nImi /P 7


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:ndivid#ali"ovan lba volba /P dleklinickho obra"# - nonadherence

0oba vynechn dvek

pHleNitostn dny tIdny m!sce*livnem

ocinanemo

cnho stres snNen

f#ngovn

manifestacepH"nak,

>elaps=hospitali"ace


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:ndivid#ali"ovan lba volba /P dleklinickho obra"#B nonadherence

97&^8[&3 8V&7

83&[89&S

7V&37^&

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Ostrava Cvič 1 Základy Biol.l.

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