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Statine (#R: 0; #F: 0)
Kompetitive Hemmung der HMG-CoA-Reduktase
- Abendliche Einnahme (v.a. bei Simvastatin)
- Kombinationstherapie mit Colestyramin

Vertreter
1) Simvastatin
- HWZ: 2h
- CYP3A4
2) Pravastatin
- HWZ: 2h
- NICHT CYP-450!

3) Lovastatin
- HWZ: 3h
- CYP3A4

4) Atorvastatin
- HWZ: 14h
- CYP3A4

Indikation
- Hypercholesterinämie
- Hyperlipidämie
- Nach Myokardinfarkt unabhängig vom Cholesterinwert zur Sekundärprävention

Nebenwirkungen
- Kopfschmerzen
- gastrointestinale Beschwerden
- Transaminasenanstieg
- Quick-Wert kann sinken
- Myalgie (10% - Keine CK-Erhöhung -> Fortsetzung der Therapie)
- Myopathie (Rhabdomyolyse -> Myoglobinurie → akutes Nierenversagen)

Interaktionen
Erhöhte Myopathie- und Rhabdomyolyseneigung bei:
- Fibraten
- Ciclosporin A
- Nikotinsäure
- Makrolide (Erythromycin)

Kontraindikationen
- Lebererkrankungen
- Muskelerkrankungen
- Schwangerschaft, Stillzeit
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Ms Sturgeon said: “Mr Armstrong met with a member of my staff and as his complaint was a party matter. The matter was quite correctly referred to SNP HQ where an investigation was conducted. As it did not relate in any way to my work as a constituency MSP, I was not made aware of the situation. My constituency office gets a very large volume of contacts from people who are not constituents but who want to raise party issues.
Fibrate (#R: 0; #F: 0)
Aktivierung des PPARα-Rezeptors
- LDL 10-20%↓
- HDL 5-20%↑
- Triglyceride 20-40%↓

Vertreter
1) Bezafibrat
2) Fenofibrat
3) Gemfibrozil

Indikation
- Mittel der 2. Wahl bei Hyperlipidämie

Nebenwirkungen
- Gastrointestinale Beschwerden
- Myalgie
- vermehrte Cholelithiasis

Kontraindikation
- Niereninsuffizienz
- Leberinsuffizienz
- Gallenblasenerkrankungen
- Schwangerschaft

Interaktionen
Wirkungsverstärkung
- Sulfonylharnstoffe
- Hemmer der Blutgerinnung
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Cholestyramin (#R: 0; #F: 0)
Austauscherharz (Bindung der Gallensäure im Darm)
- Unterbrechung des enterohepatischen Kreislaufes

Vertreter
1) Cholestyramin
2) Colestipol

Indikation
- Mittel der 2. Wahl bei Hyperlipidämie
- Kombinationstherapie mit Statinen bei Hypercholesterinämie
- Digitoxin-Überdosierung
- Pruritus auf dem Boden erhöhter Gallensäurewerte (Cholestase)
- Chologene Diarrhoe
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Nikotinsäure (#R: 0; #F: 0)
Inhibition der Freisetzung von Fettsäuren

Nebenwirkungen: Treten häufig auf!
- Flush
- Brennen
- Pruritus
- Durchfall, Flatulenz, Bauchschmerzen
- Verstärkte Glukoseintoleranz
- Hyperurikämie
- Myopathie

Kontraindikationen
- Leberinsuffizienz
- Gicht
- Blutung
- Magenulkus
- Kreislaufinstabilität

Indikation
- 2. Wahl bei Hypercholesterinämie
Diuretika (#R: 0; #F: 0)
1) Thiaziddiuretika
- Hemmung Na+-Cl--Kotransporter im distalen Tubulus
-> Natrium↓; Kalium↓; Kalzium↑

2) Schleifendiuretika
- Hemmung Na+-K+-2Cl--Kotransporter im aufsteigenden Ast der Henle-Schleife
-> Natrium↓; Kalium↓; Kalzium↓

3) Kaliumsparende Diuretika
- Verminderte Natriumresorption und Kaliumsekretion im distalen Tubulus und proximalen Sammelrohr
-> Natrium↓; Kalium↑; Kalzium-

4) Osmodiuretika
- Direkt osmotischer Effekt im Tubulussystem
-> Natrium↑; Kalium-; Kalzium-

5) Carboanhydrase-Hemmer
- Hemmung der Carboanhydrase → Bikarbonatausscheidung↑
-> Natrium↓; Kalium↓; Kalzium-
Carboanhydrase-Hemmer (#R: 0; #F: 0)
Hemmung der Carboanhydrase
- Im Auge: Kammerwasserproduktion↓
- Im proximalen Tubulus: starke Bikarbonatausscheidung
- Liquorproduktion↓

Vertreter
- Acetazolamid

Indikation:
- Akutes Glaukom
- Idiopathische intrakranielle Hypertension (Pseudotumor cerebri)

Nebenwirkung
- Metabolische Azidose
Osmodiuretika (#R: 0; #F: 0)
- Intravenöse Applikation → Intravasale Wasserbindung
- Glomeruläre Filtration ohne Rückresorption → Osmotische Diurese
- Keine Salurese

Vertreter
- Mannit
- Glycerin
- Sorbit

Indikation
- Hirnödem
- akutes Glaukom

Nebenwirkungen
- Exsikkose
- initiale Volumenbelastung

Kontraindikation
- kardiale Dekompensation
Thiaziddiuretika (#R: 0; #F: 0)
Hemmung des Na+-Cl--Kotransporters im distalen Tubulus
- Ausscheidung von Natriumchlorid↑
- Ausscheidung von Kalium↑
- Verringerte Ausscheidung von Kalzium → Günstig bei Osteoporose
- Wirkung nur bei GFR 2mg/dl
- Hypokaliämie oder Hyponatriämie
- Hyperkalzämie
- Exsikkose

Interaktionen
- Verstärkte Digitalis-Wirkung (Hypokaliämie)
- Verstärkung der Lithium-Wirkung
- Wirkungsabschwächung von Zytostatika und depolarisierender Muskelrelaxanzien
- Abgeschwächte antihypertensiven Wirkung durch NSAR
Schleifendiuretika (#R: 0; #F: 0)
Blockade des Na+-K+-2Cl--Kotransporters
- Venodilatation bei intravenöser Applikation → Vorlastsenkung
- Furosemid intravenös wirkt für etwa 6 Stunden
- Gabe sollte morgens und mittags erfolgen

Vertreter
1) Furosemid

Indikationen
- Behandlung von Ödemen (Kardial, Renal, Hepatisch)
- Niereninsuffizienz (Auch bei deutlich eingeschränkter GFR
Aldosteronantagonisten (#R: 0; #F: 0)
Hemmung der Expression von Na+-Kanälen im Sammelrohr
- Serumnatrium↓, Serumkalium↑
- KALIUMSPAREND
- Verzögerter Wirkungseintritt (>24h)

Vertreter
1) Eplerenon
2) Spironolacton
- ♂: Gynäkomastie, Impotenz
- ♀: Amenorrhoe, Hirsutismus

Indikationen
- Primärer Hyperaldosteronismus
- Herzinsuffizienz (Ab Stadium II indiziert, Verbesserung der Prognose)
- Leberzirrhose mit Aszites bzw. Ödemen

Nebenwirkungen
- Hyperkaliämie
- Gastrointestinale Nebenwirkungen
- Nur Spironolacton: Endokrine Nebenwirkungen (-> Umstellung auf Eplerenon)

Kontraindikation
- Schwere Niereninsuffizienz (Spironolacton: Kreatinin > 1,8mg/dl bzw. GFR
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Kaliumsparende aldosteronunabhängige Diuretika (#R: 0; #F: 0)
Direkte Blockade der Na+-Kanäle in Sammelrohr und distalen Tubuli
- Serumnatrium↓, Serumkalium↑
- KALIUMSPAREND
- Schneller Wirkungseintritt

Vertreter
1) Triamteren
2) Amilorid

Indikationen
- in Kombination mit Thiaziden zur Behandlung chronischer Ödeme (-> Kalium ausgewogen)

Nebenwirkungen
- Hyperkaliämie
- Gastrointestinale Nebenwirkungen

Kontraindikation
- Schwere Niereninsuffizienz
- KEINE Kombination mit ACE-Hemmern bzw. AT1-Rezeptorblockern
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H1-Antihistaminika (#R: 0; #F: 0)
Kompetitiver Antagonismus am Histamin H1-Rezeptor

Vertreter
1) 1. Generation
- ZNS-gängig
- Ausgeprägt sedierend
- Anticholinerge Nebenwirkungen
-> Dimetinden
-> Diphenhydramin
-> Meclozin
-> Promethazin
-> Clemastin

2) 2. Generation
- Kaum sedierend
-> Loratadin
-> Cetirizin
-> Azelastin
-> Fexofenadin

Indikationen
- Anaphylaktischer Schock
- Antiallergikum
- Juckreiz
- Antiemetikum (1. Generation)
- Schlafmittel (1. Generation)

Kontraindikationen (1. Generation - Anticholinerg)
- Prostatahyperplasie mit Bildung von Restharn
- Winkelblockglaukom
- Pylorusstenose
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History http://xvedio.in.net/ sexvedio After a lengthy cross examination, Judge Colonel Denise Lind accepted retired Air Force Colonel Morris Davis, a former chief prosecutor at the U.S. prison at Guantanamo Bay, Cuba, as an expert witness on Guantanamo Bay prisoner assessment. Manning is accused of leaking assessments.
H2-Antihistaminika (#R: 0; #F: 0)
Kompetitiver Antagonismus am Histamin-H2-Rezeptor

Vertreter
1) Ranitidin
2) Cimetidin

Indikation
- Senkung der Magensäureproduktion (2. Wahl)
- Zusätzlich zu H1-Antihistaminika bei anaphylaktischem Schock
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Glukokortikoide (#R: 0; #F: 0)
Antiinflammatorische (Akut) und immunsuppressive Wirkung (Langfristig)
- Gabe möglichst einmalig morgens vor 8 Uhr
- NICHT i.m.!

Vertreter
1) Cortisol (Hydrocortison)
- Cushing-Schwelle: 30mg
- relative glukokortikoide Wirkung: 1
- relative mineralkortikoide Wirkung: 1
2) Prednisolon
- Cushing-Schwelle: 7,5mg
- relative glukokortikoide Wirkung: 4
- relative mineralkortikoide Wirkung: 0,8
3) Dexamethason
- Cushing-Schwelle: 1mg
- relative glukokortikoide Wirkung: 30
- relative mineralkortikoide Wirkung: -
4) Budesonid
- relative glukokortikoide Wirkung: 30000
5) Fluticason
- relative glukokortikoide Wirkung: 90000

Indikationen
- Morbus Addison
- Adrenogenitales Syndrom
- Allergische Reaktionen und anaphylaktischer Schock
- Antiemetisch
- Akuter Asthma-Anfall
- Lungenödem / Hirnödem
- multipler Sklerose
- Morbus Crohn, Sarkoidose, Sjögren-Syndrom, Morbus Basedow
- Induktion der fetalen Lungenreife

Nebenwirkungen
- Hypokaliämie
- Hypertonie, Ödeme
- Hypokalzämie -> Osteoporose
- Myopathie und Muskelatrophie
- Diabetogene Wirkung
- Menstruationsstörungen, Hirsutismus, Impotenz
- Lymphozytopenie, Eosinopenie und Monozytopenie -> Immunsuppresion
- Thrombozyten↑ → erhöhtes Thromboserisiko
- Granulozyten↑ → dadurch insgesamt Leukozytose
- Kombination aus Glukokortikoiden und NSAR erhöht das Ulkusrisiko (x10)
- Katarakt
- Glaukom
- Euphorie oder Dysphorie
- Bei Kindern: Wachstumshemmung
- Inhalativ: Heiserkeit (Mundausspülung nach jedem Glukokortikoid-Sprühstoß)
Protonenpumpenhemmer (#R: 0; #F: 0)
Irreversible Hemmung der H+/K+-ATPase der Parietalzellen
-> Vollständige Suppression der Magensäuresekretion

Indikationen
- Ulcus ventriculi und duodeni
- Refluxkrankheit
- Eradikation von Helicobacter pylori
- Zollinger-Ellison-Syndrom
- Gastropathien durch NSAR

Nebenwirkungen
- Gastrointestinale Nebenwirkungen (10%)
- Schwindel, Kopfschmerzen
- Sehstörungen (bei iv. Applikation)
- Exantheme
- Reaktive Hypergastrinämie
Antidiabetika (#R: 0; #F: 0)
Vertreter
1) Biguanide
- Metformin

2) Sulfonylharnstoffe
- Glibenclamid
- Glimepirid

3) Glinide
- Repaglinid

4) α-Glukosidasehemmer
- Acarbose

5) Glitazone
- Pioglitazon
- Rosiglitazon

6) Inkretinmimetika
- Exenatide

7) Dipeptidylpetidase-4-Hemmer
- Sitagliptin
- Vildagliptin
Biguanide (#R: 0; #F: 0)
- Vaskuläre Komplikationen↓
- Mortalität durch mikro- und makroangiopathische Folgeerkrankungen↓
- Keine erhöhte Hypoglykämiegefahr

Vertreter
- Metformin

BZ bis zu 40%↓
- Insulinwirkung↑
- Kohlenhydratumsatz↑
- Glukoneogenese↓
- Resorption Kohlenhydrate im Darm↓

- Lipolyse↑
- Triglycerid- und LDL-Spiegel↓

Nebenwirkungen
- Gastrointestinale Nebenwirkungen
- Laktatazidose

Kontraindikationen
- Niereninsuffizienz (Kreatinin >1,2mg/dL, GFR
Sulfonylharnstoffe (#R: 0; #F: 0)
- Vaskuläre Komplikationen↓
- Mortalität durch mikro- und makroangiopathische Folgeerkrankungen↓
- Keine erhöhte Hypoglykämiegefahr

Vertreter
- Metformin

BZ bis zu 40%↓
- Insulinwirkung↑
- Kohlenhydratumsatz↑
- Glukoneogenese↓
- Resorption Kohlenhydrate im Darm↓

- Lipolyse↑
- Triglycerid- und LDL-Spiegel↓

Nebenwirkungen
- Gastrointestinale Nebenwirkungen
- Laktatazidose

Kontraindikationen
- Niereninsuffizienz (Kreatinin: 1,2mg/dL, GFR: 60ml/min)
- Leberinsuffizienz
- Katabole Stoffwechsellage
- Schwangerschaft, Stillzeit
- Herzinsuffizienz NYHA III und IV
- Respiratorische Insuffizienz
- Gleichzeitige Gabe mit Kontrastmittel i.v.
- OP

Wechselwirkungen:
- Sulfonylharnstoffe: Glibenclamid
Sulfonylharnstoffe (#R: 0; #F: 0)
Verschluss von Kaliumkanälen der ß-Zellen des Pankreas → Insulinsekretion↑
- Mortalität durch mikro- und makroangiopathische Folgeerkrankungen↓

Vertreter
- Glibenclamid
- Glimepirid

- Gewichtszunahme

Nebenwirkungen
- Lebensgefährliche Hypoglykämien

Kontraindikationen
- Leber- und Niereninsuffizienz
- Sulfonamidallergie
- Schwangerschaft und Stillzeit
- Operation

Wechselwirkungen:
- Biguanide: Metformin
Glinide (#R: 0; #F: 0)
Verschluss von Kaliumkanälen der ß-Zellen des Pankreas → Insulinsekretion↑
- Einnahme vor dem Essen

Vertreter
- Repaglinid

Nebenwirkungen
- Lebensgefährliche Hypoglykämien
- Gewichtszunahme

Kontraindikationen
- Leber- und Niereninsuffizienz
- Sulfonamidallergie
- Schwangerschaft und Stillzeit
- Operation

Wechselwirkungen:
- Sulfonylharnstoffe: Glibenclamid
α-Glukosidasehemmer (#R: 0; #F: 0)
Glukoseresorption in Intestinum↓
- Einnahme vor dem Essen

Vertreter
- Acarbose

Nebenwirkungen
- Gastrointestinale Nebenwirkungen (starke Blähungen möglich!)
- Gewichtsreduktion möglich

Kontraindikationen
- Chronisch entzündliche Darmerkrankungen
- Malassimilationssyndrom
- Schwangerschaft
Inkretinmimetika (#R: 0; #F: 0)
Agonismus am GLP-1-Rezeptor (glucagon-like peptide) → Insulinsekretion↑, Glukagonsekretion↓

Vertreter
- Exenatide

Nebenwirkungen
- Gastrointestinale Nebenwirkungen
- Pankreatitis

Kontraindikationen
- Niereninsuffizienz
- Pankreatitis
Dipeptidylpetidase-4-Hemmer (#R: 0; #F: 0)
Hemmung der Dipeptidylpetidase-4 → Verminderter Abbau und somit verstärkte Wirkung von GLP-1 → Insulinsekretion↑, Glukagonsekretion↓

Vertreter
- Sitagliptin
- Vildagliptin

Nebenwirkungen
- Gewichtszunahme
- Gastrointestinale Nebenwirkungen
- Pankreatitis

Kontraindikationen
- Niereninsuffizienz
- Schwangerschaft und Stillzeit
Insuline (#R: 0; #F: 0)
Vertreter

Kurzwirksam (Wirkung bis zu 8 Stunden)
1) Normalinsulin
- Wirkbeginn: 20min
- Wirkmaximum: 2h
- Wirkdauer: 8h

2) Insulin Lispro/Aspart/Glulisin
- Wirkbeginn: 10min
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- HWZ: 2h
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- Hypercholesterinämie
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- Schwangerschaft, Stillzeit
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Lovastatin (#R: 0; #F: 0)
Kompetitive Hemmung der HMG-CoA-Reduktase
- Abendliche Einnahme (v.a. bei Simvastatin)
- Kombinationstherapie mit Colestyramin

- HWZ: 3h
- CYP3A4

Indikation
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Nebenwirkungen
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- Nikotinsäure
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- Hypercholesterinämie
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- Schwangerschaft, Stillzeit
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- Myalgie
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Indikation
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Vertreter
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Wirkspektrum
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Vertreter
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2) Meropenem
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Nebenwirkungen
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Vertreter
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- Pseudomonas

Nebenwirkungen
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Nebenwirkungen
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Vertreter
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Wirkspektrum
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Nebenwirkungen
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Pharmakokinetik (#R: 0; #F: 0)
Beschreibt, wie ein Pharmakon vom Körper aufgenommen, verteilt, metabolisiert und ausgeschieden wird!

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- Hydrophil
2) Verteilungsvolumen
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3) Clearance
4) Halbwertszeit
- Zeitraum, in der die Konzentration des Pharmakons im Plasma die Hälfte der Ursprungskonzentration erreicht hat
5) Elimination
- Leber (Phase I und II)
- Niere
- Biliär
- Pulmonal
Pharmakodynamik (#R: 0; #F: 0)
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CYP3A - Inhibition (#R: 0; #F: 0)
1) Statine
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2) Steroidhormone
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- Testosteron
3) Orale Kontrazeptiva
4) Makrolide
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5) Carbamazepin
6) Benzodiazepine
7) HIV-Virostatika
8) Kalziumantagonisten
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9) Amiodaron
10) Antimykotika
- Itraconazol

Zahlreiche weitere Medikamente
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1) Carbamazepin
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- Rivastigmin
- Galantamin

Indikation
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- Leichte und mittelschwere Demenzen

NW
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- Diarrhoe
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- Übelkeit
Direkte Parasympathomimetika (#R: 0; #F: 0)
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2) Carbachol

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NW
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Parasympatholytika (#R: 0; #F: 0)
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- Tropicamid (diagnostischen Mydriasis)
- Biperiden (M. Parkinson; Antidot bei typischen Antipsychotika)
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2) Nicht Liquorgängig
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- Ipratropiumbromid (Asthma + COPD)

Wirkung
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- Verengung des Kammerwinkels
- Bronchodilatation
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- Zunahme der Herzfrequenz
- Verkürzung der AV-Überleitung
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- Tonusabnahme der Harnblase
Anticholinerges Syndrom (#R: 0; #F: 0)
Ätiologie
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- Parasympatholytika
- Antipsychotika
- Antihistaminika der 1. Generation

Symptome
- Mundtrockenheit
- heiße Haut
- Tachykardie, Herzrhythmusstörungen
- Mydriasis
- zentrale Erregung

Therapie
- Physostigmin
β-2-Sympathomimetika (#R: 0; #F: 0)
Stimulation des β2-Rezeptors, gering auf β1 (Nebenwirkungen!)

Vertreter
1) Kurzwirksam (Asthma ab Stufe I)
- Salbutamol
- Fenoterol (Tokolyse - Geburtshilfe)
- Reproterol
- Terbutalin

2) Langwirksam (Asthma ab Stufe III)
- Formoterol
- Salmeterol

Wirkung
- Bronchodilatation
- Tokolyse
- Dilatation der Gefäße
- Hemmung der Histaminfreisetzung

NW
- Hyperglykämie
- Hypokaliämie
- Tachykardie, Unruhe, Tremor

Kontraindikationen
- Phäochromozytom
- Glaukom
- Ausgeprägte Hyperthyreose
- Hypertrophe obstruktive Kardiomyopathie
Rezeptoren (#R: 0; #F: 0)
Auge - α1
- Mydriasis
- Fernakkommodation

Bronchien - β2
- Bronchodilatation

Herz - β1
- Herzfrequenz↑
- Kontraktilität↑
- Überleitung↑

Gefäße - α1
- Kontraktion von renalen und dermalen Gefäßen (führend)
Gefäße - β2
- Periphere Gefäßdilatation

Magen-Darm-Trakt - α1
- Sphinkterkontraktion
- Sekretion↓
Magen-Darm-Trakt - β2
- Peristaltik↓

Harnblase - α1
- Sphinkterkontraktion
Harnblase - β2
- Detrusorerschlaffung

Skelettmuskulatur - β2
- Kontraktion↑
- Glykogenolyse↑

Fettgewebe - β1
- Lipolyse↑
Sympathomimetika (#R: 0; #F: 0)
1) Noradrenalin
- Sepsis

2) Adrenalin
- Kardiopulmonale Reanimation
- Anaphylaxie

3) Dopamin
- kardiogenen Schock (akuter Herzinsuffizienz)

4) Dobutamin
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Antisympathotonika (#R: 0; #F: 0)
- Zentrale Drosselung der Aktivität der sympathischen Nervenfasern
- Hemmung der Synthese, Speicherung oder Freisetzung von Noradrenalin

Verterter
1) Reserpin
- Noradrenalin- und Dopamin-Wiederaufnahmehemmer
- NW: Depression

2) Urapidil
- Postsynaptische Blockade des α1-Rezeptors
- Stimulierung zentraler Serotoninrezeptoren
-> bei hypertensiver Krise
- NW: Kopfschmerzen und gastrointestinale Nebenwirkungen

3) α-Methyl-Dopa
- falscher Neurotransmitter (α-Methylnoradrenalin)
- Chronische Hypertonie in der Schwangerschaft
- NW: Na+- und H20-Retention

4) Clonidin
- Stimulation zentraler prä- und postsynaptischer α2-Rezeptoren
- Alkoholentzugstherapie + Glaukom + Hypertensive Krisen
- NW: Initialer Blutdruckanstieg; Rebound-Hypertonie nach Absetzen

5) Moxonidin
- Stimulation zentraler Imidazolin-Rezeptoren
- Arterielle Hypertonie

6) Tizanidin
- Stimulation zentraler α2-Rezeptoren
- zentrales Spasmolytikum

NW
- orthostatische Dysregulation
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Typische Antipsychotika (#R: 0; #F: 0)
= Dopaminantagonismus am D2-Rezeptor
Hochpotent -> Antipsychotisch
Niederpotent -> Sedierend + vegetativ
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Hochpotente Antipsychotika (#R: 0; #F: 0)
Starke antipsychotische Wirkung, gering sedierende Wirkung

1) Haloperidol
2) Benperidol
3) Flupentixol
4) Fluspirilen
5) Fluphenazin

Nebenwirkungen
- Extrapyramidal-motorische Störungen (EPS)
- Hyperprolaktinämie
- QT-Zeit-Verlängerung
Mittelpotente Antipsychotika (#R: 0; #F: 0)
Sowohl antipsychotische Wirkung als auch sedierende Wirkung

1) Melperon
2) Chlorpromazin
3) Perphenazin
Niedrigpotente Antipsychotika (#R: 0; #F: 0)
Gering antipsychotische Wirkung; Stark sedierende Wirkung

1) Levomepromazin
2) Chlorprothixen
3) Pipamperon

Nebenwirkungen
1) Anticholinerg
- Mundtrockenheit
- Mydriasis
- Obstipation
- tachykarde Herz-Rhythmus-Störungen
2) α-sympatholytische Wirkung
- Orthostatische Dysregulation
3) Antihistaminerge Wirkung
- Sedierung
4) Kardiale Wirkung
- QT-Zeit-Verlängerung
5) Metabolische Wirkung
- Gewichtszunahme / Gewichtsabnahme
Atypische Antipsychotika (#R: 0; #F: 0)
Antipsychotisch wirksame Substanz ohne klinisch relevante motorische Nebenwirkung

1) Clozapin (Agranulozytose möglich, Keine EPS, Keine Prolaktinerhöhung!)
2) Olanzapin (Mundtrockenheit, Obstipation)
3) Risperidon (als Depot möglich)
4) Quetiapin
5) Amisulprid
6) Ziprasidon
7) Aripiprazol

Nebenwirkungen
- Metabolisches Syndrom
- Hyperglykämien
- Hypercholesterinämie
- Gewichtszunahme
Frühdyskinesie (#R: 0; #F: 0)
Beginn
- 1. Woche

Symptome
- Zungen- und Schlundkrämpfe
- Grimassieren
- Torticollis
- Blickkrämpfe

Therapie
- Biperiden
Spätdyskinesie (#R: 0; #F: 0)
Beginn
- Monate - Jahre

Symptome
- Sterotype Kau- und Schmatzbewegungen
- Choreatische Bewegungen

Therapie
- Umstellung auf Clozapin
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Akathisie (#R: 0; #F: 0)
Beginn
- 1. - 8. Woche

Symptome
- Quälende Rastlosigkeit
- Sitz- und Stehunruhe

Therapie
- Antipsychotikum absetzen
- Propranolol
Malignes neuroleptisches Syndrom (#R: 0; #F: 0)
4 Wochen nach Beginn der Einnahme von Antipsychotika

Symptome
- Hohes Fieber
- Tachykardie, Tachypnoe
- Vigilanzminderung, Stupor, Verwirrtheitszustände
- Mutismus
- Extrapyramidal-motorische Symptome: Akinese, Tremor, Rigor

Diagnostik
- CK↑↑
- Transaminasen↑
- Leukozytose
- metabolische Azidose
- Myoglobinurie

Therapie
- Antipsychotika absetzen!
- Intensivmedizinische Betreuung
- L-Dopa, Apomorphin, Amantadin, Bromocriptin
- Dantrolen
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Selektive Serotoninwiederaufnahme-Hemmer (#R: 0; #F: 0)
Vertreter
1) Citalopram
2) Escitalopram
3) Sertralin
4) Fluvoxamin
5) Fluoxetin
6) Paroxetin

Nebenwirkungen
- Sexualstörungen
- Durchfälle, Übelkeit, Erbrechen
- Schlafstörungen
- Kopfschmerzen

Kontraindikationen
- Kombination von Tranylcypromin und SSRI ist streng kontraindiziert
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Trizyklische Antidepressiva (#R: 0; #F: 0)
Amytriptilin-Typ (sedierend, beruhigend, anticholinerg)
1) Amitriptylin
2) Trimipramin
3) Doxepin

Despiramin-Typ (antriebssteigernd; bei Suizidalität kontraindiziert)
4) Desipramin (Geringste anticholinerge Wirkung)
5) Nortriptylin

Imipramin-Typ
6) Imipramin
7) Clomipramin

Nebenwirkungen
- Tachykardie, hypertensive Krise
- Anticholinerges Syndrom und anticholinerges Delir
- Kardiotoxizität (Herzrhythmusstörungen)
- Reduktion der Krampfschwelle
- Orthostatische Hypotonie
Selektive Serotonin-Noradrenalin-Wiederaufnahme-Hemmer (#R: 0; #F: 0)
Vertreter
1) Venlafaxin
2) Duloxetin (Indikation: Belastungsinkontinenz)

Nebenwirkungen
- Übelkeit
- Hypertonie
Präsynaptische α-Blocker (#R: 0; #F: 0)
Vertreter
1) Mirtazapin

Nebenwirkungen
- Gewichtszunahme
- Sedierung
Kardioselektive Betablocker (#R: 0; #F: 0)
Indikationen
- KHK
- Arterielle Hypertonie
- Chronische Herzinsuffizienz

Vertreter
1) Metoprolol
- Hepatische Elimination
- Wirkdauer 12 Stunden

2) Atenolol
- Renal Elimination
- Wirkdauer 18 Stunden
- Sinnvoll bei Leberinsuffizienz

3) Bisoprolol
- Hepatische & Renale Elimination
- Wirkdauer 18 Stunden
- Besonders ausgeprägte β-1-Selektivität

4) Nebivolol
- Hepatische & Renale Elimination
- Wirkdauer 24 Stunden
- Bei schlechter Compliance sinnvoll (langwirksam!)
- Periphere Vasodilatation
Selektive Noradrenalin-Dopamin-Wiederaufnahmehemmer (#R: 0; #F: 0)
Vertreter
1) Bupropion
Unselektive Betablocker (#R: 0; #F: 0)
Vertreter
1) Propranolol
- Hepatische Elimination
- Wirkdauer 12 Stunden
-> Thyreotoxische Krise
-> Akute Aufregung und Unruhe
-> Portale Hypertension

2) Carvedilol
- Hepatisch & Renale Elimination
- Wirkdauer 18 Stunden
-> α1: Periphere Vasodilatation
-> β1: Negativ inotrope Wirkung am Herzen
Selektive Noradrenalin-Wiederaufnahmehemmer (#R: 0; #F: 0)
Vertreter
1) Reboxetin
Beta-Blocker - Kontraindikationen (#R: 0; #F: 0)
Absolut
- Deutliche Bradykardie
- Hypotonie
- Phäochromozytom
- Dekompensierte Herzinsuffizienz
- Asthma bronchiale
- Kalziumantagonisten vom Diltiazem- oder Verapamil-Typ → Gefahr des AV-Blocks
- Unselektive Beta-Blocker: Akutes Koronarsyndrom

Relativ
- Psoriasis
- Raynaud-Syndrom
- pAVK
- Schwangerschaft
MAO-Hemmer (#R: 0; #F: 0)
Vertreter
1) Moclobemid
2) Tranylcypromin

Kontraindikationen
- Kombination von Tranylcypromin und SSRI ist streng kontraindiziert
Kalzium-Antagonisten (#R: 0; #F: 0)
Blockade von L-Typ Kalziumkanälen (gehemmter Ca2+-Einstrom)

1) Nifedipin-Typ
- Dilatation der peripheren Gefäße
-> Nifedipin (HWZ < 2h)
-> Nitrendipin (HWZ 8 - 12h)
-> Lercanidipin (HWZ 8 - 12h)
-> Amlodipin (HWZ > 24h)

2) Verapamil-Typ
- negative inotrop, dromotrop und chronotrop
-> Verapamil
-> Gallopamil

3) Diltiazem-Typ
- Einfluss auf alle Zielorgane (Gefäße + Herz)
- geringerer Effekt
-> Diltiazem

Indikationen
- arteriellen Hypertonie
- stabile Angina pectoris
- Supraventrikuläre Tachykardie
- Raynaud-Syndroms (Nifedipin)

Nebenwirkungen
- Kopfschmerzen
- Flush
- periphere Ödeme
- reflektorische Tachykardien

Kontraindikationen
- Herzinsuffizienz
- Hypotension
- schwere stenosierende Herzvitien
- Kombination mit Nitraten
Melatonin-Analoga (#R: 0; #F: 0)
Vertreter
1) Agomelatin
ACE-Hemmer (#R: 0; #F: 0)
Vertreter
1) Enalapril
2) Lisinopril
3) Ramipril
4) Captopril

Indikationen
- Diabetes mellitus (Mittel der 1. Wahl: Nephroprotektiv)
- Herzinsuffizienz
- Zustand nach Herzinfarkt
- Junge Patienten
- Metabolisches Syndrom

Nebenwirkungen
- Hypotension
- Hyperkaliämie (+ Thiazide gleicht aus)
- Angioneurotisches Ödem
- Allergische Reaktionen
- Reizhusten

Kontraindikationen
- Beidseitige Nierenarterienstenose
- Hyperkaliämie
- Schwangerschaft und Stillzeit
Sartane (#R: 0; #F: 0)
Vertreter
1) Valsartan
2) Candesartan
3) Losartan

Indikationen
- Diabetes mellitus (Mittel der 1. Wahl: Nephroprotektiv)
- Herzinsuffizienz
- Zustand nach Herzinfarkt
- Junge Patienten
- Metabolisches Syndrom

Nebenwirkungen
- Hypotension
- Hyperkaliämie (+ Thiazide gleicht aus)
- Angioneurotisches Ödem
- Allergische Reaktionen
- Schwindel
- Kopfschmerzen

Kontraindikationen
- Beidseitige Nierenarterienstenose
- Hyperkaliämie
- Schwangerschaft und Stillzeit
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Direkte Renin-Inhibitoren (#R: 0; #F: 0)
Verterter
1) Aliskiren

Indikation
- arterieller Hypertonus

Nebenwirkungen
- Gastrointestinale Beschwerden, vor allem Diarrhö

Kontraindikationen
- Kombination mit Ciclosporin, Chinidin und Verapamil
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Phosphodiesterase-Hemmer (#R: 0; #F: 0)
- Periphere vasodilatatorische Wirkung
- + positiv inotrop (nur PDE-III-Hemmer)

Vertreter
1) Phosphodiesterase-V-Hemmer
- Erektile Dysfunktion
- Pulmonale Hypertonie
- NW: Kopfschmerzen und Schwindel; Sehstörungen; Flush; Schnupfen; Exanthem
-> Sildenafil
-> Tadalafil
-> Vardenafil

2) Phosphodiesterase-III-Hemmer
- Kurzzeittherapie bei schwerer akuter Herzinsuffizienz
- NW: Hypotension; Gastrointestinale Nebenwirkungen
-> Milrinon
-> Enoximon
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Herzglykoside (#R: 0; #F: 0)
Hemmung der Natrium/Kalium-ATPase in den Kardiomyozyten
- positiv inotrop
- negativ dromotrop
- geringe therapeutische Breite

Verterter
1) Digoxin
- hydrophil
- renale Elimination → Kumulation bei Niereninsuffizienz
- Antidot: Digitalisantikörper
2) Digitoxin
- lipophil
- Hepatische Metabolisierung → Bevorzugter Einsatz bei Niereninsuffizienz
- Antidot: Digitalisantikörper + Cholestyramin + Hämoperfusion

Indikationen
- Tachykardes Vorhofflimmern
- Herzinsuffizienz Stadium ≥ NYHA III
- Paroxysmale supraventrikuläre Tachykardie

Nebenwirkungen
- Gastrointestinale Nebenwirkungen
- Herzrhythmusstörungen
- Neurotoxizität: Sehstörungen
- Bei Digoxin: Niereninsuffizienz

Kontraindikationen
- Hypokaliämie
- Hyperkalzämie
- AV-Block ≥ II°
- Sick-Sinus-Syndrom
- Wolff-Parkinson-White-Syndrom
- Hypertrophische Obstruktive Kardiomyopathie (HOCM)
- Digoxin bei Niereninsuffizienz

Interaktion
1) Wirkungsverstärkend
- Erythromycin
- Butylscopolamin
- Captopril
- Nitrendipin
2) Wirkungsmindernd
- Anionenaustauscherharze (Colestipol, Colestyramin)
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Prävention von arteriellen Embolien

Verterter
1) Irreversible Cyclooxygenase-1-Hemmer
- Akutes Koronarsyndrom
- Pekutane transluminale Angioplastie (PTCA)
- Stentimplantation
- Sekundärprophylaxe zerebraler Ischämien und der KHK
-> Acetylsalicylsäure

2) ADP-Rezeptor-Hemmer
- Z.n. ischämischem Apoplex und Myokardinfarkt
- pAVK, akutes Koronarsyndrom in Kombination mit ASS
- Stentimplantation, ASS-Unverträglichkeit
-> Clopidogrel
-> Ticlopidin
-> Prasugrel
-> Ticagrelor

3) Glykoprotein-IIb/IIIa-Antagonisten
- PTCA mit hohem Risiko
- Instabile Angina pectoris
-> Abciximab
-> Eptifibatid
-> Tirofiban

Nebenwirkungen
- Blutungen
- ASS: Reye-Syndrom bei Kindern (heftiges Erbrechen + hepatische Enzephalopathie)
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