{"id":4647,"count":22,"description":"Kategorie L\u00e9\u010dba situa\u010dn\u00ed \u00fazkosti na MedsBase je zav\u00e1d\u011bj\u00edc\u00ed n\u00e1zev, kter\u00fd stoj\u00ed za pochopen\u00ed.<\/strong> Ka\u017ed\u00fd produkt na t\u00e9to str\u00e1nce je psychiatrick\u00fd l\u00e9k pro chronick\u00e9 u\u017e\u00edv\u00e1n\u00ed \u2013 antidepresiva (SSRI, SNRI, TCA), atypick\u00e1 antipsychotika nebo souvisej\u00edc\u00ed l\u00e1tky p\u0159edepisovan\u00e9 a titrovan\u00e9 po t\u00fddny pro diagnostikovan\u00e9 poruchy n\u00e1lady, \u00fazkostn\u00e9 a psychotick\u00e9 poruchy. \u017d\u00e1dn\u00fd z t\u011bchto l\u00e9k\u016f nen\u00ed prvn\u00ed volbou pro akutn\u00ed, v\u00fdkonnostn\u011b souvisej\u00edc\u00ed \u201csitua\u010dn\u00ed\u201d \u00fazkost<\/strong> (leteck\u00e1 doprava, ve\u0159ejn\u00e9 vystupov\u00e1n\u00ed, zkou\u0161ky, pohovory) \u2013 pro tyto situace jsou klinicky vhodn\u00fdmi mo\u017enostmi kr\u00e1tkodob\u011b p\u016fsob\u00edc\u00ed betablok\u00e1tory (propranolol), benzodiazepiny a sedativn\u00ed antihistaminika (hydroxyzin), z nich\u017e \u017e\u00e1dn\u00e9 nejsou v t\u00e9to kategorii skladem. Pokud m\u00e1te pouze ob\u010dasn\u00e9 akutn\u00ed \u00fazkostn\u00e9 stavy, n\u00ed\u017ee uveden\u00e9 l\u00e9ky nejsou vhodn\u00fdm v\u00fdchoz\u00edm bodem. Pokud se jedn\u00e1 o diagnostikovanou depresivn\u00ed, \u00fazkostnou, bipol\u00e1rn\u00ed nebo psychotickou poruchu vy\u017eaduj\u00edc\u00ed dlouhodobou l\u00e9\u010dbu, n\u00ed\u017ee uveden\u00fd p\u0159ehled organizuje dostupn\u00e9 p\u0159\u00edpravky podle t\u0159\u00edd l\u00e9\u010div.\n\nSSRI \u2013 selektivn\u00ed inhibitory zp\u011btn\u00e9ho vychyt\u00e1v\u00e1n\u00ed serotoninu\nPrvn\u00ed volba antidepresiv celosv\u011btov\u011b pro velkou depresivn\u00ed poruchu (MDD), generalizovanou \u00fazkostnou poruchu (GAD), panickou poruchu, soci\u00e1ln\u00ed \u00fazkostnou poruchu, OCD, PTSD a PMDD. \u00dapln\u00fd \u00fa\u010dinek na n\u00e1ladu nastupuje za 4\u20136 t\u00fddn\u016f; \u00fazkostn\u00e9 p\u0159\u00edznaky \u010dasto reaguj\u00ed ji\u017e za 1\u20132 t\u00fddny. \u010cast\u00e9 ne\u017e\u00e1douc\u00ed \u00fa\u010dinky jsou nevolnost, gastrointestin\u00e1ln\u00ed pot\u00ed\u017ee (obvykle p\u0159echodn\u00e9), sexu\u00e1ln\u00ed dysfunkce a m\u00edrn\u00e9 zm\u011bny hmotnosti. Vysazov\u00e1n\u00ed mus\u00ed b\u00fdt postupn\u00e9 \u2013 nikdy n\u00e1hl\u00e9.\n\nSertraline<\/strong> \u2014 nej\u010dist\u0161\u00ed CYP profil ze skupiny SSRI a preferovan\u00fd v t\u011bhotenstv\u00ed \/ kojen\u00ed: Sertafine<\/a>, Sertagress<\/a>, Sertima<\/a>, Zosert<\/a> (50\/100 mg). Schv\u00e1leno pro MDD, OCD (dosp\u011bl\u00ed a d\u011bti), panickou poruchu, soci\u00e1ln\u00ed \u00fazkost, PTSD, PMDD.\nParoxetine<\/strong> \u2014 Xepar<\/a> 20 mg. SSRI s nej\u0161ir\u0161\u00edm spektrem indikac\u00ed schv\u00e1len\u00fdch FDA pro \u00fazkostn\u00e9 poruchy (MDD, GAD, soci\u00e1ln\u00ed \u00fazkost, panick\u00e1 porucha, OCD, PTSD, PMDD). Kompromisy: nejhor\u0161\u00ed abstinen\u010dn\u00ed syndrom ve t\u0159\u00edd\u011b (velmi kr\u00e1tk\u00fd polo\u010das), nejv\u011bt\u0161\u00ed n\u00e1r\u016fst hmotnosti, nejvy\u0161\u0161\u00ed v\u00fdskyt sexu\u00e1ln\u00ed dysfunkce, t\u011bhotensk\u00e1 kategorie D.\n\n\nSNRI \u2013 inhibitory zp\u011btn\u00e9ho vychyt\u00e1v\u00e1n\u00ed serotoninu a noradrenalinu\nDruh\u00e1 hlavn\u00ed t\u0159\u00edda antidepresiv prvn\u00ed volby. Venlafaxine<\/strong> (s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm) je schv\u00e1len pro MDD, GAD, soci\u00e1ln\u00ed \u00fazkost a panickou poruchu. Mechanismus se m\u011bn\u00ed s d\u00e1vkou: podobn\u00fd SSRI pod 150 mg\/den, skute\u010dn\u00e9 SNRI (s inhibic\u00ed zp\u011btn\u00e9ho vychyt\u00e1v\u00e1n\u00ed noradrenalinu) p\u0159i 150\u2013225 mg\/den, s pln\u00fdm \u00fa\u010dinkem u rezistentn\u00ed deprese p\u0159i 225\u2013375 mg\/den u MDD. Specifick\u00e9 obavy: d\u00e1vkov\u011b z\u00e1visl\u00fd vzestup krevn\u00edho tlaku (monitorovat TK p\u0159i > 225 mg\/den) a t\u011b\u017ek\u00fd abstinen\u010dn\u00ed syndrom (nutn\u00e9 postupn\u00e9 vysazov\u00e1n\u00ed). Nebezpe\u010dn\u011bj\u0161\u00ed p\u0159i p\u0159ed\u00e1vkov\u00e1n\u00ed ne\u017e SSRI.\n\nAffexor XR<\/a> \u00b7 Venish SR<\/a> \u00b7 Venpad XR<\/a> \u00b7 Ventab XL<\/a> \u2013 v\u0161echny p\u0159\u00edpravky venlafaxinu s prodlou\u017een\u00fdm uvol\u0148ov\u00e1n\u00edm v sil\u00e1ch 37,5 \/ 75 \/ 150 mg.\n\n\nTricyklick\u00e1 antidepresiva (TCA) a TCA-p\u0159\u00edbuzn\u00e1 anxiolytika\nStar\u0161\u00ed t\u0159\u00edda antidepresiv v\u011bt\u0161inou nahrazen\u00e1 SSRI\/SNRI jako prvn\u00ed volba u deprese, ale st\u00e1le u\u017eite\u010dn\u00e1 pro rezistentn\u00ed depresi, neuropatickou bolest, panickou poruchu, d\u011btskou enur\u00e9zu a prevenci migr\u00e9ny. Hlavn\u00edmi probl\u00e9my jsou anticholinergn\u00ed z\u00e1t\u011b\u017e, sedace, ortostatick\u00e1 hypotenze a kardiotoxicita p\u0159i p\u0159ed\u00e1vkov\u00e1n\u00ed \u2013 u pacient\u016f nad 50 let je nutn\u00e9 v\u00fdchoz\u00ed EKG.\n\nD-mine<\/a> \u2014 imipramin 25 mg, p\u016fvodn\u00ed tricyklik; pro MDD, panickou poruchu, d\u011btskou enur\u00e9zu, neuropatickou bolest.\nPrimox<\/a> \u2014 nortriptylin 25 mg, sekund\u00e1rn\u00ed-amin TCA s nejni\u017e\u0161\u00ed anticholinergn\u00ed z\u00e1t\u011b\u017e\u00ed ve t\u0159\u00edd\u011b; tricyklik prvn\u00ed volby pro prevenci migr\u00e9ny a chronick\u00e9 neuropatick\u00e9 bolesti.\nOpiprol<\/a> \u2014 opipramol 50 mg, atypick\u00e9 TCA-p\u0159\u00edbuzn\u00e9 anxiolytikum, kter\u00e9 ne<\/em> inhibuje zp\u011btn\u00e9 vychyt\u00e1v\u00e1n\u00ed serotoninu (jeho mechanismus je agonismus sigma-receptor\u016f plus antihistaminikum); prim\u00e1rn\u011b se pou\u017e\u00edv\u00e1 u generalizovan\u00e9 \u00fazkostn\u00e9 poruchy a somatoformn\u00edch poruch, hlavn\u011b v n\u011bmecky mluv\u00edc\u00edch zem\u00edch.\n\n\nAtypick\u00e1 antidepresiva \u2013 mirtazapin, trazodon, vilazodon\nT\u0159i l\u00e9ky s mechanismy mimo paradigma SSRI \/ SNRI \/ TCA.\n\nNasdep<\/a> \u2014 mirtazapin 30 mg, tetracyklick\u00fd NaSSA se silnou antihistaminovou aktivitou H1. Paradoxn\u00ed vzorec sedace (v\u00edce sedativn\u00ed p\u0159i 15 mg ne\u017e p\u0159i 45 mg). V\u00fdrazn\u00fd n\u00e1r\u016fst hmotnosti. Nejvhodn\u011bj\u0161\u00ed pro MDD s nespavost\u00ed, sn\u00ed\u017eenou chut\u00ed k j\u00eddlu nebo \u00fabytkem hmotnosti, kdy vedlej\u0161\u00ed \u00fa\u010dinky pracuj\u00ed pro pacienta, nikoli proti n\u011bmu.\nTrazalon<\/a>, Trazonil<\/a>, Tridon<\/a> \u2014 trazodon (50 \/ 100 mg). Schv\u00e1len pro MDD, ale dominantn\u00ed modern\u00ed pou\u017eit\u00ed je off-label v n\u00edzk\u00fdch d\u00e1vk\u00e1ch (25\u2013100 mg) pro chronickou nespavost. \u017d\u00e1dn\u00fd potenci\u00e1l vzniku z\u00e1vislosti; hlavn\u00ed obavy jsou ortostatick\u00e1 hypotenze (blok\u00e1da alfa-1), priapismus u mu\u017e\u016f (vz\u00e1cn\u011b 1 z 1 000\u201310 000 \u2014 nouzov\u00fd stav, pokud trv\u00e1 > 4 hodiny) a prodlou\u017een\u00ed QT intervalu p\u0159i vy\u0161\u0161\u00edch d\u00e1vk\u00e1ch.\nVilano<\/a> \u2014 vilazodon 40 mg, SSRI plus parci\u00e1ln\u00ed agonista 5-HT1A s ni\u017e\u0161\u00edmi sexu\u00e1ln\u00edmi vedlej\u0161\u00edmi \u00fa\u010dinky ne\u017e jin\u00e1 SSRI. Mus\u00ed se u\u017e\u00edvat s j\u00eddlem o obsahu \u2265 500 kalori\u00ed<\/strong> \u2013 biologick\u00e1 dostupnost se na la\u010dno sni\u017euje na polovinu.\n\n\nAtypick\u00e1 antipsychotika\nAntipsychotika druh\u00e9 generace pro schizofrenii, bipol\u00e1rn\u00ed poruchu a adjuvantn\u00ed l\u00e9\u010dbu rezistentn\u00ed deprese. V\u0161echny nesou varov\u00e1n\u00ed FDA o zv\u00fd\u0161en\u00e9 \u00famrtnosti u star\u0161\u00edch pacient\u016f s psych\u00f3zou souvisej\u00edc\u00ed s demenc\u00ed. Monitorujte hmotnost, hladinu gluk\u00f3zy nala\u010dno a lipidy na za\u010d\u00e1tku, po 3 m\u011bs\u00edc\u00edch a pak ro\u010dn\u011b (metabolick\u00fd syndrom je t\u0159\u00eddn\u00edm rizikem).\n\nPsyquit<\/a> \u00b7 Q-Siz SR 400<\/a> \u2014 kvetiapin v okam\u017eit\u011b uvol\u0148ovan\u00e9 a prodlou\u017een\u011b uvol\u0148ovan\u00e9 form\u011b. Siln\u00e1 sedace; \u0161irok\u00e9 indikace (schizofrenie, bipol\u00e1rn\u00ed m\u00e1nie a deprese, adjuvans u MDD).\nRiscon<\/a> \u2014 risperidon pro schizofrenii, bipol\u00e1rn\u00ed m\u00e1nii a podr\u00e1\u017ed\u011bnost u autismu. Charakteristick\u00fd vedlej\u0161\u00ed \u00fa\u010dinek: nejvy\u0161\u0161\u00ed hyperprolaktin\u00e9mie mezi atypick\u00fdmi antipsychotiky (galaktorea, gynekomastie, amenorea, sexu\u00e1ln\u00ed dysfunkce). P\u0159i d\u00e1vk\u00e1ch > 6 mg\/den p\u0159ech\u00e1z\u00ed do EPS podobn\u00e9ho typick\u00fdm antipsychotik\u016fm.\nZipsydon<\/a> \u2014 ziprasidon pro schizofrenii a bipol\u00e1rn\u00ed m\u00e1nii. Nejni\u017e\u0161\u00ed metabolick\u00e1 z\u00e1t\u011b\u017e mezi b\u011b\u017en\u00fdmi atypick\u00fdmi antipsychotiky (men\u0161\u00ed p\u0159\u00edr\u016fstek hmotnosti, men\u0161\u00ed vliv na gluk\u00f3zu\/lipidy), ale nejvy\u0161\u0161\u00ed riziko prodlou\u017een\u00ed QT intervalu (nutn\u00e9 v\u00fdchoz\u00ed EKG). Mus\u00ed se u\u017e\u00edvat s j\u00eddlem o obsahu \u2265 500 kalori\u00ed<\/strong>.\n\n\nKombinace antipsychotika prvn\u00ed generace s anticholinergikem\nObjednejte si Glynase XL (5 mg nebo 10 mg (XL)) od spole\u010dnosti MedsBase v balen\u00edch po 30, 60, 90 nebo 180 tablet\u00e1ch. Dod\u00e1v\u00e1me po cel\u00e9m sv\u011bt\u011b, s diskr\u00e9tn\u00edm balen\u00edm a certifikovan\u00fdm v\u00fdrobcem WHO-GMP.<\/a> \u2013 trifluoperazin 5 mg + trihexifenidyl 2 mg. Vysoce potentn\u00ed typick\u00e9 antipsychotikum sp\u00e1rovan\u00e9 s anticholinergn\u00edm anti-Parkinsonov\u00fdm \u010dinidlem k prevenci EPS (parkinsonismus, dystonie, akatizie), kter\u00e9 vysoce potentn\u00ed typick\u00e1 antipsychotika rutinn\u011b zp\u016fsobuj\u00ed. Pou\u017e\u00edv\u00e1 se tam, kde typick\u00e1 antipsychotika z\u016fst\u00e1vaj\u00ed prvn\u00ed volbou z d\u016fvodu n\u00e1klad\u016f nebo dostupnosti a ve stabiln\u00edch dlouhodob\u00fdch re\u017eimech. Modern\u00ed praxe obecn\u011b up\u0159ednost\u0148uje monoterapii atypick\u00fdmi antipsychotiky tam, kde jsou dostupn\u00e9 \u2013 ni\u017e\u0161\u00ed riziko EPS, ni\u017e\u0161\u00ed riziko tardivn\u00ed dyskineze a nen\u00ed nutn\u00e1 rutinn\u00ed anticholinergn\u00ed kryt\u00ed. Trihexifenidyl m\u00e1 uzn\u00e1van\u00fd potenci\u00e1l zneu\u017eit\u00ed p\u0159i supraterapeutick\u00fdch d\u00e1vk\u00e1ch.\n\nJak vybrat\nPro nel\u00e9\u010denou MDD nebo \u00fazkostn\u00e9 poruchy bez p\u0159edchoz\u00ed l\u00e9\u010dby, sertralin<\/strong> je nejobhajiteln\u011bj\u0161\u00ed volbou prvn\u00ed linie na z\u00e1klad\u011b \u010dist\u00e9ho interak\u010dn\u00edho profilu, \u0161irok\u00fdch indikac\u00ed a bezpe\u010dnosti v t\u011bhotenstv\u00ed\/kojenc\u00ed. U MDD s v\u00fdraznou nespavost\u00ed, sn\u00ed\u017eenou chut\u00ed k j\u00eddlu nebo \u00fabytkem hmotnosti je, mirtazapin<\/strong> je rozumnou alternativou, proto\u017ee ne\u017e\u00e1douc\u00ed \u00fa\u010dinky p\u016fsob\u00ed ve prosp\u011bch pacienta. Pro chronickou nespavost nereaguj\u00edc\u00ed na behavior\u00e1ln\u00ed intervence je n\u00edzk\u00e1 d\u00e1vka trazodonu<\/strong> celosv\u011btov\u011b nej\u010dast\u011bji p\u0159edepisovan\u00fdm hypnotikem off-label. U schizofrenie nebo bipol\u00e1rn\u00ed poruchy I. typu je v modern\u00ed praxi atypick\u00e9 antipsychotikum (kvetiapin, risperidon, ziprasidon) prvn\u00ed volbou p\u0159ed typick\u00fdmi antipsychotiky. \u017d\u00e1dn\u00fd z t\u011bchto l\u00e9k\u016f nenahrazuje individu\u00e1ln\u00ed psychiatrick\u00e9 hodnocen\u00ed<\/strong> \u2014 spr\u00e1vn\u00e1 volba z\u00e1vis\u00ed na diagn\u00f3ze, komorbidit\u011b, p\u0159edchoz\u00ed l\u00e9\u010debn\u00e9 historii, l\u00e9kov\u00fdch interakc\u00edch a t\u011bhotenstv\u00ed.\n\nOrigin\u00e1ln\u00ed z\u00e1soby od v\u00fdrobce certifikovan\u00e9ho WHO-GMP \u00b7 diskr\u00e9tn\u00ed balen\u00ed \u00b7 celosv\u011btov\u00e1 doprava \u00b7 1 400+ z\u00e1kazn\u00edk\u016f ve v\u00edce ne\u017e 50 zem\u00edch.<\/strong> Ka\u017ed\u00e1 objedn\u00e1vka je pokryta na\u0161\u00edm Z\u00e1rukou op\u011btovn\u00e9ho odesl\u00e1n\u00ed<\/a>.","link":"https:\/\/medsbase.com\/cs\/situational-anxiety-treatment\/","name":"L\u00e9\u010dba situa\u010dn\u00ed \u00fazkosti","slug":"situational-anxiety-treatment","taxonomy":"product_cat","parent":3223,"meta":[],"menu_order":0,"acf":[],"_links":{"self":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/4647","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat"}],"about":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/taxonomies\/product_cat"}],"up":[{"embeddable":true,"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product_cat\/3223"}],"wp:post_type":[{"href":"https:\/\/medsbase.com\/cs\/wp-json\/wp\/v2\/product?product_cat=4647"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}