Final 6e URG

Question 1

Quels sont les Side effects des AINS ? 5

Answer 1

1. Gastric and duodenal ulcers → gastrointestinal bleeding and perforation
2. Increased risk of heart attack and stroke (sauf aspirin et naproxen)
3. Renal function impairment:
   _{Prostaglandins normally maintain renal blood flow by inducing vasodilation of the afferent arterioles.}
4. Aplastic anemia
5. Pseudoallergic reactions

Question 2

Selective COX-2 inhibitors

1. Side effects 2
2. Indication 2

Answer 2

1. Side effects
   
   1. Increased risk of thrombosis, infarctus, and/or AVC
   2. Sulfa drug allergic reaction
2. Indications
   
   1. Rheumatoid arthritis
   2. Osteoarthritis

Question 3

Acetaminophen

1. Effet secondaire 1
2. Indication 2

Answer 3

1. ES
   
   1. Hepatotoxicity → acute hepatic failure
   2. Limited nephrotoxicity
2. Indic
   
   • Preferred durant pregnancy
   • Preferred over aspirin in pediatric viral infections → lower risk of Reye syndrome

Question 4

N-acetyl-cyctéine

1. Indication 3
2. Effet sec 2

Answer 4

1. Indications :
   
   1. Paracétamolémie en zone toxique = 0.15g/kg ou 150ug/ml
      4-24 h après ingestion unique
   2. Dose potentiellement toxique (ou inconnue) et délai entre 8h et 24h
   3. Prise paracétamol non datable ou > 24h, et atteinte hépatique et/ou paracétamolémie > 10μg/ml
2. ES
   
   1. Vomissement
   2. Réaction alergique

Question 5

1. Naltrexone 3 VS
2. Nalaxone 1

Answer 5

1. Prevention of opioid relapse after acute detoxification
   Alcohol use disorder
   Smoking cessation
2. Acute opioid intoxication (pour reversal of CNS and respiratory depression)

Question 6

Abus d’opioïde → clinique 9

Answer 6

1. EC altéré, euphorie, depression SNC
2. Miosis bilat
3. Dépression resp
4. Epilepsie, myoclonie
5. Constipation + ↓ Bowel sounds
6. ↓ Gag reflex
7. ↓ Heart rate
8. ↓ blood pressure
9. hypo T°

Question 7

Sevrage d’opioïde

1. → clinique 4
2. TTT 2

Answer 7

1. clinique
   
   1. Flu-like symptoms
   2. Gastrointestinal symptoms
   3. Sympathetic hyperactivity
      
      1. Mydriasis
      2. Tachycardia, hypertension
      3. Hyperreflexia, muscle cramps
   4. CNS stimulation
      
      1. Insomnia, irritability, anxiety, agitation
2. Treatment
   
   1. Buprenorphine
   2. Methadone

Question 8

Si patient se présente avec stridor à l’inspi et une dyspnée progressive depuis quelque jour, post intubation il y’a 4 semaine d’une durée de 10jours

1. on pense à quoi ?
2. doit faire quel analyse ?

Answer 8

1. Complication d’intubation > 7j → peut donner ischémie, inflammation, nécrose et fibrose endotrachéale mène à sténose laryngé
2. Laryngoscopie

Question 9

Anesthésiant inhalation

1. Indication ?
2. Mécanisme ? 4
3. Effet secondaire ? 2

Answer 9

1. Initié et maintenir AG
2. Pas connu
   
   1. Sedation/narcosis
   2. Anesthesia (nitrous oxide)
   3. ↓ Respiration and arterial blood pressure, myocardial depression
   4. ↑ Cerebral blood flow and PIC, ↓ cerebral metabolic demand
3. ES
   
   1. PostOp N/V
   2. Hyperthermie

Question 10

Anesthésiant inhalation

1. pharmacocynétique ?
2. Pharmacodynamique ?
3. Effet secondaire ? 2

Answer 10

1. Initié et maintenir AG
2. Dynamique
   
   1. si lower the MAC value, the more fat soluble the anesthetic.
      
      • slow induction and high potency → high lipid and blood solubility.
      • fast induction and low potency → low lipid and blood solubility.

Question 11

A 46-year-old woman is brought to the emergency department for respiratory depression. Routine urine toxicology screening is positive for alcohol, fentanyl, and benzodiazepines. Blood glucose is 80 mg/dL. Naloxone, flumazenil, and lactated Ringer’s solution are administered intravenously. Two hours later, the woman has a tonic-clonic seizure lasting for one minute. Her pulse is 100/min, blood pressure is 145/90 mm Hg, and respiratory rate is 24/min. Pulse oximetry on room air shows an oxygen saturation of 98%. The patient appears drowsy and diaphoretic. She is not oriented to place or time but responds to her name. Examination shows a hematoma on her left temple. Neurological examination shows stiff extremities and a tremor in both hands. The remainder of the examination shows no abnormalities. Which of the following is the most likely cause of this patient’s seizure?

1. Hyponatremia
2. Hypoxic-ischemic brain injury
3. Hypoglycemia
4. Benzodiazepine withdrawal
5. Alcohol withdrawal
6. Fentanyl overdose
7. Subdural hemorrhage

Answer 11

Benzodiazepine withdrawal due to administration of its antagonist, flumazenil, may precipitate withdrawal seizure, especially in patients with high tolerance to benzodiazepines from chronic use. If benzodiazepine dependence is suspected, an anticonvulsant (e.g., carbamazepine) is indicated as seizure prophylaxis. Because of the high risk of withdrawal seizure and the relatively low rates of benzodiazepine overdose, the use of flumazenil should only be administered in a controlled setting in cases of severe respiratory depression.