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ECN > Pharma > Flashcards

Pharma Flashcards

1
Q

Mecanisme d’action diuretique de l’anse

A

inh. absorbtion Na (Na-K-2Cl) branche asc. anse Hale

action rapide ++

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2
Q

Mecanisme d’action diuretique thiasidique

A

inh. reab Na (Na-K) TCD

plus lent que diuretique d’anse

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3
Q

Mecanisme d’action diuretique epragner K

A

inh. absorbtion Na apical

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4
Q

Heparine curative: CI

A

endocardite infect
hemorragie
infarctus cerebral etandu

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5
Q

Mecanisme d’action aspirine

A

inh. cyco-oxygenase - COX1
dim. TXA - thromboxane A2 et prostaglandine
- -> dose faible- plus antiagregant
- -> > 500 mg- anti-inflamatoire

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6
Q

Indication aspirine- antiagregante

A

angor, IDM, AOMI, AVC/AIT

FA a faible risque embolique

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7
Q

CI aspirine

A 
Maladie hemorragique congenitale
Allergie vrai
ulcer GD
sy. Widal
pas indique association avec autres AINS
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8
Q

EI aspirine

A

UGD
hemorragie digestive
anemie feriprive
sy. hemorragique

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9
Q

aspirine et chirurgie- comment arreter?

A

arreter aspirine 5 J avant chiru majeur et relai imediatement. Si fibroscopie, biopsie: pas neccesaire
si SCA, retarder chiru:
–>6 SA si stent nu
–>6M si stent actif

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10
Q

Inh. P2Y12: 2 classes- mechanisme d’action

A
  • thyenopiridine= clopidogrel, prasugrele= bloque la fixation d’ ADP- IRREVESIBLE
  • CPTP= tycagrelor= empeche la transduction du signal= reversible
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11
Q

Doses inh. P2Y12

A

Clopidogrel= Plavix: 300 et 75
Prasigrel: 60 et 10
Ticagrelor= Brilique= 180 et 90

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12
Q

Ci absolute et relative Prasugrel

A

absolute: AVC/AIT
relative: < 60 ans > 75 ans

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13
Q

Inh. P2Y12 avant chirurgie - meme si biopsie, fibroscopie

A

Clopidogrel et ticagrelor: interromtion 5 J avant

Prasugrel: 7 J avant

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14
Q

Diuretiques thiazidique- representants

A

Hydrochlorodhiazide
Indapamide
Cicletamine

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15
Q

Ei diruetiques thiazidiques

A 
hypoNa
hypoK + alcalose metabolique
HyperCa
Hyperuricemie
hyperTRIGLICERIDEMIE ET CHOLESTEROLEMIE
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16
Q

CI diuretiques thiazidique

A 
IR <30
allergie aux sulfamides
obstruction des vois urninaires
trb. electrolitiques
goutte
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17
Q

Mecansime d’action IEC et ARA2

A

IEC: inh. competitive l’enzime de conversion de l’angiotensine 1 en angiotensine 2 et aug. bradikinine

ARA2: inh. competitive le recepteur AT1 de l’angiotensine 2

  • dim RVP
  • dim. la retention hydrosodee: baisse de l’aldosterone)
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18
Q

Representants: IEC et ARA2

A

IEC:

  • Captopril
  • Enalapril
  • Perindopril
  • Ramipril

ARA2:

  • Valsartan
  • Olmesartan
  • Irbesartan
  • Candesartan
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19
Q

Ei IEC/ARA2

A 
hyperK
hypotension orthostatique
toux seche (aug. bradikinine)
IR fonctionelle
IEC: oedeme angioneurotique
foetopathie au 2eme et 3eme trim

! Captopril: neutropenie, agranulocitose

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20
Q

Ci IEC/ARA2

A

grossesse
atcd d’oedeme angioneurotique
hyperK > 6
stenose bilat d’artere renale

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21
Q

Interactions IEC/ARA2

A

AINS
produis de contraste, diuretique
diuretique epargneur de K
sels de K

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22
Q

mechanisme d’action inh. calciques

A

inh. canaux Ca voltage dependents de type L
- -> effect vasodilatateru peripherique + DIM. rvp
- -> Dilatarea arterelor: coronare, cerebrale

! verapamil: ef. dromotrop neg (dim. condiction) et ralentissement de l’activite sinusale

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23
Q

2 types de inh. Ca + representants

A

dihidropiridines: amlodipine, nicardipine, nifedipine, felodipine

non-dihidropiridine: Verapamil et Diltiazem

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24
Q

Ei inh. Ca

A 
IC
rush, cephalee, vertige
oedeme MI
reflex tachycardia
Verapamil: constipation
Bloc conduction nodale: BAV, BB, BSA
bradicardie

! dihidropiridine: TACHYCARDIE

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25
Q

Indications inh. Ca

A 
Angine Prinzmetal
Raynaud
Apres hemorragie meningee- nemedipine
Pre-eclampsie
Prevention migraines
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26
Q

a-bloquant pour HTA- representants et effect adverses

A

Urapidil
Prazosine
Doxazosine

EI:

  • hypotension orthostatique
  • reponse importante
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27
Q

Antihypertenseurs centraux et EI

A

Clonidine
Methyldopa
Monoxidine

EI:

  • sy. depressif
  • hypotension orthostatique
  • somnolence, trb. de vigilance
  • secheresse bucale
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28
Q

Actions des stimulation rec B non selective

A

Heart: dromotrop, chronotrop, ionotrop, batmotrop
Kidney: dim. cel. juxtaglomerulare-> stim. renine
GI: dim. conractilite
Smooth muscle: vasoconstrictie
Lungs: bronchocdilatation
aug. umoarea apoasa
hyperglicemie

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29
Q

B1 non-selectives- representatives: 1ere et 3eme gen:

A

Propranolol
Timolol

3eme gen: Labetolol, Cartelolol

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30
Q

B-blockers 3eme gen: particularite

A

+ a-blocker–> HTA

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31
Q

B-Blockers selectives: 2eme gen

A

Atenolol
Bisoprolol
Metorpolol
Acebutolol

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32
Q

Indication B-blockers non-selectives: PROPRANOLOL

A 
angine
migraine
HTA
rupture varices oesophagienes
anxiete
glaucoma
hemangiome infantile
tremor essentiel
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33
Q

EI b-blockers

A

diarrhee, vomissements
insomnias, cauchemars
trb. de libido
psoriazis

bradycardia
BAV, BSA, BB
IC

aggravation asthem + BPOC
phenomene Raynaud
spasme coronaire
aggravaion d’AOMI

hypoglicemie
hypertrigliceridemie

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34
Q

Mechanisme d’action heparine:

A

inh. indirecte de coagulation par inh. d’antithrombine par liaison penta-saccharidique, accelerant l’inactivation facteurs II (thrombine) et Xa
++ courte–> Xa

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35
Q 
HNF: 
- Elimination
-Influencee par: 
- Grossesse?
representant: 
Dose: prevention et curative
A
  • elimination: reticulo-macrophage- pas reins- ok en IR
  • Influencee par: inflamation
    ok en grossesse: ne traverse pas la barrierre placentaire
    representant: Calciparine
    Dose prevention: 2,5 ml= 5000 UI x2/J si risque moyenne et x3/j si risque haute

Curative: IV: bolus: 50 UI/kg/J–> 500 UI/kg/J
SC: 400-800 UI/kg/J x3/J

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36
Q

CI absolute HNF et HBPM et a dose curative

A

atcd. thrombopenie induite par heparine type 2
hemorragie
trb. de l’hemostase
dissection Ao

HNF: anesthesie peridurale ou rachianesthesie
HBPM: IR < 30

a dose curative:
endocardite infect
hemorragie
infarctus cerebral etandu

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37
Q

HBMP:

  • mechanisme d’action
  • elimination
  • Representant:
  • Dose preventive:
  • Curative:
A
  • binds antithrombine III –> Xa
  • elimination: renale- CI < 30–>HNF
  • Representant: Enoxaparine
  • Dose preventive: 2000 UI ou 4000 UI
  • Curative: 100 UI X2/J
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38
Q

HBNP a des chaines plus coures ou longues que HNF et effect?

A

plus courtes

- pas action sur II mais plutot sur Xa

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39
Q

Mechanisme d’action fondaparinux

A

fix l’antithrombine III- inh. que Xa

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40
Q

Fondaparinux:

  • CI
  • Dose preventive et curative
A

CI: IR < 30
Dose preventive: 2,5 mg 6h apres l’intervation
curative: SCA: 2,5 mg= 1 inj
EP: 7,5 mg

– n’est pas risque de TIH

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41
Q

Antagonist heparine (++ HNF, peu sur HNBF)

A

protamine- 1 mg

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42
Q

Surveillence HNF et HBPM

valeurs N: TCA et heparinemie
quand on fait la surveillence

A

HNF: systhematique. HBPM: pas systhematique. si :

  • age, enfant, grossesse
  • poids extreme
  • IR
  • risque hemorragique

TCA ou heparinemie:
TCA= 2-3
heparinemie: 5-7

HNF: 5 H apres iv ou a moitie distance entre 2 inj
HBPM: a 4 h apres 3eme inj

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43
Q

EI heparine

A 
TIH
kyperK
osteoporose
alopecie
ISA
priapisme
eruption cutanee
aug. transaminases
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44
Q

TIH type 2: mechanisme

A

IgG anti-facteur 4 plaquettique

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45
Q

clinique TIH

A

thrombose: veineuse ou art
necrose au point d’injection
necrose SRA
CIVD

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46
Q

Bio pour TIH

A

thrombopenie: > 30-50% ou < 100 G/l
Ac. anti-PT4
Test d’activation plaquetaire
Test de liberation de la serotonine

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47
Q

TT pour TIH

A

arrete heparine
Danaparoide
Lepirudine
Agrotaban

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48
Q

Surveillence des plaquettes apres heparine:

A

avant
a J1 si atcd d’TIH
J5
2 fois /sa

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49
Q

On doit declarer le TIH au centre regional de pharmacovifilance?

A

oui.

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50
Q

Ci terlipressine:

A

ateromatose evoluee

allergie

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51
Q

EI amiodarone

A

neuro: parestesie, convulsii, confusion, ataxia
- dysthiroidie
- photosensibilitate (depos intraoculaires)
- fibrose pulmonare
- hepatita toxica
- blocaj cardiac, !! IC !!!
- photodermatita
- intoleranta GI, constipatie

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52
Q

Types des antidepresseures

A 
tricyclique = imipraminiques
ISRS= inh. selectivi R Serotonina
ISRN= inh. selctifs R. serotonina si noradrenalina
IMAO= inh. monoamin oxidazei
antidepresivi atipici:
- a2-bloc. pre-sinaptic
- modulateur glutaminergique
- ag. melanotinergique et antagoniste 5-HT-C
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53
Q

Antidepresive tricilice: imipraminice: representants

A

amitriptiline
Doxepine
Imipramine
Clopiramine

Maproptiline- tetraciclic- just NA

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54
Q

Apres combien de temps on voit l’effect d’antideresseurs tricycliques:

A

3-4 SA

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55
Q

Pharmacocynetique antidepresseurs

A

effect de 1ere passage hepatique

metabolisme par cytocrome P450

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56
Q

EI imipraminiques

A
  1. anticholinergiques:
    - constipation
    - retention urinaire
    - xerostomie
  2. antihistaminiques:
    - prise des poids
    - coma
    - somnolence diurne
    - sedation
  3. a1- adrenolitiques: hTA orthostatique
  4. convulsions
  5. coeur: trb. conduction (torsade des pointes), all. QT et PR
  6. cytolise hepatique
  7. trb. erectiles
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57
Q

Tianeptine (glutaminergique) - specifique de prescription

A

risque d’abus et dependence:

- ordonance securise, max. 28 J

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58
Q

Representants ISRS

A

Paroxetine
Fluoxetine
Seraline
Citalopram

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59
Q

Representants IRSNA

A

Venlaflaxine

Duloxetine

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60
Q

Indications antidepresseurs:

A
  1. sy. depressive
  2. Trb. anxieuse:
    - anxiete generalise
    - panic disorder
    - socialy anxiety
  3. OCT
  4. PTSD
  5. trb. du sommeil ( insomnie, enuresie, narcolepsie)
  6. algies neurologiques rebeles (++ IRSNA, imipraminiques)
  7. IRSNA: douleur chroniques
  8. cephalees rebeles, migraines (imipraminiques, IMAO)
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61
Q

EI ISRS et ISRSN

A 
SIADH- hypoNa
trb. erectiles
prise des poides
insomnie
xerostomie, diarrhee
cytolise hepatique
agranulocytose
Sy. serotoninergiques: 
- hyperthermie
- HTA
- hyperreflexia
- myoclonie
- rigidite musculaire
ISRSN: HTA
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62
Q

antidepresseur stimulant:

A

fluoxetina (ISRS)

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63
Q

IMAO- mechanisme d’action:
IMAO-A
IMAO-B
effect antidepressive

A

dim. aminooxidaza din creier:
IMAO-A: catabolismul serotoninei ++ NA, dopa
IMAO-B: catabolismul Dopaminei ++

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64
Q

Representants IMAO: selectif A

non-selectif:

A

moclobemide

non-selectif: iproniazide

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65
Q

CI absolue antidepresseurs

A
  • association IMAO et d’autre antidepresseur
  • hypersensibilite:
    1. imipraminiques:
  • IDM recent ou coronaropathie non-stabilise
  • IC decompense
  • trb. rythme cardiaque
  • glaucome aigue
  • adenome prostate
    2. IMAO:
  • HTA
  • pheochromocitome
  • AVC
  • polynevrite
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66
Q

CI relative anti-depresseurs

A 
gorssesse/ allaitement- privilegier ISRS
si IH ou IR- ajuster la dose
\+ Imipraminiques:
- > 75 ans
- epilepsie
- trb. dementiel
\+ IMAO neselectives: allimentation riche en tryptophane et tyramine (fromage fermente, sauce soja, bier, hareng)
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67
Q

Mechanisme d’action B-bloc

A

inhibation competitve des recepteurs B des cathecolamine.

inhibitie presinaptica B-receptorilor

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68
Q

Selectivitatea B1- betabloc

A

Nebivolol> Bisoprolol> atenolo> metoprolol

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69
Q

B-bloc avec activite vasodilatateur peripherique

A

prin eliberarea NO

  • Nebivolol
  • Carteolol
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70
Q

B-blockers + a1

A

Labetolol

Carvedilol

71
Q

Farmacocinetique B-bloc

A

Lipophile: elimination hepatique, demi-vie courte, passage encephalique (cauchemars)- PROPRANOLOL
Hidrophile: elimination renale, demi-vie longue, peu passage encephalique (ATENOLOL)

72
Q

CI b-bloc:

A
  1. bradycardie
  2. BAV 2 et 3 non apparaies
  3. angine prinzmetal
  4. IC decompense
  5. asthme
  6. pheochormocitome (relative)
  7. AOMI
73
Q

Interaction B-bloc:

A

spray nazal
AINS
Anti-arithmiques
antidepresive triciclice, antipshihotice

74
Q

Prevention of cardiovascular complications

in Ehler-Danlos syndrome- what B-blocker?

A

celiprolol

75
Q

Schema angiotensionogene- angiotensine II

A

angiotensionegen –> angiotensina I sou renine
angiotensina I—> angiotensina II sou ECO
angiotensina II: - vasoconstriceur et ++ aldosteron, vasoconstriction de l’arteriole efferente–> preserve GFR

76
Q

Indication inh. can Ca

A
  1. HTA ++ varstinici
  2. Boala coronala
  3. post- hemoragie cerebrala (Nomodipine)
  4. sy. Raynaud
  5. pre-eclampsie
  6. migrene
  7. tachicadie supraventriculare
77
Q

EI dihidropiridine specifique

A

tachicardie

78
Q

Interactions diuretiques thiasidiques

A 
AINS
produis de contrast
digitaliques--> risque de hypoK
LITHIUM
medicaments a risque de torsade des pointes
79
Q

Associations des antihypertenseurs deconseilles:

A 
IEC + ARA2
B-Bloc + inh. ca bradycardisants
B-bloc + IEC/ARA2
Diuret + B-bloc-> aug. risque de DZ
Inh. renina + IEC/ARA2
B-bloc + inh. simpatic central
80
Q

pour la HTA, on peut associer a-adrnolitiques avec:

A

diuretiques

B-bloc

81
Q

Indications pour a-adrenolitiques

A
  1. HTA refractaire ou nephroparenchimateuse
  2. CI aus: diuretiques, B-bloc, IEC
  3. Sy. Raynaud
  4. HBP
82
Q

Comment on adaisse la TA en HTA?

A

25% les 2 premieres h

83
Q

Tratament urgenta hipertensiva:

A
  1. Nitroglicerina 10 ug/min
  2. Enalaprila
  3. Verapamil
  4. Nicardipina
84
Q

TT feocromocitome - urgence

A

Labetolol (a+b):

85
Q

CI: nicardipine en urgence hypertensive

A

IC

86
Q

Difference entre:
efect sedativ
efect tranchilizant
efect hipnotic

A

sedativ: diminuarea activitatii globale a SNC
tranchilizant: diminuarea starii de tensiune, anxietate
hipnotic: favorizeaza instalarea somunului- se utilizeaza cantitati mai mari din medicamentele mentionate

87
Q

Medicamente hipnotice:

A 
BDZ
apparentes BDZ: ag. specifique a l'unite a1 du R GABA-1
antihistaminiques
neuroleptiques sedatifs
barbituriques (plus utilises)
88
Q

Reprezentants de BDZ:
1/2 vie courte = 4-8 h
1/2 intermediaire= 10-20 h
1/2 vie longue= 30-150 h

A

courte: 4-8 h:
Oxazepam
- Clotiazepam

Intermmediare: 10-20h:

  • Lorazepam
  • Alprazolam
  • Bromazepam
  • Clobazepam

Longue: 30-150 h:

  • Prazepam
  • Diazepam
  • Clorazepat
  • Norazepam
89
Q

Reprezentants apparentes-BDZ

A

Zolpidem

Zopiclone

90
Q

Medicam anxiolytique:

A 
BDZ
Carbamate
Antihistaminique
Azapirone
bb
Neuroleptique sedatif
Antidepresseurs
91
Q

BDZ- effects

A 
sedatif
anxiolytique
anticonvulsivant
myorelaxant
amnesiant
orexigene
92
Q

Pharmacocinetique BDZ

A 
lipophile
catabolisme helatique
faibel inducteur enzymatique
elimination renale
--> catabolizati in substante active (oxazepam) sunt gluguronoconjugare
93
Q

Antidot BDZ

A

flumazenil

94
Q

Mechanisme d’action BDZ:

A

efect agnosit
se leaga de R GABA–> modificare alosterica–> deschiderea canalului pt Cl–> influx de Cl–> dim. l’exitabilite neuronale–> faciliteaza transmiterea sinaptica GABAergica

!! cresc frecventa deschiderr =/ barbitudice care cresc durata deschiderii

95
Q

BDZ: traverseaza BHE si placenta?

A

DAAAAA

96
Q

BDZ:

  • hipnotiques
  • anxiety
  • convulsions
A

hipnotics:

  • Triazolam
  • Loprazolam
  • Nitrazepam

Anxiety:

  • Diazepam
  • Alprazolam
  • Lorazepam
  • Oxazepam

Convulsion:

  • Dia
  • Clonazepam
  • Lorazepam
97
Q

Indications BDZ:

A
  1. sedare
  2. anestezie
  3. hipnotic
  4. insonie
  5. anxietate: generalizata
  6. convulsii
  7. parasomnia cosmaruri la copii
  8. relaxare musculara
  9. panic disorders
  10. sevrage: alcoolic, barbitrice, opiacee
98
Q

EI BDZ:

A
  1. amnezie retrograda
  2. depresie respiratorie
  3. trb. confusionel
  4. dependenta
  5. sy. sevrage
  6. down-regulation
  7. trb. cognitif
99
Q

Sy. sevrage: alcool, BDZ

A 
< 12h:
- insomnie
- agitatie
- sy. autonomic ++
- tremors
12-18h:
- convulsii
>18h:
- anxietate extrema
- febra
- desorientation
100
Q

CI BDZ:

A
  1. IRA
  2. IH- !! la doze- efect mai marcat
  3. sy. d’apnee de someil
  4. MYASTHENIA GRAVIS
  5. atcd. des reactions paradoxales
101
Q

Mecanisme d’action barbiturice

A

aproape la fel ca BDZ:
- se leaga de receptorul GABA-> deschid canal Cl-> Cl intra in celula-> stimuleaza GABA.
Diferenta: barbituricele pot functiona si in lipsa GABA (mai periculoase)
!! cresc durata deschiderii=/ BDZ care cresc frecventa

102
Q

Efectele barbituricelor in functie de doza:

A 
15 mg: sedativ
100 mg: hipnotic
! ef. paradoxal copil: excitatie psiho-motorie
antiepileptice
si AG
103
Q

interactiunea barbiturice cu alte medicamente:

A

influenteaza enzima de inductie hepatica si actioneaza cu alte medicamente ! la doze

104
Q

EI barbiturice:

A

residual dizzines, sedation (mail ales la inceput)
! ef. invers de stimulare
toleranta ++
allergic reactions

105
Q

! intoxicatie acuta cu barbiturice- clinic

A 
relaxare musculara
coma profunda
bradicardie--> asfixie
hipersecretie bronsica
hipotensiune
colaps
106
Q

Antipsihotice:
tipice
atipice
Reprezentanti

A

Tipice:

  • Holoperidol
  • Flufenazina
  • Chlorpromazine

Atypical:

  • Clozapine
  • Olazapine
107
Q

Ef. atarctic al neurolepticelor:

A

Normal people:

  • apathia
  • decreased interest, will
  • decreased psychomotor

Ill people: dim agitation and agravation

  • improve psychic disturences, hallucinations,
  • anti-nausea
  • hypothermia
108
Q

EI neuroleptiques:

A
  1. Anticolinergice: xerostomie, retentie urina, constipare, trb, vision
  2. a1- antagon: hTA orthosattique + tachycardie
  3. Antihistaminice: sedare
  4. ++ gen I (Holoperidol, Flu..): parkinson-like (extra-piramidale).
  5. dystonia: contraction musc, torticolis
  6. akathisia
  7. diskinezie
  8. hyperprolactinemie: galactoree, trb. libido, hypogondaism central
  9. NMS: rigiditate, agitate, hipertermie, tachicardie, rabdomioliza (CK)
  10. QT ++–> torsade des pointes
  11. convulsii
109
Q

Mecanism de actiune intre neurolepticele tipice si atipice:

A

tipice: blocheaza doar D2
atipice: D2+ serotininergice

110
Q

EI en plus neuroleptice atipice:

Clozapine

A 
weight gain
dyslipidemia
DZ
Clozapine: - neutropenie si agranulocitoza
- miocardita
dim. efecte extrapiramidale
111
Q

Ce vase dilata nitratii:

A
  • vene
  • cantitai mai mari: artere
  • coronarele mari
  • nu dilata coronarele mici
    + corecteaza disfunctia endoteliului vascular si impiedica remodelarea patologica
112
Q

EI nitrati:

A

hypoTA orthostatica
cephalee (dilatatia arterelor meningeale)
tinitus
flushing

113
Q

Angina Prinzmetal- tt. premiere intention

A

inh. can Ca

114
Q

Medicamente care favorizeaza disfunctia erectila:

A 
Antihistaminice
Antidepresivele triciclice
barbiturice
BDZ
BB
Clonidina, Metildopa
Antagoniste dopaminergici: fenotiazide, metoclopramid
Fibrati
Interferon
115
Q

Medicamente utilizate in disfunctia erectila:

  • reprezentanti
  • mecanism de actiune
  • CI
A

SILDENAFIL
TADALAFIL
VERDENAFIL

- inh. fosfodiesteraza 5 care nu mai degradeaza cGMP, acesta se acumuleaza si determina vasodilatatia
!! CI:
- nitrati
-hTA
--> produce hTA
116
Q

EI antiaritmice IA

A 
pot sa dea tahicardie si torsade de pointes
Chinidina: 
- trombocitoza
- headache
- dizziness
Procainamida: lupus like syndrome
ECG: prelungirea QT- monitorizare!!!
117
Q

EI lidocaina

A
  • parestezii
  • tremor
  • convulsii
  • sedare
  • nistagmus
  • artimii
118
Q

Indicatii antiartimice clasa I
A
B
C

A

A: WPW. supraventirculare si ventriculare
B: ventriculare - mai ales in ischemie!!
C: WPW, Fia

119
Q

Indication classe IV antiaritmice (inh. can. Ca)

A

TPSV

FA si Flutter

120
Q

Indication antiarithmique pour BB et Digoxin

A

tachicardie atriale

121
Q

Mecanism de actiune antiartmice clasa V

A

inhiba Na/K ATP-aza

actioneaza direct X–> actiune parasimpatica–> inhiba nodul AV

122
Q

EI Adenozina

A 
asistolie scurta
flushing
dureri in piept
hTA
bronhospasm
123
Q

paliers de tt du fond asthme

A

P1: BDCA
P2: BDCA. CI a faible dose.
P3: BDCA. BDLA + CI faible ou CI moyenneou CI faible + AL
P4: BDCA. CI haute + BDLA ou + AL ou theophylline
P5: BDCA. + anti-IgE ou anti-IL5 ou corticoides sythematique

124
Q

B-mimetiques:

  • BDCA
  • BDLA

Anti-cholinergique

A

BDCA:

  • Salbutamol
  • Terbutaline

BDLA:

  • Salmeterol
  • Formoterol

Anti-cholinergique: Ipatropium

125
Q

En asthme:
CI inhales
CI sisthemiques

A

Inhalee:

  • Beclomethasone
  • Budesonide
  • Fluticasone

Systhematique: Prednison, prednisolone

126
Q

Anti-leukotirene
Anti- IgE
Anti-IL5

A

Anti-leukotirene: Montelukast
Anti- IgE: Omalizumab
Anti-IL5: Mepolizumab

127
Q

Associations CI + BDLA possibles

A

formoterol + budesonide
Salmeterol + fluticasone
Formoterol+ beclomethasone

128
Q

TT asthme leger ou moyenne en urgence:

A

1.oxigene
2. BDCA: chambre d’inhalation + dispositif d’inhalation: 4-10 puffs tous les 20 min.
ou nebulisation: 5 mg sur 10 min
3. CI systhematique: prednisolone: 1 mg/kg/j adult ou 2 mg/kg/ j enfant– jusque’a 5 J
4. augumentation tt de fond

129
Q

TT asthem grave ou extreme

A

BDCA + anticholinergique: Slabutamol + Ipatropium
B2-mimetiques inj: salbutamol: 0,25-0,5 mg/h.
CI systhemique
Rehydratation MODEREE
Intubation
+ sulfat Mg

130
Q

Forme de administrare inhalatorie a medic pt. astm

A

aerosoli presurizati dozati- metered dosed inhalor
dispozitiv cu pulbere pentru inhalare- dry. powder inhaler (tulbuhaler)
solutie pentru nebulizare

131
Q

Alte efecte ale B2-mimentice in afara de bronhodilatatie:

A

previn degranularea mastocitelor
limiteaza putin inflamatia
previn formarea edemului
asigura o functionare mai buna a R pt glucocorticoizi

132
Q

EI B2-mimetice

A
  1. spasm vascular
  2. efect tocolitic
  3. tahicardie, palpitatii (daca sistemic)
  4. hypoK
  5. cefalee, anxietate
  6. toleranta
  7. bronhospasm paradoxal
  8. tremor
133
Q

Ipatropium: EI

A

uscaciunea gurii, gust metalic

bronhospasm paradoxal

134
Q

Mecanism de actiune M-colinolititce bronhodilatatoare

A

blocarea receptorilor M3 din bronhoo

* ipatropium blocheaza M1-M3–> bronhospasmul paradoxal

135
Q

EI valporat

A 
teratogen
prise des poids
vomissement
tremblement
pancreatite
cytolise hepatique
136
Q

Lamotrigine- EI

A

eruption cutane

sy. Lylle

137
Q

Levetiracetam- EI

A

sedation

trb. psychiatrique

138
Q

EI carbamazepine et phenytoine

A
  • diplopia et ataxia
  • DRESS
  • Sy. Lyell
  • teratogen
  • lupus-like syndrome
  • osteoporoza
  • anemie megaloblastica

Phenytoine:

  • hirsutisme
  • hypertrophie gingivale

Carbamazepine: SIADH

139
Q

type d’epilepsy CI carbamazepine et phenytoine

A

alsence et myoclonie

140
Q

TT epilepsie de type absence de l’enfant

A

Ethoxusimide

141
Q

Antiepileptice : mecanism d’actiune

A

blocheaza canalele Na in stadiul inactiv–> diminueaza transmiterea PA

Blocheaza can Ca tip T: Etosiximida, Gabapentina

Blocheaza can K
Inh. anhidrazei carbonice

142
Q

Ethosuximida- mechanism d’action

A

blocheaza can. Ca tip T de la nivel talamic

143
Q

Mechanism actiune ac. valporic:

A

creste disponibilitatea pentru GABA

  • canalele Na voltaj dependente
  • can. Ca tip T
144
Q

Mecanism de actiune levetiracetam

A

modifica concentratia de Ca intracelulara:

  • inhibarea partiala a curentului de Ca
  • reducerea eliberarii de Ca
145
Q

Gabalina- mecanism de aciune

A

inrudite structural cu neurotrans GABA dar functioneaza prin blocarea can de Ca

146
Q

EI Salbutamol

A
  1. tremor musculare
  2. tocolitic
  3. tahicardie, palpitaii, artimii
  4. cefalee
  5. brohospasm paradoxal
  6. toleranta
147
Q

Digoxine:

  • mecanisme d’action
  • Indication
  • EI
  • CI
A 
inh. specifici Na/K ATP-aza: inhiba direct nervul X--> act. parasimpatica--> inhiba AV
Indicatie: Fia, TPSV
CI: WPW
EI: bigeminism
TV
FV
148
Q

Digoxina afecreaza rata sau F?

A

rata

149
Q

Intoxication digoxine: antidot

A

imunoTh par fragmente Fab antidigoxine

! se face dozarea plasmatica

150
Q

Mecanism de functionare L-dopa

A

precursor al Dopaminei
absorbtie la nivelul jejunului si duodenului
tranverseaza BHM printr-un transportator activ Na
- se transforma in dopamina prin decarboxilare

151
Q

Efecte ale L-Dopa

A

tremor
bradikinezie
rigiditate

152
Q

Ei L-Dopa et surdosage

A
  • diskinezie
  • choree
  • vomissemente, nausee
  • hTA orthostatique
  • trb. psychiques

Surdosage:

  • cosmaruri
  • sy. confusionel
  • hellucinations
  • delire
153
Q

CI L-Dopa

A 
delir
IDM recent
IC
trb. rythme
UGD
association neuroleptiques
154
Q

Interactions medicam L-DOPA

A

neuroleptique
antyhiertens. central
vit B6
IMAO non-selectif

155
Q

L-dopa se prend en association avec:

A

carbidopa: dim. effects indesirables peripheriues

156
Q

Mecanism actiune Ivabradine

A

inh. canalele If (funny) din nodul sinoatrial

FC trebuie >=75 bpm

157
Q

Ei nitroglicerina

A 
cefalee pulsaila (dilatarii arterelor meningeene)
hTA ortostatica
tintus
flush
158
Q

EI digitalice

A

!! anorexie, greturi, varsaturi
extrasistole, bradicardie
parestezii
cefalee, oboseala

159
Q

CI digitalice:

A 
ESV
WPW
BAV, braidcardie
TV
pericadita contrictiva
160
Q

Antiarythmiques: rate ou rythme classe

A

1 et 3: rythme

2 et 4, 5: rate

161
Q

Clasa IV antiaritmice: bloc can Ca: mecanism de actiune

A

blocheaza can. Ca tip L

  • -> incetinesc transmiterea prin nodurile SA si AV
  • > prelungsc faza refreactara
  • -> prelungesc PR
  • -> afecteaza rata
162
Q

GCC: courte duree, moyenne et longue douree representants

A

Courte: Cortison, HHC
Moyenne: Prednison, Prednisolone, Methylprednysolone
Longue: Dexa, Betamethasone

163
Q

Avec un tt de GCC, on doit prescriere egalement:

A 
Suplementant vit. D 800U/j
Apport Ca
regime: hyposode
\++ laitage et proteines
activite physique ++
si > 3 M et > 7,5 mg/j --> biphoshonate
164
Q

CI AINS

A 
grossesse > 24 SA
allaitement
IR, IH, IC
coagulopathie
UGD
165
Q

Indication thrombolyse:

A 
IDM < 12 h
AVC < 4h30 min
EP <7 j
TP  avec phlegmatia coerulea
Prothese valculaire thrombose
Occlusion: VVC chambre 
Hemothorax cloisonne
166
Q

Dose Alteplasa en IDM et EP

A

EP: 10 mg bolus/ 2 min puis 90 mg/ 2 h
IDM: 15 mg –> 0,75 mg/kg/30 min puis 0,5 mg/kg/ 60 min

167
Q

CI absolute thrombolyse

A 
hemorragie cerebrale
AVC ischemique <6M
Tu cerebrale
Saignement digestive/ ulcer dg saignement < 1 M
Malformation vasculaire cerebrale
Diathese hemorragique
trb. hemostase
Hemorragie severe
Dissection Ao
Ponction hepatique ou PL < 24h
168
Q

TCA cible thrombolyse

A

1,5-2,5

169
Q

Comment faire la prescription des AVK

A

Avant traitement: dosage INR, trb. coagulation (NFS-plaquettes)
1 prise/ j–> INR 2-3 J apres–> 1/SA–> 1/mois
*aug. avec 1/3 dose

170
Q

Prescription AVK: relai heparine

A

> 5 J de chevauchement
INR a 48-72 h
2 INR ok a ditance de 48-72 h

171
Q

Interdits sous AVK

A

IM

extraction dentaire

172
Q

INR avant chirurgie

A

< 1,5 (<1,2 neurochir)

173
Q

Avant chirurgie si patient sous AVK, mais sans atcd de MTEV, commnet proceder?
si atcd MTEV

A

arrete AVK 3-4 J avant sans relais par heparine
Reprise 24-48 h apres chirurgie
– si atcd MTEV:
arrete 4-5 J avant
relai heparine le lendement de l’operation
repreise AVK en 24-48 h

ECN (29 decks)

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