Drugs And Reactions Flashcards
(28 cards)
NMS vs. serotonin syndrome
NMS: lead-pipe RIGIDITY, rhabdo, VERY high fevers
(from antipsychotics)
Serotonin: tremor, hyperreflexia, myoclonus, milder fever, GI sx (NO rigidity!)
(due to combination of serotonergic meds or interaction of these meds with MAOIs)
Hypercarbia, muscle rigidity, hyperthermia
Fast onset
Malignant hyperthermia (faster onset than NMS)
diff clinical context from NMS. Malignant hyperthermia is from anesthestics
Intoxication from which TWO combined drugs?
-> bradycardia, hypotension, respiratory depression, hyporeflexia
(But normal pupils, does NOT respond to naloxone, normal bowel sounds)
Alcohol and benzos (sedative-hypnotic overdose)
Antipsychotic side effect: sudden, sustained contraction of neck, mouth, tongue, eye muscles
Treatment?
Acute dystopia
To: benztropine or diphenhydramine (anticholinergics)
Antipsychotic side effect: subjective restlessness, inability to sit still
Treatment?
Akathisia
Tx: B blocker (propranolol) or benzo (lorazepam)
Antipsychotic side effect: gradual-onset tremor, rigidity, bradykinesia
Treatment?
Parkinsonism
Tz: benztropine or amantadine
Antipsychotic side effect:
Gradual onset after >6mo of therapy
Stereotypic, involuntary, painless movements of mouth, face, trunk, extremities
Tardive dyskinesia No treatment (maybe clozapine?)
Giving anticholinergics or decreasing neuroleptic may initially worsen tardive
Intoxication with which drug > violence, nystagmus?
PCP
Nystagmus distinguishes this from meth (which can also cause psychomotor agitation etc).
First line for alcohol use disorder
Naltrexone to decrease craving if still actively drinking
Can’t use in acute hepatitis or liver failure
Can’t use in those taking opiods
Acamprosate (glutamate modulator) used to maintain abstinence
Difference between PCP, meth, Bath salts for length of intoxication
PCP: ~8 hours
Meth: a day
Bath salts: days-weeks
Alcohol withdrawal timing
Seizures: 12-48hr
DT 2-4 days
Tx of alcohol withdrawal
Benzo (lorazepam preferred in inpatient setting, especially in those with liver dz)
Tx of benzo toxicity
Flumazenil (benzo antagonist)
contraindication to lithium
renal dysfunction.
use valproate instead
MAO inhibitor (eg phenelzine) + tyramine (eg wine, aged cheese, cured meets etc) –> what?
Hypertensive crisis
Headache, intracranial bleeding, stroke, death
Side effects of TCA
Anti HAM
Histamine - drowsiness
Adrenergic - orthostatic hypotension
Muscarinic - dry mouth, etc
OCD personality disorder vs. OCPD
OCPD: ego syntonic (comfortable with behaviors, believes they are good)
OCD: ego dystonic (distressed about symptoms)
what recreational drug can cause serotonin syndrome and hyponatremia
ecstasy
What to check before starting Lithium
preg test
Calcium (risk of hyperpara with hyperCa)
Renal function (risk of nephrogenic DI)
thyroid (risk of thyroid dysfunction)
antipsychotic side effect:
fever, confusion, rigidity, autonomic instability
Neuroleptic malignant syndrome
Treatment for NMS
Dantrolene (muscle relaxant to alleviate the rigidity!)
bromocriptine or amantadine
dopamine agonists
Treatment for serotonin syndrome
Cyproheptadine
Treatment for dystonias and parkinsonism
Benztropine (anticholinergic)
Diphenhydramine
Treatment for anticholinergic toxicity
Physostigmine (cholinesterase inhibitor)
