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clin med III final > Serotonin syndrome > Flashcards

Serotonin syndrome Flashcards

1
Q

serotonin is a neurotransmitter that acts in what

A
  • CNS
  • GI tract
  • platelets
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2
Q

functions of serotonin

A
  • feelings of well-being
  • regulate clotting, mood, appetite, and sleep
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3
Q

what is serotonin syndrome

A
  • over activation of serotonin at postsynaptic receptors
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4
Q

what is the serotonin syndrome triad

A
  1. altered mental status: agitation
  2. neuromusclar abnormalities: hyperreflexia, tremor
  3. autonomic hyperactivity: tachycardia, mydirasis, diaphoresis
  • rapid onset
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5
Q

what are some of the altered mental status changes seen with serotonin syndrome

A
  • agitation
  • anxiety
  • excitement
  • disorientation
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6
Q

what are some of the neuromuscular abnormalities seen with serotonin syndrome

A
  • tremors
  • clonus
  • hyperreflexia
    • babinski’s sign
  • akasthesia: need to be in constant motion
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7
Q

what are some of the symptoms of autonomic hyperactivity seen with serotonin syndrome

A
  • HTN
  • tachycardia
  • hyperthermia
  • mydriasis
  • V/D
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8
Q

how is serotonin syndrome diagnosed

A
  • clinical diagnosis
    • ​Hunter toxicity criteria
      • ​pt must have taken a serotonergic agent AND have one of the following
        • spontaneous clonus
        • inducible clonus (or ocular clonus) + agitation or diaphoresis
        • tremor + hyperreflexia
        • hypertonia + temp > 100.4 + ocular clonus or inducible clonus
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9
Q

MOA of MAOIs

A
  • inhibit the metabolism of serotonin
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10
Q

what is neuroleptic malignant syndrome

A
  • life threatenng neurologic emergency associated with neuroleptic drugs (typical and atypical antipsychotics and antiemetics)
    • cause: dopamine antagonists
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11
Q

onset of neuroleptic malignant syndrome

A

days to weeks

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12
Q

neuromuscular findings associated with neuroleptic malignant syndrome

A
  • bradyreflexia
  • severe muscular rigidity
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13
Q

anticholinergic toxicity has some similarity to serotonin syndrome, but does NOT present with

A
  • abnormal muscle tone
  • abnormal reflexes
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14
Q

what is malignant hyperthermia

A
  • potentially life threatening syndrome occuring in susceptible individuals post anesthesia
    • ​not an allergy
    • inherited autosomal dom.
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15
Q

management of serotonin syndrome

A
  • discontinue all serotonin agents
  • sedation with benzodiazepines
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16
Q

serotonin syndrome antidote

A
  • cyproheptadine
    • ​histamine -1 receptor antagonist
    • adjuct option if combo supportive care + benzos not improving
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17
Q

how is dementia diagnosed

A
  • decline in cognition involving one or more cognitive domains
  • decline from baseline
  • progressive
  • not occuring only during times of delirium
  • not caused by another mental disorder
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18
Q

if a patient does have cognitive decline associated with aging, these changes are NOT

A
  • not progressive
  • do not affect daily function
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19
Q

List the 5 neurocognitive disorder (dementia) syndrome

A
  1. alzheimers disease
  2. dementia with lewy bodies
  3. frontotemporal dementia
  4. vascular dementia
  5. parkinsons disease with dementia
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20
Q

the mini mental state exam is the most widely used cognitive test for dementia. is it sensitive for mild dementia

A
  • test NOT sensitive for mild dementia
21
Q

is neuroimaging (CT/MRI) indicated in initial eval of dementia

A
  • yes
22
Q

what is the most common cause of chronic dementia in elderly patients

A
  • alzheimers disease
23
Q

hallmark neuropathologic changes associated with alzheimers disease

A
  • neuritic plaques
    • ​neuronal injury
  • neurofibrillary tangles
    • ​degeneration
  • extracellular deposits of amyloid beta peptides
24
Q

incidence of alzheimers disease doubles

A
  • doubles every decade after age 60
25
Q

risk factors for alzheimers disease

A
  • age
  • genetics
  • family history
  • 1/3 might be attributable to modifiable risk factors: DM, HTN, sedentary activity
26
Q

most common early symptoms of alzheimers disease

A
  • memory impairment
  • sleep disturbances
27
Q

sundowning occurs in 2/3 of dementia patients. what is it

A
  • agitation, aggression, wandering
  • peak in late afternoon and evening
  • worse the sleep, the worse the sundowning
28
Q

definitive diagnosis of alzheimers disease

A
  • requires histopathologic examination
29
Q

whar are lewy bodies

A
  • abnormal aggregates of protein that develop inside nerve cells in brain
30
Q

what impairments come first in dementia with lewy bodies

A
  • attention and executive/visuospatial function
    • ​difficulty driving, impaired work performance
  • memory affected later
31
Q

clinical presentation

  • early
    • attention and executive/visuospatial function
    • repeated falls
    • parkinsonism sx
    • urinary dysfunction
    • hallucinations
    • delusions
A
  • dementia with lewy bodies
32
Q

avoid in treatment of hallucinations associated with dementia with lewy bodies due to risk of

A
  1. avoid neuroleptics (haloperidol)
  2. risk of neuroleptic malignant syndrome
33
Q

what is frontotemporal dementia

A
  • degeneration of frontal and/or temporal lobes
34
Q

frontotemporal dementia is characterized by progressive changes in

A
  • personality and behavior
  • may also have motor involvement: parkinsonsim
35
Q

age on onset of frontotemporal dementia

A
  • early onset
    • ave age: 60
36
Q

age of onset of vascular multi-infarct dementia

A
  • prevalence increases with age
37
Q

vascular multi-infarct dementia is characterized by

A
  • ischemic or hemorrhagic strokes
38
Q

when does memory impairment occur in vascular multi-infarct dementia

A
  • late
39
Q

cause of parkinson disease with dementia

A
  • loss of dopamine neurons in substantia nigra
40
Q

list the cardinal motor features of parkinsonism

A
  • bradykinesia
  • rigidity
  • resting tremor
  • postural instability
41
Q

early symptoms of parkinson disease with dementia

A
  • dysfunction of executive function
  • impaired visuospatial function
  • cardinal motor sxs
  • hallucination
  • delusions
42
Q

late symptoms of alzheimers disease

A
  • personality and behavior changes
  • incontinence
  • hallucinations
43
Q

mainstay of management of neurocognitive disorders

A

symptomatic

44
Q

patient presents with NCD and visual hallucinations and parkinsonism. patient likely has what condition? avoid what medication

A
  • dementia with lewy bodies or parkinsons disease with dementia
  • caution with neuroleptics
45
Q

treatment of behavioral disturbance in NCD

A
  • soothing activities
  • reset sleep wake cycle
  • assess pain
46
Q

what are the two types of medication that slow progression of NCDs

A
  • cholinesterase inhibitors
    • D/C after 3 months if no response and move to
  • NMDA receptor antagonist
    • D/C after 5-6 months if no response
47
Q

function of cholinesterase inhibitors

A
  • prevent breakdown of acetylcholine
48
Q

list the cholinesterase inhibitors

A
  • Donepezil: watch for bradycardia
  • Rivastigmine: most GI cholinergic SE
  • Galantamine
49
Q

MOA and main side effect of Memantine

A
  • NMDA receptor antagonist -> neuroprotective
  • dizzziness

clin med III final (7 decks)

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