Serotonin Syndrome Flashcards Preview

X Clin Med III Final Exam > Serotonin Syndrome > Flashcards

Flashcards in Serotonin Syndrome Deck (24)
Loading flashcards...
1

Pathophys of serotonin syndrome

Increased serotonergic activity in CNS
Serotonin is NT in GI tract, platelets and in CNS (well-being, attention, behavior, thermoregulation, clotting)
Overactivation of serotonin at postsynaptic receptors

2

Cause of serotonin syndrome

Simultaneous administration of 2 (or more) serotonergic agents
Can even be with initiation of 1 serotonergic drug or after increased dosing

3

Serotonergic agents

Increase release of serotonin (meth, cocaine, E, levodopa)
Impairing reuptake (cocaine, E, meperidine, SSRIs, tramodol, SNRIs, TCAs, antiemetics, dextromethorphan, cyclbenzaprine)
Inhibit metabolism (MAOis)
Agonist (busprione, triptans, ergots, fentanyl)
Lithium (sensitivity of postsynaptic receptor)

4

Triad of serotonin syndrome

AMS
Neuromuscular abnormalities
Autonomic hyperactivity
(within mins to hours of agent)

5

AMS changes in serotonin syndrome

Agitation
Anxiety
Disorientation
Restlessness
Excitement
Startle easily

6

Neuromuscular abnormalities in serotonin syndrome

Tremors
Clonus
Hyperreflexia
Muscle rigidity
+bilteral Babinski
Akasthisia (needs to be in motion)

7

Autonomic hyperactivity of serotonin syndrome

HTN, tachycardia/pnea, hyperthermia, shivering, vomiting, diarrhea, diaphoresis, dry mucous, flushed, hyperactive BS, mydriasis, arrhythmias

8

Labs or imaging in serotonin syndrome

No lab to confirm
Serum levels don't predict if have it
Labs: cBC, CMP, culture, UA, CSF, TSH, tox screen
May see elevated CPK or myoglobin (nonspecific)

9

Hunter toxicity criteria

Pt must have taken a serotonergic agent AND have 1:
Spontaneous clonus
Inducible clonus PLUS agitation or diaphoresis
Ocular clonus PLUS agitation or diaphoresis
Tremor PLUS hyperrefelxia
Hypertonia PLUS temp >38 C PLUS ocular clonus or inducible clonus

10

What is neuroleptic malignant syndrome associated with?

Antipsychotics (Haldol, Risperdal, Reglan, Phenergan)
Anti-emetics

11

Tetrad of neuroleptic malignant syndrome

FARM
Fever
Autonomic instability
Rigidity
Mental status changes

12

Things to differentiate NMS from serotonin syndrome

Hyporeflexia and bradyreflexia
Slower onset and slower resolution (Days to weeks)
Use bromocriptine for tx

13

When do you see malignant hyperthermia?

Genetic ppl (inherited autosomal dominant disorder) with exposure to anesthesia and succinylcholine (during or right after)

14

Why does malignant hyperthermia happen?

Uncontrolled release of large quantities of Ca from muscle leading to hypermetabolic state

15

Most reliable sign of malignant hyperthermia

Rapid rise in CO2 resistant to increased ventilation

16

Presentation of malignant hyperthermia

Muscle rigidity
Tachycardia
Hyperthermia
(can become DIC and organ failure)

17

Tx of malignant hyperthermia

Discontinue agent
Administer dantrolene to block Ca release

18

How to differentiate anticholinergic toxidrome from serotonin syndrome

Anticholinergic does not affect muscle tone or reflexes! (red as a beet, dry as a bone, blind as a bat, hot as a hare, mad as a hatter)

19

Management of seretonin syndrome

Discontinue all agents
Support to normalize vitals (O2, fluids, cardiac monitor, no restraints)
Sedate with benzos (control agitation and correct BP/ HR)

20

Antipyretics for serotonin syndrome?

No b/c elevated temp is due to increase in muscular activity rather than hypothalamic temp set point

21

Mild management of serotonin syndrome

Observe 4-6 hrs
Eliminate agent
If mental status, VS normal and no clonus or increase in DTRs, may d/c and f/u in 24 hrs

22

Moderate/severe management of serotonin syndrome

Hospital (ICU with intubation)

23

Management for pts with temp >41.1 C (105.9 F)

Critically ill so immediate sedation, paralysis and intubation

24

What is cyproheptadine and when use?

Serotonin antagonist/ Histamine 1 receptor antagonist
Use if combo of supportive care and benzos don't improve sxs (adjunct!!)