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Pharmacology > Serotonin syndrome and neuroleptic malignant syndrome > Flashcards

Serotonin syndrome and neuroleptic malignant syndrome Flashcards

1
Q

Triad of symptoms seen in serotonin syndrome

A

Neuromuscular abnormalities - myoclonus, clonus
Altered mental state
Autonomic dysfunction

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2
Q

Time from starting or increasing a serotonergic drug to developing symptoms of serotonin syndrome

A

Within 24 hours

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3
Q

Vital signs seen in serotonin syndrome

A

HTN
Tachycardia
Tachypnoea
Hyperthermia >40 degrees

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4
Q

Neurological and psychiatric features of serotonin syndrome

A 
Variable mental state - agitation to coma
Increased muscle tone especially in legs
Hyperreflexia
Clonus
Dilated pupils
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5
Q

Treatment for serotonin syndrome

A 
Withdrawal of causative agent
Supportive care
5HT2A antagonist e.g. cyproheptadine
Benzodiazepines
Atypical antipsychotics
Paralysis and intubation in severe cases
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6
Q

Vital signs seen in neuroleptic malignant syndrome

A

HTN
Tachycardia
Tachypnoea
Hyperthermia >40 degrees

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7
Q

Neurological and behavioural features of neuroleptic malignant syndrome

A 
Lead pipe rigidity in all limbs
Confusion
Fluctuating consciousness
Hyporeflexia
Normal pupils
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8
Q

GI feature of serotonin syndrome

A

Diarrhoea

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9
Q

High risk combinations for serotonin syndrome

A 
SSRI and MAOI
SSRI and RIMA
SSRI and TCA
SSRI and SNRI
SSRI and lithium
SSRI and l-tryptophan
TCA and MAOI
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10
Q

Blood test results seen with neuroleptic malignant syndrome

A

Raised WCC
Raised CK
Deranged LFTs
Raised myoglobin

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11
Q

Proposed mechanisms causing neuroleptic malignant syndrome

A

Dopamine blockade at the hypothalamus causing hyperthermia

Calcium uptake into the muscles causing rigidity

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12
Q

Mortality rate for neuroleptic malignant syndrome

A

20%

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13
Q

Patient risk factors for developing neuroleptic malignant syndrome

A 
Young age
Male
Psychosis
Psychomotor retardation
Intellectual disability
Dehydration
Previous NMS
Hyperthyroidism
Alcoholism
Parkinson's disease
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14
Q

Drug related risk factors for developing neuroleptic malignant syndrome

A

Recent or rapid antipsychotic dose change
First generation antipsychotics
Sudden withdrawal of anticholinergic agents
Antipsychotic polypharmacy

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15
Q

Number of days antipsychotics should be stopped for following neuroleptic malignant syndrome

A

At least 5 days

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16
Q

Time frame neuroleptic malignant syndrome occurs in

A

Can occur at any time

Often 24-72 hours after a change in antipsychotic dose

17
Q

Length of time neuroleptic malignant syndrome lasts if untreated

A

10-14 days

18
Q

Treatments for neuroleptic malignant syndrome

A 
Withdraw antipsychotic
Benzodiazepines
Rehydration
Bromocriptine
Dantrolene
ECT - not generally used
19
Q

Differences in time frames for serotonin syndrome and neuroleptic malignant syndrome

A

Serotonin syndrome has sudden onset over <12 hours; neuroleptic malignant syndrome has subacute onset over hours to days
Serotonin syndrome resolves within a day after the agent is stopped; neuroleptic malignant syndrome can take 1-2 weeks to resolve

20
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in presence of myoclonus

A

Present in serotonin syndrome; not in neuroleptic malignant syndrome

21
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in presence of hypomania

A

Hypomania may be present in serotonin syndrome; not present in neuroleptic malignant syndrome

22
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in reflexes

A

Hyperreflexia in serotonin syndrome; normal reflexes or hyporeflexia in neuroleptic malignant syndrome

23
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in presence of rhabdomyolysis and resultant renal failure

A

Common in neuroleptic malignant syndrome; not present in serotonin syndrome

24
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in presence of WCC elevation

A

More common in neuroleptic malignant syndrome

25
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in pupils

A

Dilated in serotonin syndrome; normal in neuroleptic malignant syndrome

26
Q

Differences between serotonin syndrome and neuroleptic malignant syndrome in bowel sounds

A

Increased in serotonin syndrome; normal or decreased in neuroleptic malignant syndrome

27
Q

Medications which can cause serotonin syndrome

A 
Antidepressants
Lithium
Opioids
Olanzapine
Risperidone
28
Q

Incidence of neuroleptic malignant syndrome

A

0.07-0.2%

29
Q

Time frame over which neuroleptic malignant syndrome develops

A

24-72 hours

30
Q

Vitamin/mineral deficiency associated with increased risk of neuroleptic malignant syndrom

A

Low iron

Pharmacology (34 decks)

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