Sweatman: Syndromes Flashcards
(41 cards)
who gets serotonin syndrome
those who overdose on SSRI’s
patients of all ages-newborn-elderly
how many doses of SSRI’s needed to precipitate the syndrome
only one
what precipitates serotonin syndrome at molecular level
concurrent CYP 2d6 and 3A4 INHIBITION BY OTHER DRUGS
WITHDRAWL OF CONCURRENT DRUG TREATMENT WHILE STILL TAKING SSRI
SEROTONERGIC NEURONS FOUND IN HIGH CONCENTRATIONS ON THE
BRAINSTEM
MIDLINE RAPHE NUCLEI
FROM MEDULLA TO MIDBRAIN
ROSTRAL (UPPER) END OF SEROTONERGIC MIDLINE RAPHE NUCLEI ASSISTS IN
REGULATION OF WAKEFULNESS, AFFECTIVE BEHAVIOR, FOOD INTAKE, THERMOREGULATION, MIGRAINE, EMESIS, AND SEXUAL BEHAVIOR
SEROTONERGIC MIDLINE RAPHE IN LOWER PONS AND MEDULLA PARTICIPATE IN
REGULATION OF VASCULAR TONE AND GI MOTILITY AND EVEN NOCIOCEPTION
AGONISM OF WHAT RECEPTOR CONTRIBUTES SUBSTANTIALLY TO SEROTONIN SYNDROME
5HT2
excess serotonin-impacts a variety of brain stem functions and thus disrupts autonomic functions on many levels-leading to the syndrome appearance
spectrum of findings in serotonin syndrome
*note not all present in a given patient and some may mask the presence of other
Akathisia (feeling of inner restlessness)
tremor
AMS
Clonus (inducible)-rhythmic muscle contraction
Clonus (sustained)
Muscular Hypertonicity
Hyperthermia
*muscular hypertonicity may overwhelm/mask tremor and hyperreflexia
critical in decision making for dx of serotonin syndrome
recent use of serotonergic agents and evidence of the classical clinical symptoms
signs that are highly diagnostic for serotonin syndrome in the historys etting of recent SSRI use
neuromuscular feature of clonus and hyperreflexia-their occurance established the diagnosis
management of serotonin syndrome
discontinue use of ALL potential precipitating drugs
supportive management
control agitation-may need additional drugs
cyproheptadine-serotonin antagonist
control autonomic instability-may need additional drugs
control hyperthermia-appropriate cooling measures
reassess need for serotonergic drug after stable
serotonin antagonist
cyproheptadine
drug classes associated with serotonin syndrome
SSRIS-duh
Antimigraine-sumatriptan
Antiemetics-setrons
MAOIs-inhibit serotonin breakdown-phenelzine and isocarboxazid
TCAs-inhibit serotonin reuptake-venlafaxine, trazodone, nefazodone, buspirone, clomipramine
st johns wort-inhibits serotonin reuptake
LI-CSF specific
tryptophan
AED-valproic acid
analgesics with serotonergic properties but are mainly opiate agonsits- meperidine, fentanyl, tramadol, pentazocine
metoclopramide
clasical symptoms of neuroleptic malignant syndrome
hyperthermia
autonomic dysfunction
muscle rigidity
extrapyramidal tremor
*possibility of a direct effect on skeletal muscle causing malignant hyperthermia
what processes bring about neuroleptic melignant syndrome
BLOCKADE OF DOPAMINERGIC D2 RECEPTORS IN THE HYPOTHALAMUS
-RESULTS IN HYPERTHERMIA
BLOCKADE OF INHIBITORY ACTIONS OF DOPAMINE ON THE SNS-AUTOMONIC DYSFUNCTION
BLOCKADE OF NIGROSTRIATAL DOPAMINE CAUSING INCREASED MUSCLE RIGIDITY/TREMOR VIA EXTRAPYRAMIDAL PATHWAYS
*POSSIBLY DIRECT MUSCLE TOXICITY VIA INCREASED CALCIUM RELEASE FROM SR
SUMMING UP NEUROLEPTIC MALIGNANT SYNDROME
BLOCKADE OF DOPAMINE IN THE HYPOTHALAMUS, ON THE SNS, NIGROSTRIATAL PATHWAY
LOSS OF THE STIMULATORY AND INHIBITORY FUNCTION OF DOPA AT DIFFERNT AREAS IN THE SNS
LEADS TO AUTONOMIC DYSFUNCITON, AND HYPERTHERMIA AND MOTOR DYSFUNCTION
MOST COMMON RISK FACTOR FOR NEUROLEPTIC MALIGNANT SYNDROME
HIGH-DOSE, HIGH POTENCY ANTIPSYCHOTIC AGENTS, DURING RAPID DOSE ESCALATION AND WITH DEPOT FORMS OF DRUG RELEASE
OTHER CAUSES
- concurrent antidepresants, antiemetics,lithium
- withdrawl of anti-parkinsonian agents
- past hx of NMS
- increased ambient temp or dehydration
- catatonia
- agitation
- hx of affective disorders or physical disorders of the brian that cause decreased mental function
USE OF IM PREPARATIONS OF ANTIPSYCHOTICS VARIES BETWEEN WHICH TWO IMPORTANT DRUGS
HALOPERIDIOL»_space;» CLOZAPINE
management of NMS
withdraw causative drug
initiate supportive care
acute symptoms=fever, rigidity, AMS
aid recovery by preventing rhabdomyolysis, renal and resp failure, prevent recurrence
dopa agonists= bromocriptine»>amantidine
dantrolene -muscle relaxant and for malignant hyperthermia
lorazepam -reduce psychosis, agitation, anxiety, and anticonvulsant
drugs indicated in management of NMS
bromocriptine
dantrolene
lorazepam-ativan
drugs associated with Neuroleptic Malignant syndrome
haloperidol and chlorpromazine (d2 antagonist)
*these are worse because they are high potency-avoid to rapid dose escalation
any antipsychotic can cause it
management of malignant hyperthermia
IV dantrolene correct metabolic acidosis-hyperventilate? monotor serum potassium -insulin and glucose -calcium chloride or glucuronate -IV lidocaine for arrhythmia COOL BODY TO 38 DEGREES CELCIUS MAINTINA URINARY OUTPUT -COLD FLUIDS, FUROSEMIDE, AND MANNITOL IF NEEDED
WHAT PRECIPITATES MALIGNANT HYPERTHERMIA
VOLITILE ANESTHETICS
- DESFLURANE
- N2O
- SEVOFLURANE
- XENON
- ISOFLURANE
SUCCINYLCHOLINE-NMBAGENT
MOA FOR MALIGNANT HYPERTHERMIA
UNCONTROLLED RELEASE OF CALCIUM FROM CR BY RYR RECEPTOR-MUSCLE CONTRACTION AND REVERSION TO INTERMEDIATE METABOLISM-METABOLIC ACIDOSIS
