Flashcards in The Syndromes Deck (46):
concurrent drugs that inhibit which CYP enzymes can precipitate serotonin syndrome, as well as withdrawal of concurrent drug treatment?
serotonin syndrome occurs most commonly with which class of drugs?
describe some of the clinical signs/symptoms of serotonin syndrome (in order of mild to life-threatening)
Tremor / hyperreflexia
Altered Mental status
in the management of serotonin syndrome you might give what serotonin antagonist?
what makes up the typical management of serotonin syndrome?
discontinue precipitating drugs
provide supportive management
give serotonin antagonists
control autonomic instability
control hyperthermia (cooling measures)
Reassess the need to resume the use of serotonergic agent once the symptoms have resolved
why are MAOis assoc. with serotonin syndrome?
they inhibit serotonin breakdown ( phenelzine)
why is St. John's wort assoc. with serotonin syndrome?
inhibits serotonin breakdown
explain how lithium is assoc. with serotonin syndrome
can increase serotonin metabolites in the CSF & may interact pharmacodynamically w/ SSRIs resulting in serotonin syndrome
name some of the dietary supplements and herbal products that are assoc. with serotonin syndrome?
St. John's wort
Name all the classes of drugs you can think of that are assoc. with serotonin syndrome
St. John's wort, Ginseng
what is the cause of neuroleptic malignant syndrome?
due to blockade of dopaminergic D2 receptors in the brain
what are the classic symptoms of neuroleptic malignant syndrome?
1-3 days for condition to develop:
stupor, alert, mutism
what is the reason that pts get hyperthermia in neuroleptic malignant syndrome?
blockade of D2 receptors in the hypothalamus causes hyperthermia
what is the mechanism by which pts experience autonomic dysfunction in neuroleptic malignant syndrome?
blockade of inhibitory actions of dopamine on the SNS--> autonomic dysfunction
what is the mechanisms behind the increased muscle rigidity/tremor in neuroleptic malignant syndrome?
blockade of nigrostriatal dopamine results in the increased rigidty/tremor via extrapyramidal pathways
-possible direct muscle tox. via increase in Ca2+ release from SR
what are the risk factors for neuroleptic malignant syndrome?
high-dose & high potency antipsychotic agents
rapid dose escalation
depot forms of drug release (haloperidol)
prev. hx of NMS
increased ambient temp. or dehydration
catatonia or agitation
hx of affective disorders or physical disorders of brain that cause a decrease in mental function
which antipsychotic when used as depot IM prep has high risk for neuroleptic malignant syndrome?
concomitant use of what types of drugs can be additional risk factors for neuroleptic malignant syndrome?
what is the most important component to the management of neuroleptic malignant syndrome?
withdraw causative drug and institute supportive care
when managing neuroleptic malignant syndrome you want to treat acute symptoms and aid recovery by preventing what kinds of complications?
renal & resp. failure
what are the drugs that may be used in the management of neuroleptic malignant syndrome?
dopamine agonists: bromocriptine >> amantadine
dantrolene: skeletal muscle relaxant
Lorazepam: to control psychosis, agitation, and anxiety
which two typical antipsychotics are common causes of neuroleptic malignant syndrome?
Note: can occur with any antipsychotic agent
which neuromuscular blocking drug commonly causes malignant hyperthermia?
how do you manage malignant hyperthermia?
correct metabolic acidosis
monitor serum potassium
cool body to < 38 C
maintain urinary output
how do you manage/treat anticholinergic poisoning?
Cooling for hyperthermia and BENZOs for agitation
why is physostigmine not necessary in most cases of anticholinergic poisoning?
can produce seizures or cause bradyasystole; these complications happen with pts who have TCA poisoning
which anticholinesterase may be used with anticholinergic poisoning?
physostigmine (althought lots of toxicity like seiures, esp. with pts overdosing on TCAs)
name the syndrome: pupils-mydriasis, sialorrhea, diaphoresis, hyperactive bowel sounds, increased neuromuscular tone (esp. in lower limbs), hyperreflexia, clonus, agitation, coma
how long does it take for serotonin syndrome to develop?
< 12 hrs
how long does it take for anticholinergic toxidrome to develop?
< 12 hrs
describe the pupils skin, mucosa in anticholinergic toxicity
mydriasis, dry erythema, hot & dry to touch
describe the bowel sounds in anticholinergic toxicity
decreased or absent
what is the mental status of a pt experiencing anticholinergic toxicity?
agitated and delirious
how long does it take neuroleptic malignant syndrome to develop?
describe the pupils, mucosa, skin in neuroleptic malignant syndrome?
normal, sialorrhea, pallor, diaphoresis
describe the neuromuscular tone in neuroleptic malignant syndrome
lead pipe rigidity in all muscles
describe the neuromuscular reflexes in neurleptic malignant syndrome?
what is the mental status of a pt in neurleptic malignant syndrome?
what is the medication history of a pt experiencing malignant hyperthermia?
describe the bowel sounds in malignant hyperthermia
describe the muscle tone in malignant hyperthermia
rigor mortis like rigidity
describe the mental status of a pt with malignant hyperthermia
about how long after administration of inhalational anesthesia or succinylcholine would a pt experience malignant hyperthermia?
30 mins-24 hrs
describe the pupils, mucosa, skin in serotonin syndrome
describe the neuromuscular reflexes in serotonin syndrome
clonus (unless masked by increased muscle tone)