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Flashcards in The Syndromes Deck (46):
1

concurrent drugs that inhibit which CYP enzymes can precipitate serotonin syndrome, as well as withdrawal of concurrent drug treatment?

CYP2D6/3A4

2

serotonin syndrome occurs most commonly with which class of drugs?

SSRIs

3

describe some of the clinical signs/symptoms of serotonin syndrome (in order of mild to life-threatening)

Akathisia
Tremor / hyperreflexia
Altered Mental status
Clonus (inducible)
Clonus (sustained)
Muscular hypertonicity
Hyperthermia

4

in the management of serotonin syndrome you might give what serotonin antagonist?

cyproheptadine

5

what makes up the typical management of serotonin syndrome?

discontinue precipitating drugs
provide supportive management
control agitation
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

6

why are MAOis assoc. with serotonin syndrome?

they inhibit serotonin breakdown ( phenelzine)

7

why is St. John's wort assoc. with serotonin syndrome?

inhibits serotonin breakdown

8

explain how lithium is assoc. with serotonin syndrome

can increase serotonin metabolites in the CSF & may interact pharmacodynamically w/ SSRIs resulting in serotonin syndrome

9

name some of the dietary supplements and herbal products that are assoc. with serotonin syndrome?

tryptophan
St. John's wort
Ginseng

10

Name all the classes of drugs you can think of that are assoc. with serotonin syndrome

SSRIs
antidepressants
MAOIs
AEDs (valproate)
analgesics
antiemetics
antimigraine drugs
St. John's wort, Ginseng
Lithium

11

what is the cause of neuroleptic malignant syndrome?

due to blockade of dopaminergic D2 receptors in the brain

12

what are the classic symptoms of neuroleptic malignant syndrome?

1-3 days for condition to develop:
stupor, alert, mutism
hyperthermia
autonomic dysfunction
muscle rigidity
extrapyramidal tremor

13

what is the reason that pts get hyperthermia in neuroleptic malignant syndrome?

blockade of D2 receptors in the hypothalamus causes hyperthermia

14

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

15

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

16

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

17

which antipsychotic when used as depot IM prep has high risk for neuroleptic malignant syndrome?

haloperidol

18

concomitant use of what types of drugs can be additional risk factors for neuroleptic malignant syndrome?

antidepressants
anticholinergic agents
lithium

19

what is the most important component to the management of neuroleptic malignant syndrome?

withdraw causative drug and institute supportive care

20

when managing neuroleptic malignant syndrome you want to treat acute symptoms and aid recovery by preventing what kinds of complications?

rhabdomyolysis
renal & resp. failure
prevent recurrence

21

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

22

which two typical antipsychotics are common causes of neuroleptic malignant syndrome?

haloperidol
chlorpromazine
Note: can occur with any antipsychotic agent

23

which neuromuscular blocking drug commonly causes malignant hyperthermia?

succinylcholine

24

how do you manage malignant hyperthermia?

IV dantrolene
correct metabolic acidosis
monitor serum potassium
cool body to < 38 C
maintain urinary output

25

how do you manage/treat anticholinergic poisoning?

Cooling for hyperthermia and BENZOs for agitation

26

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

27

which anticholinesterase may be used with anticholinergic poisoning?

physostigmine (althought lots of toxicity like seiures, esp. with pts overdosing on TCAs)

28

name the syndrome: pupils-mydriasis, sialorrhea, diaphoresis, hyperactive bowel sounds, increased neuromuscular tone (esp. in lower limbs), hyperreflexia, clonus, agitation, coma

serotonin syndrome

29

how long does it take for serotonin syndrome to develop?

< 12 hrs

30

how long does it take for anticholinergic toxidrome to develop?

< 12 hrs

31

describe the pupils skin, mucosa in anticholinergic toxicity

mydriasis, dry erythema, hot & dry to touch

32

describe the bowel sounds in anticholinergic toxicity

decreased or absent

33

what is the mental status of a pt experiencing anticholinergic toxicity?

agitated and delirious

34

how long does it take neuroleptic malignant syndrome to develop?

1-3 days

35

describe the pupils, mucosa, skin in neuroleptic malignant syndrome?

normal, sialorrhea, pallor, diaphoresis

36

describe the neuromuscular tone in neuroleptic malignant syndrome

lead pipe rigidity in all muscles

37

describe the neuromuscular reflexes in neurleptic malignant syndrome?

bradyreflexia

38

what is the mental status of a pt in neurleptic malignant syndrome?

stupor
alert mutism
coma

39

what is the medication history of a pt experiencing malignant hyperthermia?

inhalational anesthesia

40

describe the bowel sounds in malignant hyperthermia

decreased

41

describe the muscle tone in malignant hyperthermia

rigor mortis like rigidity

42

describe the mental status of a pt with malignant hyperthermia

agitation

43

about how long after administration of inhalational anesthesia or succinylcholine would a pt experience malignant hyperthermia?

30 mins-24 hrs

44

describe the pupils, mucosa, skin in serotonin syndrome

mydriasis
sialorrhea
diaphoresis

45

describe the neuromuscular reflexes in serotonin syndrome

hyperreflexia
clonus (unless masked by increased muscle tone)

46

describe the mental status of a pt in serotonin syndrome

agitation, coma