The Syndromes

Question 1

Name the syndromes (4)

Answer 1

Serotonin Syndrome
Anticholinergic “toxidrome”
Neuroleptic malignant (NM) syndrome
Malignant hyperthermia

Question 2

Serotonin syndrome - medication history

Answer 2

Pro-serotinergic drug

Question 3

Serotonin syndrome - time to develop

Answer 3

< 12 hr

Question 4

Serotonin syndrome - vital signs

Answer 4

HTN
Tachycardia
Tachypnea
Hyperthermia (>41.1)

Question 5

Serotonin syndrome - Pupils / Mucosa / Skin

Answer 5

Mydriasis
Sialorrhea
Diaphoresis

Question 6

Serotonin syndrome - Bowel sounds

Answer 6

Hyperactive

Question 7

Serotonin syndrome - Neuro-muscular tone

Answer 7

Increasesed (mostly lower limbs)

Question 8

Serotonin syndrome - Neuro-muscular reflexes

Answer 8

Hyperreflexia

Clonus

Question 9

Serotonin syndrome - Mental status

Answer 9

Agitation

Coma

Question 10

Anticholinergic “toxidrome” - medication history

Answer 10

Anti-cholinergic agent

Question 11

Anticholinergic “toxidrome” - time to develop

Answer 11

< 12 hr

Question 12

Anticholinergic “toxidrome” - vital signs

Answer 12

HTN
Tachycardia
Tachypnea
Hyperthermia (<38.8)

Question 13

Anticholinergic “toxidrome” - Pupils / Mucosa / Skin

Answer 13

Mydriasis
Dry Erythema
Hot and dry to touch

Question 14

Anticholinergic “toxidrome” - bowel sounds

Answer 14

Decreased / Absent

Question 15

Anticholinergic “toxidrome” - Neuro-muscular tone

Answer 15

Normal

Question 16

Anticholinergic “toxidrome” - Neuro-muscular reflexes

Answer 16

Normal

Question 17

Anticholinergic “toxidrome” - Mental status

Answer 17

Agitated delirium

Question 18

NM syndrome - medication history

Answer 18

Dopamine antagonist

Question 19

NM syndrome - time to develop

Answer 19

1-3 days

Question 20

NM syndrome - Vital signs

Answer 20

HTN
Tachycardia
Tachypnea
Hyperthermia (>41.1)

Question 21

NM syndrome - Pupils / Mucosa / Skin

Answer 21

Normal
Sialorrhea
Pallor, diahporesis

Question 22

NM syndrome - Bowel sounds

Answer 22

Normal or decreased

Question 23

NM syndrome - neuromuscular tone

Answer 23

“Lead pipe” rigidity

Question 24

NM syndrome - neuromuscular reflexes

Answer 24

Bradyreflexia

Question 25

NM syndrome - Mental status

Answer 25

Stupor, alert mutism, coma

Question 26

Malignant hyperthermia - medication history

Answer 26

Inhalational anasthesia

Question 27

Malignant hyperthermia - time to develop

Answer 27

30 min - 24 hr

Question 28

Malignant hyperthermia - vital signs

Answer 28

HTN Tachycardia Tachypnea Hyperthermia (up to 46)

Question 29

Malignant hyperthermia - Pupils / Mucosa / Skin

Answer 29

Normal Normal Mottled appearance / diaphoresis

Question 30

Malignant hyperthermia - Bowel sounds

Answer 30

Decreased

Question 31

Malignant hyperthermia - Neuromuscular tone

Answer 31

Rigor mortis "like" rigidity

Question 32

Malignant hyperthermia - Neuromuscular reflexes

Answer 32

Hyporeflexia

Question 33

Malignant hyperthermia - mental status

Answer 33

Agitation

Question 34

Serotonin syndrome Tx

Answer 34

Discontinue precipitating drugs Supportive management Serotonin antagonist - cyproheptadine

Question 35

NM syndrome Tx

Answer 35

``` Discontinue precipitating drugs Supportive management Dopamine agonists (Bromocriptine >> Amantadine) Muscle relaxant (dantrolene) Lorazepam ```

Question 36

Malignant Hyperthermia Tx

Answer 36

``` IV Dantrolene Correct metabolic acidosis Monitor serum potassium - insulin / glucose - calcium chloride or gluconate - IV lidocaine (arrhythmia) Cool to < 38 Maintain urinary output ```

Question 37

Anticholinergic Toxidrome Tx

Answer 37

Cooling Benzos Physostigmine (CI w/ TCAs bc seizures) -anti-cholinesterase agent

Question 38

Cyproheptadine indication/MOA

Answer 38

Serotonin Syndrome

Question 39

bromocriptine indication/MOA

Answer 39

Neuroleptic Malignant Syndrome

Question 40

dantrolene indication/MOA

Answer 40

Neuroleptic Malignant Syndrome

Question 41

physostigmine indication/MOA

Answer 41

Anti-ACh poisoning / anti-cholinesterase

Question 42

amantadine indication/MOA

Answer 42

Parkisonian syndrome / DA releaser & enhancer (NMDA antagonist too)