Drugs And Reactions

Question 1

NMS vs. serotonin syndrome

Answer 1

NMS: lead-pipe RIGIDITY, rhabdo, VERY high fevers
(from antipsychotics)

Serotonin: tremor, hyperreflexia, myoclonus, milder fever, GI sx (NO rigidity!)
(due to combination of serotonergic meds or interaction of these meds with MAOIs)

Question 2

Hypercarbia, muscle rigidity, hyperthermia

Fast onset

Answer 2

Malignant hyperthermia (faster onset than NMS)

diff clinical context from NMS. Malignant hyperthermia is from anesthestics

Question 3

Intoxication from which TWO combined drugs?

-> bradycardia, hypotension, respiratory depression, hyporeflexia
(But normal pupils, does NOT respond to naloxone, normal bowel sounds)

Answer 3

Alcohol and benzos (sedative-hypnotic overdose)

Question 4

Antipsychotic side effect: sudden, sustained contraction of neck, mouth, tongue, eye muscles

Treatment?

Answer 4

Acute dystopia

To: benztropine or diphenhydramine (anticholinergics)

Question 5

Antipsychotic side effect: subjective restlessness, inability to sit still

Treatment?

Answer 5

Akathisia

Tx: B blocker (propranolol) or benzo (lorazepam)

Question 6

Antipsychotic side effect: gradual-onset tremor, rigidity, bradykinesia

Treatment?

Answer 6

Parkinsonism

Tz: benztropine or amantadine

Question 7

Antipsychotic side effect:
Gradual onset after >6mo of therapy
Stereotypic, involuntary, painless movements of mouth, face, trunk, extremities

Answer 7

Tardive dyskinesia
No treatment (maybe clozapine?)

Giving anticholinergics or decreasing neuroleptic may initially worsen tardive

Question 8

Intoxication with which drug > violence, nystagmus?

Answer 8

PCP

Nystagmus distinguishes this from meth (which can also cause psychomotor agitation etc).

Question 9

First line for alcohol use disorder

Answer 9

Naltrexone to decrease craving if still actively drinking
Can’t use in acute hepatitis or liver failure
Can’t use in those taking opiods

Acamprosate (glutamate modulator) used to maintain abstinence

Question 10

Difference between PCP, meth, Bath salts for length of intoxication

Answer 10

PCP: ~8 hours
Meth: a day
Bath salts: days-weeks

Question 11

Alcohol withdrawal timing

Answer 11

Seizures: 12-48hr

DT 2-4 days

Question 12

Tx of alcohol withdrawal

Answer 12

Benzo (lorazepam preferred in inpatient setting, especially in those with liver dz)

Question 13

Tx of benzo toxicity

Answer 13

Flumazenil (benzo antagonist)

Question 14

contraindication to lithium

Answer 14

renal dysfunction.

use valproate instead

Question 15

MAO inhibitor (eg phenelzine) + tyramine (eg wine, aged cheese, cured meets etc) –> what?

Answer 15

Hypertensive crisis

Headache, intracranial bleeding, stroke, death

Question 16

Side effects of TCA

Answer 16

Anti HAM
Histamine - drowsiness
Adrenergic - orthostatic hypotension
Muscarinic - dry mouth, etc

Question 17

OCD personality disorder vs. OCPD

Answer 17

OCPD: ego syntonic (comfortable with behaviors, believes they are good)

OCD: ego dystonic (distressed about symptoms)

Question 18

what recreational drug can cause serotonin syndrome and hyponatremia

Answer 18

ecstasy

Question 19

What to check before starting Lithium

Answer 19

preg test
Calcium (risk of hyperpara with hyperCa)
Renal function (risk of nephrogenic DI)
thyroid (risk of thyroid dysfunction)

Question 20

antipsychotic side effect:

fever, confusion, rigidity, autonomic instability

Answer 20

Neuroleptic malignant syndrome

Question 21

Treatment for NMS

Answer 21

Dantrolene (muscle relaxant to alleviate the rigidity!)

bromocriptine or amantadine
dopamine agonists

Question 22

Treatment for serotonin syndrome

Answer 22

Cyproheptadine

Question 23

Treatment for dystonias and parkinsonism

Answer 23

Benztropine (anticholinergic)

Diphenhydramine

Question 24

Treatment for anticholinergic toxicity

Answer 24

Physostigmine (cholinesterase inhibitor)

Question 25

Treatment for malignant hyperthermia

Answer 25

Dantrolene (muscle relaxant to alleviate the rigidity!)

Question 26

Tx of opioid withdrawal

Answer 26

Methadone or buprenorphine

Or clonidine

Question 27

Tx of opioid overdose

Answer 27

Naloxone

Question 28

Tx of benzo overdose

Answer 28

Flumazenil