Hot and Crazy Flashcards
CONSOLIDATION
SERITONIN SYNDROME DIAGNOSTIC CRITERIA
Exposure to serotonergic medication with 1 of the following
1.spontaneous clonus
2.inducible clonus AND agitation or diaphoresis
3.occular clonus AND agitation or diaphoresis
4.Tremor and hyperreflexia
5.Hypotonia AND Tmax >38 AND occular or inducible clonus
List 8 causative agents of serotonin syndrome?
Which receptors do they act on?
All act on 5-HTP receptors
Antidepressants (SSRIs, SNRIs and MAOIs) - most common
Analgesics (fentanyl, methadone, and tramadol)
Antiemetics (ondansetron and metoclopramide)
Cold medications (dextromethorphan and pseudoephedrine)
Illicit substances (cocaine, ecstasy, methamphetamine, LSD)
Others (triptans, ergots, bromocriptine, linezolid, carbamazepine, cyclobenzaprine and methylene blue)
Serotonin syndrome management
Stop causative agents
IVF if dehydrated
External cooling measures, as antipyretics are ineffective
O2 as needed
Benzodiazepines for agitation
For severe/refractory autonomic instability (HTN)- esmolol or nitroprusside
cyproheptadine (12 mg po/OG) in severe cases.
Intubation+ sedation+ paralysis for Tmax >41.1
Differential diagnosis for hot and agitated
- serotonin syndrome
- ASA toxicity
- Sympathomemetic toxicity
- Anti-cholinergic toxicity
- Sepsis
- Thyroid storm
- NMS
- MH
- meningitis/ encephalitis
10.Sedative-hypnotic (eg, alcohol, benzodiazepine, clonidine, baclofen) withdrawal - acute extra pyramidal syndromes (dystonic reactions)
NMS etiology
blockade or rapid withdrawal of dopamine agonist medications, leading to AMS, muscle rigidity, fever, and autonomic instability.
List 6 causative agents of NMS
Intoxication with the following:
1.All antipsychotics
2.Antiemetics (Droperidol, Domperidone,, Metoclopramide, Promethazine, Prochlorperazine)
3.TCAs
4.Others (Tetrabenazine, ionated contrast medium, Lithium,
Phenelzine (MAOI), Dosulepin,
Rapid withdrawal from the following:
Levodopa
Amantadine
Tolcapone
