NMS Flashcards
what is neuroleptic malignant syndrome?
a neurologic emergency associated with the use of antipsychotic (neuroleptic) agents
what is NMS characterized by?
a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia
Incidence for NMS?
0.02 to 3 percent among patients taking antipsychotic agents
Age is a risk factor for the occurrence of NMS
true or false
false
What is NMS most often associated with?
High-potency first-generation antipsychotic agents
NMS stands for Neuroleptic Malignant Syndrome, commonly linked to agents like haloperidol and fluphenazine.
Name a high-potency first-generation antipsychotic agent.
Haloperidol
Other examples include fluphenazine.
Which class of drugs has been implicated in NMS aside from high-potency first-generation antipsychotics?
Low-potency first-generation drugs and second-generation antipsychotic drugs
Examples include chlorpromazine, thioridazine, clozapine, risperidone, olanzapine, and aripiprazole.
Fill in the blank: NMS has been reported with _______ drugs whose mechanism of action involves dopamine blockade.
Antiemetic
Examples are metoclopramide, promethazine, domperidone, droperidol, prochlorperazine, and levosulpiride.
True or False: Only high-potency first-generation antipsychotics can cause NMS.
False
NMS can occur with all classes of antipsychotic drugs and certain antiemetic agents.
What are some examples of second-generation antipsychotic drugs?
Clozapine, risperidone, olanzapine, aripiprazole
These drugs have also been implicated in NMS.
When do symptoms of NMS typically develop after the initiation of antipsychotic therapy?
During the first week after initiation or increase of therapy
Is the occurrence of NMS dose-dependent?
No, it is not a dose-dependent phenomenon
What are some risk factors for developing NMS?
- Higher doses
- Recent or rapid dose escalation
- A switch from one agent to another
- Parenteral administration
Can NMS occur after a single dose of antipsychotic medication?
Yes, it can occur after a single dose
Is it possible for NMS to develop after years of treatment with the same agent at the same dose?
Yes, it can occur rarely after long-term treatment
What is the relationship between drug use and NMS?
The association is idiosyncratic§
What should be prioritized if NMS is suspected?
Stopping or restarting/continuing the causative drug
NMS stands for Neuroleptic Malignant Syndrome, a potentially life-threatening condition often associated with antipsychotic medications.
What types of drugs are commonly associated with NMS?
Dopamine antagonists
Most antipsychotics are dopamine antagonists that can lead to NMS.
Name other dopamine antagonists/modulators that may contribute to NMS.
- Metoclopramide
- Lithium
- Tolcapone
- Amantadine
- Certain tricyclic antidepressants
These drugs can also induce NMS-like symptoms.
What should be done with dopamine agonists in the context of NMS?
Re-start/continue the causative drug
Dopamine agonists are not typically associated with NMS.
What is a practical tip regarding the restart of antipsychotic medication after NMS?
Delay restarting withdrawn antipsychotic medication for at least 2 weeks following complete resolution of the NMS episode
This helps reduce the risk of recurrence.
What initial supportive therapy should be ensured for a patient with NMS?
Ensure the patient has a patent airway and is adequately ventilated
Adequate ventilation is crucial in managing NMS.
When should the critical care team be alerted in cases of NMS?
If the patient has moderate or severe NMS, severe hyperthermia, compromised ventilation due to rigidity, is in a coma, or develops acute renal failure or severe hyperkalaemia
These conditions indicate a high risk and require urgent intervention.
What is the recommended fluid management for patients with NMS?
Give fluids to all patients with NMS
Most patients are dehydrated in the acute phase of the illness.
Which cooling methods are effective for mild to moderate hyperthermia in NMS?
- Mist and fan techniques
- Ice packs to groin and axillae
- External cooling devices
These methods help reduce body temperature effectively.
What should be done for severe hyperthermia in NMS patients?
Instigate urgent additional cooling methods with regular monitoring of the patient’s core temperature
These methods include internal or invasive measures such as cold fluid lavage.
What is the management protocol for rhabdomyolysis in NMS patients?
Give intravenous fluids to maintain a urine output of ≥1 mL/kg/hour
Monitoring fluid balance and electrolytes is crucial in this context.
What is the purpose of urine alkalinisation in rhabdomyolysis?
To prevent or reduce the severity of renal failure that is due to rhabdomyolysis
This is not commonly used as patients are often referred to critical care early.
What type of sedation is appropriate for agitated NMS patients?
Using an oral or intravenous benzodiazepine
Examples include diazepam and lorazepam.
What are the adverse effects of benzodiazepines in NMS management?
Respiratory depression and/or worsening delirium
Close monitoring is necessary when administering benzodiazepines.
What should be considered if a patient with severe NMS does not respond to supportive therapy?
Consider a dopamine agonist (bromocriptine or amantadine) or dantrolene
These medications can help reduce NMS-associated hyperthermia and rigidity.
