NMS

Question 1

what is neuroleptic malignant syndrome?

Answer 1

a neurologic emergency associated with the use of antipsychotic (neuroleptic) agents

Question 2

what is NMS characterized by?

Answer 2

a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia

Question 3

Incidence for NMS?

Answer 3

0.02 to 3 percent among patients taking antipsychotic agents

Question 4

Age is a risk factor for the occurrence of NMS

true or false

Answer 4

false

Question 6

What is NMS most often associated with?

Answer 6

High-potency first-generation antipsychotic agents

NMS stands for Neuroleptic Malignant Syndrome, commonly linked to agents like haloperidol and fluphenazine.

Question 7

Name a high-potency first-generation antipsychotic agent.

Answer 7

Haloperidol

Other examples include fluphenazine.

Question 8

Which class of drugs has been implicated in NMS aside from high-potency first-generation antipsychotics?

Answer 8

Low-potency first-generation drugs and second-generation antipsychotic drugs

Examples include chlorpromazine, thioridazine, clozapine, risperidone, olanzapine, and aripiprazole.

Question 9

Fill in the blank: NMS has been reported with _______ drugs whose mechanism of action involves dopamine blockade.

Answer 9

Antiemetic

Examples are metoclopramide, promethazine, domperidone, droperidol, prochlorperazine, and levosulpiride.

Question 10

True or False: Only high-potency first-generation antipsychotics can cause NMS.

Answer 10

False

NMS can occur with all classes of antipsychotic drugs and certain antiemetic agents.

Question 11

What are some examples of second-generation antipsychotic drugs?

Answer 11

Clozapine, risperidone, olanzapine, aripiprazole

These drugs have also been implicated in NMS.

Question 12

When do symptoms of NMS typically develop after the initiation of antipsychotic therapy?

Answer 12

During the first week after initiation or increase of therapy

Question 13

Is the occurrence of NMS dose-dependent?

Answer 13

No, it is not a dose-dependent phenomenon

Question 14

What are some risk factors for developing NMS?

Answer 14

• Higher doses
• Recent or rapid dose escalation
• A switch from one agent to another
• Parenteral administration

Question 15

Can NMS occur after a single dose of antipsychotic medication?

Answer 15

Yes, it can occur after a single dose

Question 16

Is it possible for NMS to develop after years of treatment with the same agent at the same dose?

Answer 16

Yes, it can occur rarely after long-term treatment

Question 17

What is the relationship between drug use and NMS?

Answer 17

The association is idiosyncratic§

Question 19

What should be prioritized if NMS is suspected?

Answer 19

Stopping or restarting/continuing the causative drug

NMS stands for Neuroleptic Malignant Syndrome, a potentially life-threatening condition often associated with antipsychotic medications.

Question 20

What types of drugs are commonly associated with NMS?

Answer 20

Dopamine antagonists

Most antipsychotics are dopamine antagonists that can lead to NMS.

Question 21

Name other dopamine antagonists/modulators that may contribute to NMS.

Answer 21

• Metoclopramide
• Lithium
• Tolcapone
• Amantadine
• Certain tricyclic antidepressants

These drugs can also induce NMS-like symptoms.

Question 22

What should be done with dopamine agonists in the context of NMS?

Answer 22

Re-start/continue the causative drug

Dopamine agonists are not typically associated with NMS.

Question 23

What is a practical tip regarding the restart of antipsychotic medication after NMS?

Answer 23

Delay restarting withdrawn antipsychotic medication for at least 2 weeks following complete resolution of the NMS episode

This helps reduce the risk of recurrence.

Question 24

What initial supportive therapy should be ensured for a patient with NMS?

Answer 24

Ensure the patient has a patent airway and is adequately ventilated

Adequate ventilation is crucial in managing NMS.

Question 25

When should the critical care team be alerted in cases of NMS?

Answer 25

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.

Question 26

What is the recommended fluid management for patients with NMS?

Answer 26

Give fluids to all patients with NMS

Most patients are dehydrated in the acute phase of the illness.

Question 27

Which cooling methods are effective for mild to moderate hyperthermia in NMS?

Answer 27

• Mist and fan techniques
• Ice packs to groin and axillae
• External cooling devices

These methods help reduce body temperature effectively.

Question 28

What should be done for severe hyperthermia in NMS patients?

Answer 28

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.

Question 29

What is the management protocol for rhabdomyolysis in NMS patients?

Answer 29

Give intravenous fluids to maintain a urine output of ≥1 mL/kg/hour

Monitoring fluid balance and electrolytes is crucial in this context.

Question 30

What is the purpose of urine alkalinisation in rhabdomyolysis?

Answer 30

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.

Question 31

What type of sedation is appropriate for agitated NMS patients?

Answer 31

Using an oral or intravenous benzodiazepine

Examples include diazepam and lorazepam.

Question 32

What are the adverse effects of benzodiazepines in NMS management?

Answer 32

Respiratory depression and/or worsening delirium

Close monitoring is necessary when administering benzodiazepines.

Question 33

What should be considered if a patient with severe NMS does not respond to supportive therapy?

Answer 33

Consider a dopamine agonist (bromocriptine or amantadine) or dantrolene

These medications can help reduce NMS-associated hyperthermia and rigidity.