NMS, SS and TD Flashcards
Review
Define NMS
Development of severe muscle rigidity and elevated temperature, associated with antipsychotic medication, includes leukocytosis, elevated CK and diaphoresis, dysphasia, tremor, incontinence, changes in concsioucness, mutism, tachycardia, hypertension and fever.
What is the incidence of NMS
0.02-3% after exposure to antipsychotics
What is the mortality rate of NMS
somewhere between 10-20% depending on severity and level of supportive care available
Define Serotonin Syndrome
Development of mental status changes, autonomic hyperactivity and neuromuscular changes related to increased serotonin activity
What are the neuromuscular changes seen with SS
Hyperactivity such as tremor, muscle rigidity, myoclonus, hyperreflexia, bilaterial babinski. Clonus and hyperreflexia are most common.
Highlight some of the differences between the onset NMS and SS
The onset of SS is usually within minutes to hours, the onset of NMS is usually days to weeks
Highlight some of the differences between the improvement or resolution of NMS and SS
SS improves within 24 hours, NMS improves over about 14 days
Highlight some of the differences between the clinical and lab findings of NMS and SS
NMS will have a much more common increase in CK, Leukocytosis, and will always have fever, NMS will also be associated with iron deficiency and elevated transaminases. Hyperreflexia is much much more common in SS (also diarrhea )
What is the Triad of NMS
Elevated CK, Leukocytosis and Fever
What is the MoA of Dantrolene
Muscle relaxant, interacts directly with skeletal muscle by interfering with the release of calcium
What are the risks of dantrolene
CNS depression, Hepatotoxicity, Muscle weakness, photosensitivity, risk for cardiac and respiratory side effects.
How long should you treat after the resolution of symptoms in NMS
about 10 days
What are the risks of using succinylcholine (with ECT) in NMS
May cause rhabdomyolysis and hyperkalemia
Define Tardive Dyskinesia
Medication induced hyperkinetic movement disorder related to dopamine receptor blocking agents.
What is the spectrum of Tardive Dyskinesia
postures, chorea, athetosis, stereotyped behaviors, dystonia, akathisisa, tics, tremor. Most often is noticed in the orofacial area, but may involve other areas.
