Psych drug syndromes

Question 1

CNS serotonergic neruons located in the…

Answer 1

midline raphe nuclei (brainstem from midbrain to medulla)

Question 2

agonism of which receptors leads to serotonin syndrome

Answer 2

5-HT2a

Question 3

serotonin syndrome clinical findings

Answer 3

in order of severity: akathisia, tremor, altered mental status, clonus (inducible then sustained), muscular hypertonicity, hyperthermia

Question 4

serotonin syndrome management

Answer 4

discontinue potential precipitants
supportive management
serotonin antagonists - cyproheptadine
control autonomic instability
control hyperthermia

Question 5

neuroleptic malignant syndrome pathogenesis

Answer 5

blockade of D2 receptos in hypothalamus leads to hyperthermia; blockade of inhibitory actions of DA on the SNS leads to autonomic dysfunction
blacked of nigrostriatal DA results in increased muscle rigidity/tremor via extrapyramidal pathways
possible increase in Ca2+ release from SR - direct cause of muscle toxicity

Question 6

neuroleptic malignant syndrome risk factors

Answer 6

high antipsychotic dosage or rapid escalation; use of depot preparations
concomitant use of predisposing drugs
withdrawal of anti-parkinsonian agents
previous Hx of NMS
increased ambient temperature or dehydration
catatonia or agitation

Question 7

management of neuroleptic malignant syndrome

Answer 7

withdraw causative drug and institute supportive care;
prevent complications - rhabdomyolysis, renal and respiratory failure
DA agonists - bromocriptine best
dantrolene - skeletal muscle relaxant
lorazepam to reduce psychosis, agitation and anxiety and as an anticonvulsant

Question 8

neuroleptic malignant syndrome symptoms

Answer 8

hyperthermia autonomic dysfunction, muscle rigidity, and extrapyramidal tremor

Question 9

drugs associated with neuroleptic malignant syndrome

Answer 9

high-potency antipsychotics such as haloperidol and chlorpromazine, but can occur with any antipsychotic

Question 10

management of malignant hyperthermia

Answer 10

administer IV dantrolene, correct metabolic acidossi, monitor K+, administer calcium chloride or gluconate; IV lidocaine for arrhythmia, cool body to < 38 C; maintain urinary output

Question 11

management of anticholinergic poisoning

Answer 11

hyperthermia and agitation should be treated with cooling and benzos
physostigmine only if self-harming psychosis or hemodynamic dysfunction secondary to tachycardia
physostigmine has intrinsic toxicity and is not necessary in most cases (containdicated in TCA overdose because of seizures)

Question 12

anticholinergic poisoning symptoms

Answer 12

absent bowel sounds, mydriasis, dry erethematous skin, agitation and delirium; HTN, tachycardia, tachypnea, normal reflexes

Question 13

malignant hyperthermia symptoms

Answer 13

HTN, tachycardia, tachypnea, pupils normal, rigor mortis like rigidity, hyporeflexia, agitation