Psychotropic Meds Flashcards
Symptoms of tyramine syndrome
(From exposure to tyramine containing foods in person on MAOI)
Headache, hypertension, diaphoresis, neuromuscular excitation
Treatment of MAOI toxicity
Consider activated charcoal in early
Benzos for CNS excitation, rigidity, seizures
Cooling for hyperthermia
Short acting antihypertensives if hypertensive emergency but avoid bb so phentolamine or nitroprusside
10 drugs that can be implicated in serotonin syndrome
SSRI SNRI TCA MAOI cocaine LSD tramadol Meperidine Destromethorphan Lithium Metoclopramide St. John's wort
Which two receptors are implicated in serotonin syndrome
5HT 1 a and 5HT2a
Clinical presentation serotonin syndrome
Hyperthermia, diaphoresis, tachycardia, tachypnea
Muscle rigidity (lower extremities most), clonus, tremors, ataxia, hyperreflexia
Confusion, disorientation, agitation, seizures, coma
Treatment serotonin syndrome
Supportive Cooling Benzos Cyproheptadine in severe cases Sodium bicarb for widening qrs Iv fluid for rhabdo
Risk factors for NMS
Rapid loading or increased dosages antipsychotics
Haldol, loxaline, droperidol via iv
Concurrent use lithium
Withdrawal from dopaminergic Parkinsonian drugs
Differentiating NMS from serotonin syndrome
SS has hyperreflexia, clonus and dilated pupils
Differential for NMS
Serotonin syndrome Malignant hyperthermia Malignant Catalonia Baclofen withdrawal Anticholinergic Sympathomimetic Meningitis Thyroid storm Sedative withdrawal Pheochromocytoma
Treatment NMS
Stop offending agent Iv fluids Cooling Benzos for aggression Antihipertensives
Treatment of acute dysgenic reaction
Diphenhydramine
Benztropine
Mechanism of the disulfiram reaction
Inhibits aldehyde dehydrogenase so can’t breakdown acetaldehyde produced by ethanol metabolism
Causes nausea vomiting skin flushing, headache
Severe reaction hypotension, seizures, dysrhythmias
Clinical presentation wernicke encephalopathy
Treatment
Confusion, cerebellar dysfunction, nystagmus and ophthalmoplegia
Korasakoff if persistent anterograde and retrograde memory impairment with confabulation
Treatment is magnesium plus thiamine
Favour major complications of alcohol withdrawal
Minor : nausea, tremor, tachycardia, hypertension, insomnia
Seizures: generalized tonic clonic
Alcoholic hallucinosis with intact orientation and normal vs
Delirium tremens: altered sensorium with hallucination, paranoia, profound autonomic hyperactivity
Risk factors for delirium tremens
History of DT age over 30 Withdrawal symptoms despite high alcohol level Persistent heavy alcohol abuse Longer period since last drink
