Serotonin syndrome

Question 1

serotonin is a neurotransmitter that acts in what

Answer 1

• CNS
• GI tract
• platelets

Question 2

functions of serotonin

Answer 2

• feelings of well-being
• regulate clotting, mood, appetite, and sleep

Question 3

what is serotonin syndrome

Answer 3

• over activation of serotonin at postsynaptic receptors

Question 4

what is the serotonin syndrome triad

Answer 4

1. altered mental status: agitation
2. neuromusclar abnormalities: hyperreflexia, tremor
3. autonomic hyperactivity: tachycardia, mydirasis, diaphoresis

• rapid onset

Question 5

what are some of the altered mental status changes seen with serotonin syndrome

Answer 5

• agitation
• anxiety
• excitement
• disorientation

Question 6

what are some of the neuromuscular abnormalities seen with serotonin syndrome

Answer 6

• tremors
• clonus
• hyperreflexia
• • babinski’s sign
• akasthesia: need to be in constant motion

Question 7

what are some of the symptoms of autonomic hyperactivity seen with serotonin syndrome

Answer 7

• HTN
• tachycardia
• hyperthermia
• mydriasis
• V/D

Question 8

how is serotonin syndrome diagnosed

Answer 8

• clinical diagnosis
  
  • ​Hunter toxicity criteria
    
    • ​pt must have taken a serotonergic agent AND have one of the following
      
      • spontaneous clonus
      • inducible clonus (or ocular clonus) + agitation or diaphoresis
      • tremor + hyperreflexia
      • hypertonia + temp > 100.4 + ocular clonus or inducible clonus

Question 9

MOA of MAOIs

Answer 9

• inhibit the metabolism of serotonin

Question 10

what is neuroleptic malignant syndrome

Answer 10

• life threatenng neurologic emergency associated with neuroleptic drugs (typical and atypical antipsychotics and antiemetics)
  
  • cause: dopamine antagonists

Question 11

onset of neuroleptic malignant syndrome

Answer 11

days to weeks

Question 12

neuromuscular findings associated with neuroleptic malignant syndrome

Answer 12

• bradyreflexia
• severe muscular rigidity

Question 13

anticholinergic toxicity has some similarity to serotonin syndrome, but does NOT present with

Answer 13

• abnormal muscle tone
• abnormal reflexes

Question 14

what is malignant hyperthermia

Answer 14

• potentially life threatening syndrome occuring in susceptible individuals post anesthesia
  
  • ​not an allergy
  • inherited autosomal dom.

Question 15

management of serotonin syndrome

Answer 15

• discontinue all serotonin agents
• sedation with benzodiazepines

Question 16

serotonin syndrome antidote

Answer 16

• cyproheptadine
  
  • ​histamine -1 receptor antagonist
  • adjuct option if combo supportive care + benzos not improving

Question 17

how is dementia diagnosed

Answer 17

• decline in cognition involving one or more cognitive domains
• decline from baseline
• progressive
• not occuring only during times of delirium
• not caused by another mental disorder

Question 18

if a patient does have cognitive decline associated with aging, these changes are NOT

Answer 18

• not progressive
• do not affect daily function

Question 19

List the 5 neurocognitive disorder (dementia) syndrome

Answer 19

1. alzheimers disease
2. dementia with lewy bodies
3. frontotemporal dementia
4. vascular dementia
5. parkinsons disease with dementia

Question 20

the mini mental state exam is the most widely used cognitive test for dementia. is it sensitive for mild dementia

Answer 20

• test NOT sensitive for mild dementia

Question 21

is neuroimaging (CT/MRI) indicated in initial eval of dementia

Answer 21

• yes

Question 22

what is the most common cause of chronic dementia in elderly patients

Answer 22

• alzheimers disease

Question 23

hallmark neuropathologic changes associated with alzheimers disease

Answer 23

• neuritic plaques
  
  • ​neuronal injury
• neurofibrillary tangles
  
  • ​degeneration
• extracellular deposits of amyloid beta peptides

Question 24

incidence of alzheimers disease doubles

Answer 24

• doubles every decade after age 60

Question 25

risk factors for alzheimers disease

Answer 25

* age * genetics * family history * 1/3 might be attributable to modifiable risk factors: DM, HTN, sedentary activity

Question 26

most common early symptoms of alzheimers disease

Answer 26

* memory impairment * sleep disturbances

Question 27

sundowning occurs in 2/3 of dementia patients. what is it

Answer 27

* agitation, aggression, wandering * peak in late afternoon and evening * worse the sleep, the worse the sundowning

Question 28

definitive diagnosis of alzheimers disease

Answer 28

* requires histopathologic examination

Question 29

whar are lewy bodies

Answer 29

* abnormal aggregates of protein that develop inside nerve cells in brain

Question 30

what impairments come first in dementia with lewy bodies

Answer 30

* **attention and executive/visuospatial function** * **​**difficulty driving, impaired work performance * memory affected later

Question 31

clinical presentation * early * **attention and executive/visuospatial function** * repeated **falls** * **parkinsonism sx** * **urinary dysfunction** * hallucinations * delusions

Answer 31

* dementia with lewy bodies

Question 32

avoid in treatment of hallucinations associated with dementia with lewy bodies due to risk of

Answer 32

1. avoid neuroleptics (haloperidol) 2. risk of neuroleptic malignant syndrome

Question 33

what is frontotemporal dementia

Answer 33

* degeneration of frontal and/or temporal lobes

Question 34

frontotemporal dementia is characterized by progressive changes in

Answer 34

* **personality** and **behavior** * may also have motor involvement: parkinsonsim

Question 35

age on onset of frontotemporal dementia

Answer 35

* early onset * ave age: 60

Question 36

age of onset of vascular multi-infarct dementia

Answer 36

* prevalence increases with age

Question 37

vascular multi-infarct dementia is characterized by

Answer 37

* ischemic or hemorrhagic strokes

Question 38

when does memory impairment occur in vascular multi-infarct dementia

Answer 38

* late

Question 39

cause of parkinson disease with dementia

Answer 39

* loss of dopamine neurons in substantia nigra

Question 40

list the cardinal motor features of parkinsonism

Answer 40

* bradykinesia * rigidity * **resting** tremor * postural instability

Question 41

early symptoms of parkinson disease with dementia

Answer 41

* dysfunction of **executive function** * impaired **visuospatial** function * **cardinal motor sxs** * **hallucination** * delusions

Question 42

late symptoms of alzheimers disease

Answer 42

* personality and behavior changes * incontinence * hallucinations

Question 43

mainstay of management of neurocognitive disorders

Answer 43

symptomatic

Question 44

patient presents with NCD and visual hallucinations and parkinsonism. patient likely has what condition? avoid what medication

Answer 44

* dementia with lewy bodies or parkinsons disease with dementia * caution with neuroleptics

Question 45

treatment of behavioral disturbance in NCD

Answer 45

* soothing activities * reset sleep wake cycle * assess pain

Question 46

what are the two types of medication that slow progression of NCDs

Answer 46

* **cholinesterase inhibitors** * D/C after 3 months if no response and move to * **NMDA receptor antagonist** * D/C after 5-6 months if no response

Question 47

function of cholinesterase inhibitors

Answer 47

* prevent breakdown of acetylcholine

Question 48

list the cholinesterase inhibitors

Answer 48

* **Donepezil**: watch for bradycardia * **Rivastigmine**: most GI cholinergic SE * **Galantamine**

Question 49

MOA and main side effect of Memantine

Answer 49

* NMDA receptor antagonist -\> neuroprotective * dizzziness