Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

X Clin Med III Final Exam > Serotonin Syndrome > Flashcards

Serotonin Syndrome Flashcards

1
Q

Pathophys of serotonin syndrome

A

Increased serotonergic activity in CNS
Serotonin is NT in GI tract, platelets and in CNS (well-being, attention, behavior, thermoregulation, clotting)
Overactivation of serotonin at postsynaptic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cause of serotonin syndrome

A

Simultaneous administration of 2 (or more) serotonergic agents
Can even be with initiation of 1 serotonergic drug or after increased dosing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Serotonergic agents

A

Increase release of serotonin (meth, cocaine, E, levodopa)
Impairing reuptake (cocaine, E, meperidine, SSRIs, tramodol, SNRIs, TCAs, antiemetics, dextromethorphan, cyclbenzaprine)
Inhibit metabolism (MAOis)
Agonist (busprione, triptans, ergots, fentanyl)
Lithium (sensitivity of postsynaptic receptor)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Triad of serotonin syndrome

A

AMS
Neuromuscular abnormalities
Autonomic hyperactivity
(within mins to hours of agent)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

AMS changes in serotonin syndrome

A 
Agitation
Anxiety
Disorientation
Restlessness
Excitement
Startle easily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Neuromuscular abnormalities in serotonin syndrome

A 
Tremors
Clonus
Hyperreflexia
Muscle rigidity
\+bilteral Babinski
Akasthisia (needs to be in motion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Autonomic hyperactivity of serotonin syndrome

A

HTN, tachycardia/pnea, hyperthermia, shivering, vomiting, diarrhea, diaphoresis, dry mucous, flushed, hyperactive BS, mydriasis, arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Labs or imaging in serotonin syndrome

A

No lab to confirm
Serum levels don’t predict if have it
Labs: cBC, CMP, culture, UA, CSF, TSH, tox screen
May see elevated CPK or myoglobin (nonspecific)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hunter toxicity criteria

A

Pt must have taken a serotonergic agent AND have 1:
Spontaneous clonus
Inducible clonus PLUS agitation or diaphoresis
Ocular clonus PLUS agitation or diaphoresis
Tremor PLUS hyperrefelxia
Hypertonia PLUS temp >38 C PLUS ocular clonus or inducible clonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is neuroleptic malignant syndrome associated with?

A

Antipsychotics (Haldol, Risperdal, Reglan, Phenergan)

Anti-emetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tetrad of neuroleptic malignant syndrome

A 
FARM
Fever
Autonomic instability
Rigidity
Mental status changes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Things to differentiate NMS from serotonin syndrome

A

Hyporeflexia and bradyreflexia
Slower onset and slower resolution (Days to weeks)
Use bromocriptine for tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do you see malignant hyperthermia?

A

Genetic ppl (inherited autosomal dominant disorder) with exposure to anesthesia and succinylcholine (during or right after)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why does malignant hyperthermia happen?

A

Uncontrolled release of large quantities of Ca from muscle leading to hypermetabolic state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most reliable sign of malignant hyperthermia

A

Rapid rise in CO2 resistant to increased ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Presentation of malignant hyperthermia

A

Muscle rigidity
Tachycardia
Hyperthermia
(can become DIC and organ failure)

17
Q

Tx of malignant hyperthermia

A

Discontinue agent

Administer dantrolene to block Ca release

18
Q

How to differentiate anticholinergic toxidrome from serotonin syndrome

A

Anticholinergic does not affect muscle tone or reflexes! (red as a beet, dry as a bone, blind as a bat, hot as a hare, mad as a hatter)

19
Q

Management of seretonin syndrome

A

Discontinue all agents
Support to normalize vitals (O2, fluids, cardiac monitor, no restraints)
Sedate with benzos (control agitation and correct BP/ HR)

20
Q

Antipyretics for serotonin syndrome?

A

No b/c elevated temp is due to increase in muscular activity rather than hypothalamic temp set point

21
Q

Mild management of serotonin syndrome

A

Observe 4-6 hrs
Eliminate agent
If mental status, VS normal and no clonus or increase in DTRs, may d/c and f/u in 24 hrs

22
Q

Moderate/severe management of serotonin syndrome

A

Hospital (ICU with intubation)

23
Q

Management for pts with temp >41.1 C (105.9 F)

A

Critically ill so immediate sedation, paralysis and intubation

24
Q

What is cyproheptadine and when use?

A

Serotonin antagonist/ Histamine 1 receptor antagonist

Use if combo of supportive care and benzos don’t improve sxs (adjunct!!)

X Clin Med III Final Exam (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions