Serotonin Syndrome (Exam #4) Flashcards
What is the pathogenesis behind Serotonin Syndrome (SS)?
Increased serotonergic activity in CNS
What five classes of meds can cause Serotonin Syndrome (SS)? In addition, which specific opioid med?
- Antidepressants
- Migraine meds
- Muscle relaxants
- Antiemetics
- Cough meds
- Tramadol
What is the TRIAD of sxs associated with Serotonin Syndrome (SS)?
- AMS
- NM Abnormalities
- Autonomic Hyperactivity
What condition involves TRIAD of AMS, NM Abnormalities, Autonomic Hyperactivity?
Serotonin Syndrome (SS)
What is the typical onset of Serotonin Syndrome (SS)?
Rapid onset
- Usually minuets (within 24 hours)
What are three examples of AMS sxs associated with Serotonin Syndrome (SS)?
- Agitation
- Anxiety
- Disorientation
What are five examples of NM abnormality sxs associated with Serotonin Syndrome (SS)?
- Tremors
- Clonus
- Hyperreflexia
- Muscle rigidity
- +Babinski
What are five examples of Autonomic Hyperactivity sxs associated with Serotonin Syndrome (SS)?
- HTN
- Tachycardia
- Tachypnea
- Hyperthermia
- D, V
How is Serotonin Syndrome (SS) typically dx? What can NOT be used to dx SS?
CLINICALLY
- Serum Serotonin levels or serum drug levels DO NOT PREDICT SS
What condition involves Hunter Toxicity Criteria? What does this involve (__ AND 1+ of…(5))?
A serotonergic agent AND 1+ of…
- Spontaneous clonus
- Inducible clonus + agitation/diaphoresis
- Ocular clonus + agitation/diaphoresis
- Tremor + hyperreflexia
- Hypertonia + temp. about 38 C/100.4 F + ocular clonus/inducible clonus
What is the #1 tx for Serotonin Syndrome (SS)?
D/C ALL Serotonin agents
What is the recommended tx for Serotonin Syndrome (SS)? What med can be used?
What two tx should be AVOIDED?
Supportive care to normalize VS (O2, IVF, cardiac monitor)
- Benzos to control agitation
AVOID physical restraints or antipyretics
With a mild case of Serotonin Syndrome (SS), what is the recommended disposition/follow up?
Observation for 4-6 hours
- Consider discharge/24-hour follow-up if normal mental status, VS and NO clonus/further inc. in DTRs
With a moderate/severe case of Serotonin Syndrome (SS), what is the recommended disposition?
When are they considered critically ill?
ADMIT +/- ICU
- Critically ill = 105.9+ temp.
What is the antidote for Serotonin Syndrome (SS), and when might it be considered?
Cyproheptadine as ADJUNCT
- IF supportive care/Benzos NOT improving sxs
What three meds can cause sxs similar to Serotonin Syndrome (SS), and what conditions are associated with each?
- Anticholinergic use (toxicity)
- DA Antagonists = Neuroleptic Malignant Syndrome (NMS)
- Anesthesia = Malignant Hyperthermia (MH)
How can you differentiate Anticholinergic use (toxicity) from Serotonin Syndrome (SS)?
Anticholinergic use has NO effect on muscle tone or reflexes
- ACT = normal NM tone, normal reflexes
- SS = increased NM tone, hyperreflexia/clonus
How can you differentiate Anticholinergic use (toxicity) from Serotonin Syndrome (SS), NMS and MH?
Anticholinergic use (toxicity) = red/dry/hot - Others are diaphoretic
What condition does NOT effect muscle tone or reflexes?
Anticholinergic use (toxicity)
What two classes of meds can cause Neuroleptic Malignant Syndrome (NMS)?
DA Antagonists
- Antipsychotics
- Antiemetics
What condition involves FARM, and what does this stand for?
Neuroleptic Malignant Syndrome (NMS)
- Fever
- Autonomic instability
- Rigidity
- Mental status
What condition involves “Lead Pipe rigidity”?
Neuroleptic Malignant Syndrome (NMS)
How can you differentiate Neuroleptic Malignant Syndrome (NMS) from Serotonin Syndrome (SS), ACT and MH?
- Hyporeflexia
- Bradyreflexia
Others are hyperreflexia, normal or variable
How does onset differ for Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS)?
- SS = within 24 hours
- NMS = days/weeks (slower onset/resolution)
What condition presents post-op/after anesthesia?
Malignant Hyperthermia (MH)
What is the recommended tx of Malignant Hyperthermia (MH)?
Dantrolene
What is the initial sign of Malignant Hyperthermia (MH)?
Rapid rise in CO2
