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Clin Med III Disease Key Notes > Serotonin Syndrome (Exam #4) > Flashcards

Serotonin Syndrome (Exam #4) Flashcards

1
Q

What is the pathogenesis behind Serotonin Syndrome (SS)?

A

Increased serotonergic activity in CNS

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2
Q

What five classes of meds can cause Serotonin Syndrome (SS)? In addition, which specific opioid med?

A
  • Antidepressants
  • Migraine meds
  • Muscle relaxants
  • Antiemetics
  • Cough meds
  • Tramadol
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3
Q

What is the TRIAD of sxs associated with Serotonin Syndrome (SS)?

A
  • AMS
  • NM Abnormalities
  • Autonomic Hyperactivity
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4
Q

What condition involves TRIAD of AMS, NM Abnormalities, Autonomic Hyperactivity?

A

Serotonin Syndrome (SS)

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5
Q

What is the typical onset of Serotonin Syndrome (SS)?

A

Rapid onset

- Usually minuets (within 24 hours)

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6
Q

What are three examples of AMS sxs associated with Serotonin Syndrome (SS)?

A
  • Agitation
  • Anxiety
  • Disorientation
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7
Q

What are five examples of NM abnormality sxs associated with Serotonin Syndrome (SS)?

A
  • Tremors
  • Clonus
  • Hyperreflexia
  • Muscle rigidity
  • +Babinski
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8
Q

What are five examples of Autonomic Hyperactivity sxs associated with Serotonin Syndrome (SS)?

A
  • HTN
  • Tachycardia
  • Tachypnea
  • Hyperthermia
  • D, V
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9
Q

How is Serotonin Syndrome (SS) typically dx? What can NOT be used to dx SS?

A

CLINICALLY

- Serum Serotonin levels or serum drug levels DO NOT PREDICT SS

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10
Q

What condition involves Hunter Toxicity Criteria? What does this involve (__ AND 1+ of…(5))?

A

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
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11
Q

What is the #1 tx for Serotonin Syndrome (SS)?

A

D/C ALL Serotonin agents

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12
Q

What is the recommended tx for Serotonin Syndrome (SS)? What med can be used?

What two tx should be AVOIDED?

A

Supportive care to normalize VS (O2, IVF, cardiac monitor)
- Benzos to control agitation

AVOID physical restraints or antipyretics

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13
Q

With a mild case of Serotonin Syndrome (SS), what is the recommended disposition/follow up?

A

Observation for 4-6 hours

- Consider discharge/24-hour follow-up if normal mental status, VS and NO clonus/further inc. in DTRs

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14
Q

With a moderate/severe case of Serotonin Syndrome (SS), what is the recommended disposition?

When are they considered critically ill?

A

ADMIT +/- ICU

- Critically ill = 105.9+ temp.

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15
Q

What is the antidote for Serotonin Syndrome (SS), and when might it be considered?

A

Cyproheptadine as ADJUNCT

- IF supportive care/Benzos NOT improving sxs

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16
Q

What three meds can cause sxs similar to Serotonin Syndrome (SS), and what conditions are associated with each?

A
  • Anticholinergic use (toxicity)
  • DA Antagonists = Neuroleptic Malignant Syndrome (NMS)
  • Anesthesia = Malignant Hyperthermia (MH)
17
Q

How can you differentiate Anticholinergic use (toxicity) from Serotonin Syndrome (SS)?

A

Anticholinergic use has NO effect on muscle tone or reflexes

  • ACT = normal NM tone, normal reflexes
  • SS = increased NM tone, hyperreflexia/clonus
18
Q

How can you differentiate Anticholinergic use (toxicity) from Serotonin Syndrome (SS), NMS and MH?

A 
Anticholinergic use (toxicity) = red/dry/hot
- Others are diaphoretic
19
Q

What condition does NOT effect muscle tone or reflexes?

A

Anticholinergic use (toxicity)

20
Q

What two classes of meds can cause Neuroleptic Malignant Syndrome (NMS)?

A

DA Antagonists

  • Antipsychotics
  • Antiemetics
21
Q

What condition involves FARM, and what does this stand for?

A

Neuroleptic Malignant Syndrome (NMS)

  • Fever
  • Autonomic instability
  • Rigidity
  • Mental status
22
Q

What condition involves “Lead Pipe rigidity”?

A

Neuroleptic Malignant Syndrome (NMS)

23
Q

How can you differentiate Neuroleptic Malignant Syndrome (NMS) from Serotonin Syndrome (SS), ACT and MH?

A
  • Hyporeflexia
  • Bradyreflexia

Others are hyperreflexia, normal or variable

24
Q

How does onset differ for Serotonin Syndrome (SS) and Neuroleptic Malignant Syndrome (NMS)?

A
  • SS = within 24 hours

- NMS = days/weeks (slower onset/resolution)

25
Q

What condition presents post-op/after anesthesia?

A

Malignant Hyperthermia (MH)

26
Q

What is the recommended tx of Malignant Hyperthermia (MH)?

A

Dantrolene

27
Q

What is the initial sign of Malignant Hyperthermia (MH)?

A

Rapid rise in CO2

Clin Med III Disease Key Notes (18 decks)

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