Serotonin Syndrome inducing medications Flashcards
A patient presents with sudden onset of agitation, tachycardia, and sweating after taking a new medication. What life-threatening condition should you consider?
Serotonin syndrome, a toxic condition caused by excessive serotonin activity, leading to autonomic instability, neuromuscular excitation, and altered mental status.
What are the earliest signs of serotonin syndrome that might be overlooked?
Mild symptoms include restlessness, anxiety, tremors, diaphoresis, tachycardia, and mild hypertension.
Which neurological symptoms indicate worsening serotonin syndrome?
Hyperreflexia, clonus (inducible, spontaneous, or ocular), myoclonus, tremor, and agitation progressing to confusion or delirium.
What neuromuscular findings help differentiate serotonin syndrome from other toxic syndromes?
Serotonin syndrome is characterized by hyperreflexia, clonus, and myoclonus—especially lower extremity clonus. In contrast, neuroleptic malignant syndrome (NMS) presents with ‘lead-pipe’ rigidity and hyporeflexia.
A patient with serotonin syndrome starts exhibiting severe hyperthermia (>41°C), muscle rigidity, and seizures. What complication is occurring?
Severe serotonin toxicity with risk of metabolic acidosis, rhabdomyolysis, and multi-organ failure. Immediate sedation, cooling measures, and cyproheptadine are required.
Which autonomic symptoms suggest serotonin syndrome?
Diaphoresis, tachycardia, hyperthermia, hypertension, mydriasis, nausea, and vomiting.
Which drugs are most frequently implicated in serotonin syndrome?
SSRIs (e.g., fluoxetine, sertraline), SNRIs, MAOIs, TCAs, tramadol, meperidine, fentanyl, linezolid, ondansetron, dextromethorphan, MDMA, amphetamines, St. John’s wort, triptans, lithium.
Which diagnostic tool is commonly used to confirm serotonin syndrome?
The Hunter Serotonin Toxicity Criteria—a validated diagnostic tool requiring serotonergic drug use plus neuromuscular and autonomic findings (e.g., clonus, tremor, hyperthermia).
What is the first step in managing serotonin syndrome?
Immediate discontinuation of serotonergic drugs and supportive care (IV fluids, benzodiazepines, cooling, and monitoring for complications).
Which medication is used as an antidote for serotonin syndrome?
Cyproheptadine, a serotonin antagonist (5-HT2A blocker), is used for moderate to severe serotonin syndrome.
What treatment should be avoided in serotonin syndrome?
Antipyretics (ineffective for hyperthermia) and dopamine antagonists (e.g., haloperidol), which may worsen symptoms.
A patient with serotonin syndrome develops severe muscle rigidity, seizures, and respiratory failure. What should be done immediately?
Intubation with neuromuscular paralysis (non-depolarizing agents like rocuronium), sedation, and aggressive cooling.
