Syndromes Flashcards
1
Q
Serotonin Syndrome
A
- can happen in all patients
- may be dismissed as inconsequential or due to pt’s mental state
- single SSRI dose can cause it
- concurrent CYP2D6 and 3A4 inhibitors can precipitate syndrome as can withdrawal of concurrent drug treatment
2
Q
location of 5HT neurons in CNS
A
- midline raphe nuclei (midbrain to medulla)
- rostral end: wakefulness, affective behavior, food intake, thermoregulation, migraine, emesis, and sexual behavior
- in lower pons/medulla - regulation of nociception and motor tone
3
Q
peripheral 5HT neurons
A
- assist in regulation of vascular tone and GI motility
4
Q
Clinical findings for serotonin syndrome
A
- akathisia, tremor, altered mental status, clonus, muscular hypertonicity, hyperthermia
- some of the signs may mask others
5
Q
Management of 5HT syndrome
A
- discontinue use of all potential precipitating drugs
- provide supportive management
- control agitation
- administer 5HT antagnoists - cyproheptadine
- control autonomic instability
- control hyperthermia
6
Q
drugs associated w/ 5HT syndrome
A
- SSRIs
- Li
- Antidepressants
- MAOI -
- AEDs - valproate
- Analgesic
- Antiemetic
- Antimigraine drug
- Trp, St John’s worts, ginseng
7
Q
What is neuroleptic malignant syndrome?
A
- blockade of D2 receptors in hypothalams –> hyperthermia
- blockade of inhibitory actions of DA on SNS –> autonomic dysfunction
- blockade of nigrostriatal dopamine –> increase muscle rigidity/tremor via extrapyramidal pathways
8
Q
Risk factors for NM syndrome
A
- high dose and high potency antipsychotic agents
- rapid dose escalation of previos
- use of depot forms (haloperidol»_space;> clozapine)
- withdrawal of anti-Parkinsonian agents
- previous history of NMS
- use of predisposing drugs such as anti-depressants, antiemetic agents, and lithium
- increased ambient temp or dehyrdration
- catatonia or agitation
- history of affective disorders or physical disorders of brain that cause a decrease in mental function
9
Q
management of NM syndrome
A
- withdraw causative drug and institute supportive care. treat acute symptoms and prevent complications
- common drugs used: DA agonists (bromocriptine), Dantrolene, Lorazepam (decreases psychosis, agitation and anxiety, and anticonvulsant)
10
Q
drugs associated w/ NM syndrome
A
high potency antipsychotics like haloperidol and chlorpromazine
- can occur w/ any antipsychotic agent
11
Q
management of malignant hyperthermia
A
- IV dantrolene
- correct metabolic acidosis
- monitor serum potassium - give insulin and gluocose, Ca gluconate, lidocaine for arrhythmia
- cool body to <38
- maintain urinary output: cold fluids, furosemide and mannitol
12
Q
Anticholinergic poisoning
A
- decreased PNS and consequent CV changes
13
Q
Management of anticholinergic posioning
A
- reduce body temp and treat agitation w/ BNZ
- physostigmine - to treat psychosis or hemodynamic dysfunction
* problem is that it has its own problems like seizures, bradyasystole, contraindicated w/ TCA overdose
14
Q
What is the timeline for all the syndromes?
A
- SS - < 12 hr
- Anticholinergic : < 12 hr
- NMS : 1-3 days
- Malignant hyperthermia: 30 min - 24 hr after admin of INHA or succinylcholine
15
Q
what happens to body temps w/ the syndromes?
A
- SS > 41
- AC < 38
- NMS > 41
- MH as high as 46
