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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
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2
Q

location of 5HT neurons in CNS

A
  1. 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
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3
Q

peripheral 5HT neurons

A
  • assist in regulation of vascular tone and GI motility
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4
Q

Clinical findings for serotonin syndrome

A
  • akathisia, tremor, altered mental status, clonus, muscular hypertonicity, hyperthermia
  • some of the signs may mask others
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5
Q

Management of 5HT syndrome

A
  1. discontinue use of all potential precipitating drugs
  2. provide supportive management
  3. control agitation
  4. administer 5HT antagnoists - cyproheptadine
  5. control autonomic instability
  6. control hyperthermia
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6
Q

drugs associated w/ 5HT syndrome

A
  1. SSRIs
  2. Li
  3. Antidepressants
  4. MAOI -
  5. AEDs - valproate
  6. Analgesic
  7. Antiemetic
  8. Antimigraine drug
  9. Trp, St John’s worts, ginseng
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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
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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&raquo_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
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9
Q

management of NM syndrome

A
  1. withdraw causative drug and institute supportive care. treat acute symptoms and prevent complications
  2. common drugs used: DA agonists (bromocriptine), Dantrolene, Lorazepam (decreases psychosis, agitation and anxiety, and anticonvulsant)
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10
Q

drugs associated w/ NM syndrome

A

high potency antipsychotics like haloperidol and chlorpromazine
- can occur w/ any antipsychotic agent

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11
Q

management of malignant hyperthermia

A
  1. IV dantrolene
  2. correct metabolic acidosis
  3. monitor serum potassium - give insulin and gluocose, Ca gluconate, lidocaine for arrhythmia
  4. cool body to <38
  5. maintain urinary output: cold fluids, furosemide and mannitol
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12
Q

Anticholinergic poisoning

A
  • decreased PNS and consequent CV changes
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13
Q

Management of anticholinergic posioning

A
  1. reduce body temp and treat agitation w/ BNZ
  2. physostigmine - to treat psychosis or hemodynamic dysfunction
    * problem is that it has its own problems like seizures, bradyasystole, contraindicated w/ TCA overdose
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14
Q

What is the timeline for all the syndromes?

A
  1. SS - < 12 hr
  2. Anticholinergic : < 12 hr
  3. NMS : 1-3 days
  4. Malignant hyperthermia: 30 min - 24 hr after admin of INHA or succinylcholine
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15
Q

what happens to body temps w/ the syndromes?

A
  1. SS > 41
  2. AC < 38
  3. NMS > 41
  4. MH as high as 46
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16
Q

What happens to pupils, muscoa, and skin w/ the syndromes?

A
  1. SS: dilation, sialorrhea, diaphoresis
  2. AC: dilation, dry erythema, hot/dry to touch
  3. NMS: normal pupils, sialorrhea, pallor, diaphoresis
  4. MH: normal pupils, normal mucosa, diaphoresis
17
Q

Bower sounds in syndromes?

A
  1. SS - hyperactive
  2. AC- decreased or absent
  3. NMS - normal or decreased
  4. MH: decreased
18
Q

neuromuscular tone in syndromes

A
  1. SS: increased esp in LE
  2. AC: normal
  3. NMS: lead pipe rigidity in all muscle groups
  4. MH: rigor mortis like rigidity
19
Q

neuromuscular reflexes in syndromes?

A
  1. SS - hyperreflexia, clonus
  2. AC - normal
  3. NMS: bradyreflexia
  4. MH: hyporeflexia
20
Q

Mental status in syndromes

A
  1. SS- agitation, coma
  2. AC- agitated, delirium
  3. NMS - stupor, alert, mutism, coma
  4. MH - agitation

Psych Pharm (7 decks)

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