The Syndromes Flashcards
concurrent drugs that inhibit which CYP enzymes can precipitate serotonin syndrome, as well as withdrawal of concurrent drug treatment?
CYP2D6/3A4
serotonin syndrome occurs most commonly with which class of drugs?
SSRIs
describe some of the clinical signs/symptoms of serotonin syndrome (in order of mild to life-threatening)
Akathisia Tremor / hyperreflexia Altered Mental status Clonus (inducible) Clonus (sustained) Muscular hypertonicity Hyperthermia
in the management of serotonin syndrome you might give what serotonin antagonist?
cyproheptadine
what makes up the typical management of serotonin syndrome?
discontinue precipitating drugs provide supportive management control agitation give serotonin antagonists control autonomic instability control hyperthermia (cooling measures) Reassess the need to resume the use of serotonergic agent once the symptoms have resolved
why are MAOis assoc. with serotonin syndrome?
they inhibit serotonin breakdown ( phenelzine)
why is St. John’s wort assoc. with serotonin syndrome?
inhibits serotonin breakdown
explain how lithium is assoc. with serotonin syndrome
can increase serotonin metabolites in the CSF & may interact pharmacodynamically w/ SSRIs resulting in serotonin syndrome
name some of the dietary supplements and herbal products that are assoc. with serotonin syndrome?
tryptophan
St. John’s wort
Ginseng
Name all the classes of drugs you can think of that are assoc. with serotonin syndrome
SSRIs antidepressants MAOIs AEDs (valproate) analgesics antiemetics antimigraine drugs St. John's wort, Ginseng Lithium
what is the cause of neuroleptic malignant syndrome?
due to blockade of dopaminergic D2 receptors in the brain
what are the classic symptoms of neuroleptic malignant syndrome?
1-3 days for condition to develop: stupor, alert, mutism hyperthermia autonomic dysfunction muscle rigidity extrapyramidal tremor
what is the reason that pts get hyperthermia in neuroleptic malignant syndrome?
blockade of D2 receptors in the hypothalamus causes hyperthermia
what is the mechanism by which pts experience autonomic dysfunction in neuroleptic malignant syndrome?
blockade of inhibitory actions of dopamine on the SNS–> autonomic dysfunction
what is the mechanisms behind the increased muscle rigidity/tremor in neuroleptic malignant syndrome?
blockade of nigrostriatal dopamine results in the increased rigidty/tremor via extrapyramidal pathways
-possible direct muscle tox. via increase in Ca2+ release from SR
what are the risk factors for neuroleptic malignant syndrome?
high-dose & high potency antipsychotic agents
rapid dose escalation
depot forms of drug release (haloperidol)
prev. hx of NMS
increased ambient temp. or dehydration
catatonia or agitation
hx of affective disorders or physical disorders of brain that cause a decrease in mental function
which antipsychotic when used as depot IM prep has high risk for neuroleptic malignant syndrome?
haloperidol
concomitant use of what types of drugs can be additional risk factors for neuroleptic malignant syndrome?
antidepressants
anticholinergic agents
lithium
what is the most important component to the management of neuroleptic malignant syndrome?
withdraw causative drug and institute supportive care
when managing neuroleptic malignant syndrome you want to treat acute symptoms and aid recovery by preventing what kinds of complications?
rhabdomyolysis
renal & resp. failure
prevent recurrence
what are the drugs that may be used in the management of neuroleptic malignant syndrome?
dopamine agonists: bromocriptine»_space; amantadine
dantrolene: skeletal muscle relaxant
Lorazepam: to control psychosis, agitation, and anxiety
which two typical antipsychotics are common causes of neuroleptic malignant syndrome?
haloperidol
chlorpromazine
Note: can occur with any antipsychotic agent
which neuromuscular blocking drug commonly causes malignant hyperthermia?
succinylcholine
how do you manage malignant hyperthermia?
IV dantrolene correct metabolic acidosis monitor serum potassium cool body to < 38 C maintain urinary output
