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PSYCH > The Syndromes > Flashcards

The Syndromes Flashcards

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1
Q

concurrent drugs that inhibit which CYP enzymes can precipitate serotonin syndrome, as well as withdrawal of concurrent drug treatment?

A

CYP2D6/3A4

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2
Q

serotonin syndrome occurs most commonly with which class of drugs?

A

SSRIs

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3
Q

describe some of the clinical signs/symptoms of serotonin syndrome (in order of mild to life-threatening)

A 
Akathisia
Tremor / hyperreflexia
Altered Mental status
Clonus (inducible)
Clonus (sustained)
Muscular hypertonicity
Hyperthermia
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4
Q

in the management of serotonin syndrome you might give what serotonin antagonist?

A

cyproheptadine

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5
Q

what makes up the typical management of serotonin syndrome?

A 
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
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6
Q

why are MAOis assoc. with serotonin syndrome?

A

they inhibit serotonin breakdown ( phenelzine)

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7
Q

why is St. John’s wort assoc. with serotonin syndrome?

A

inhibits serotonin breakdown

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8
Q

explain how lithium is assoc. with serotonin syndrome

A

can increase serotonin metabolites in the CSF & may interact pharmacodynamically w/ SSRIs resulting in serotonin syndrome

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9
Q

name some of the dietary supplements and herbal products that are assoc. with serotonin syndrome?

A

tryptophan
St. John’s wort
Ginseng

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10
Q

Name all the classes of drugs you can think of that are assoc. with serotonin syndrome

A 
SSRIs
antidepressants
MAOIs
AEDs (valproate)
analgesics
antiemetics
antimigraine drugs
St. John's wort, Ginseng
Lithium
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11
Q

what is the cause of neuroleptic malignant syndrome?

A

due to blockade of dopaminergic D2 receptors in the brain

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12
Q

what are the classic symptoms of neuroleptic malignant syndrome?

A 
1-3 days for condition to develop:
stupor, alert, mutism
hyperthermia
autonomic dysfunction
muscle rigidity
extrapyramidal tremor
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13
Q

what is the reason that pts get hyperthermia in neuroleptic malignant syndrome?

A

blockade of D2 receptors in the hypothalamus causes hyperthermia

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14
Q

what is the mechanism by which pts experience autonomic dysfunction in neuroleptic malignant syndrome?

A

blockade of inhibitory actions of dopamine on the SNS–> autonomic dysfunction

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15
Q

what is the mechanisms behind the increased muscle rigidity/tremor in neuroleptic malignant syndrome?

A

blockade of nigrostriatal dopamine results in the increased rigidty/tremor via extrapyramidal pathways
-possible direct muscle tox. via increase in Ca2+ release from SR

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16
Q

what are the risk factors for neuroleptic malignant syndrome?

A

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

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17
Q

which antipsychotic when used as depot IM prep has high risk for neuroleptic malignant syndrome?

A

haloperidol

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18
Q

concomitant use of what types of drugs can be additional risk factors for neuroleptic malignant syndrome?

A

antidepressants
anticholinergic agents
lithium

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19
Q

what is the most important component to the management of neuroleptic malignant syndrome?

A

withdraw causative drug and institute supportive care

20
Q

when managing neuroleptic malignant syndrome you want to treat acute symptoms and aid recovery by preventing what kinds of complications?

A

rhabdomyolysis
renal & resp. failure
prevent recurrence

21
Q

what are the drugs that may be used in the management of neuroleptic malignant syndrome?

A

dopamine agonists: bromocriptine&raquo_space; amantadine
dantrolene: skeletal muscle relaxant
Lorazepam: to control psychosis, agitation, and anxiety

22
Q

which two typical antipsychotics are common causes of neuroleptic malignant syndrome?

A

haloperidol
chlorpromazine
Note: can occur with any antipsychotic agent

23
Q

which neuromuscular blocking drug commonly causes malignant hyperthermia?

A

succinylcholine

24
Q

how do you manage malignant hyperthermia?

A 
IV dantrolene
correct metabolic acidosis
monitor serum potassium
cool body to < 38 C
maintain urinary output
25
Q

how do you manage/treat anticholinergic poisoning?

A

Cooling for hyperthermia and BENZOs for agitation

26
Q

why is physostigmine not necessary in most cases of anticholinergic poisoning?

A

can produce seizures or cause bradyasystole; these complications happen with pts who have TCA poisoning

27
Q

which anticholinesterase may be used with anticholinergic poisoning?

A

physostigmine (althought lots of toxicity like seiures, esp. with pts overdosing on TCAs)

28
Q

name the syndrome: pupils-mydriasis, sialorrhea, diaphoresis, hyperactive bowel sounds, increased neuromuscular tone (esp. in lower limbs), hyperreflexia, clonus, agitation, coma

A

serotonin syndrome

29
Q

how long does it take for serotonin syndrome to develop?

A

< 12 hrs

30
Q

how long does it take for anticholinergic toxidrome to develop?

A

< 12 hrs

31
Q

describe the pupils skin, mucosa in anticholinergic toxicity

A

mydriasis, dry erythema, hot & dry to touch

32
Q

describe the bowel sounds in anticholinergic toxicity

A

decreased or absent

33
Q

what is the mental status of a pt experiencing anticholinergic toxicity?

A

agitated and delirious

34
Q

how long does it take neuroleptic malignant syndrome to develop?

A

1-3 days

35
Q

describe the pupils, mucosa, skin in neuroleptic malignant syndrome?

A

normal, sialorrhea, pallor, diaphoresis

36
Q

describe the neuromuscular tone in neuroleptic malignant syndrome

A

lead pipe rigidity in all muscles

37
Q

describe the neuromuscular reflexes in neurleptic malignant syndrome?

A

bradyreflexia

38
Q

what is the mental status of a pt in neurleptic malignant syndrome?

A

stupor
alert mutism
coma

39
Q

what is the medication history of a pt experiencing malignant hyperthermia?

A

inhalational anesthesia

40
Q

describe the bowel sounds in malignant hyperthermia

A

decreased

41
Q

describe the muscle tone in malignant hyperthermia

A

rigor mortis like rigidity

42
Q

describe the mental status of a pt with malignant hyperthermia

A

agitation

43
Q

about how long after administration of inhalational anesthesia or succinylcholine would a pt experience malignant hyperthermia?

A

30 mins-24 hrs

44
Q

describe the pupils, mucosa, skin in serotonin syndrome

A

mydriasis
sialorrhea
diaphoresis

45
Q

describe the neuromuscular reflexes in serotonin syndrome

A

hyperreflexia

clonus (unless masked by increased muscle tone)

46
Q

describe the mental status of a pt in serotonin syndrome

A

agitation, coma

PSYCH (8 decks)

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