The Syndromes Flashcards
Describe Serotonin syndrome
Akathisia, tremor, confusion, clonus (increased reflexes), increased muscle tone, hyperthermia, increased bowel sounds
Drugs causing Serotonin syndrome?
- SSRI
- -triptans
- -setrons (anti-emetics)
- MAOIs (decrease 5HT metabolism)
- TCAs (decrease 5HT reuptake)
- St. John’s Wort
- Lithium
Serotonin syndrome is thought to occur to?
5HT2A agonism
Where is serotonin made in the CNS?
Raphe nucleus
Rostral end of raphe nucleus does what?
Regulates arousal, affect, appetite, thermoregulation, migraine, emesis, libido
Pontine/medullary end of raphe nucleus regulates?
Nociception & motor tone
Peripherally serotonin does what?
Decrease vascular tone & GI motility
Increased risk of Serotonin syndrome with what?
CYP2D6/3A4 inhibition
Tx for serotonin syndrome?
Stop SSRI, supportive, sedatives, decrease temp, control autonomic dysfunction, give 5HT antagonist (Cyproheptadine)
Describe neuroleptic malignant syndrome
Decreased reflexes (opposite from serotonin), lead pipe rigidity, normal bowel sounds, no mydriasis
- Hypothalamus = hyperthermia & autonomic dysfunction
- Basal ganglia = EPS
- Possible direct muscle effect on SR (malignant hyperthermia)
Cause of neuroleptic malignant syndrome? What drugs?
D2 block (antipsychotics like Haloperidol & Chlorpromazine especially)
Risk factors for neuroleptic malignant syndrome?
- High dose/potency/depot preps of anti-psychotics
- Concomitant use w/ anti-depressants, anti-cholinergics, lithium
- Withdrawal from anti-parkinson drugs
- History of NMS
- Increased temp or dehydration
- Catatonia or agitation
- History of decreased cognition
Tx of NMS?
- Withdraw drug & supportive care
- Bromocriptine (D2 agonist)
- Dantroline (muscle relaxer)
- Lorazepam (decrease psychosis, agitation, anticonvulsant)
Malignant hyperthermia presentation?
Hyperthermia, rigor mortis muscle tone, decreased reflexes
Malignant hyperthermia happens in what pts?
Pts undergoing anesthesia w/ succinylcholine or volatile anesthetics
