UW MED psych drugs cases: Serotinin table, withdrawal table, Neuroleptic

Question 1

Serotonin. DRUGS INTERACTION. ??

Answer 1

Serotonergic medications + MAOI or linezolid

Question 2

Serotonin. Serotonergic medications?

Answer 2

SSRI/SNRI, TCA, Tramadol

Question 3

Serotonin. Intentional overdose of serotonergic medications.

Answer 3

.

Question 4

Serotonin. Serotonergic substances?

Answer 4

MDMA, dextromethorphan, amphetamines

Question 5

Serotonin. neural CP?

Answer 5

Mental status changes (anxiety, agitation, delirium)

Question 6

Serotonin. autonomic dysregulation CP?

Answer 6

diaphoresis, HTN, tachy, hyperthermia, vomiting, diarrhea

Question 7

Serotonin. neuromuscular hyperactivity CP?

Answer 7

tremor, MYOCLONUS, hyperreflexia

Question 8

Serotonin. Mx? first thing

Answer 8

Discontinuation of all serotonergic medications

Question 9

Serotonin. Mx? after discontinuation

Answer 9

Supportive care; sedation with BZD

Question 10

Serotonin. Mx? if supportive does not work

Answer 10

Serotonin antagonist (CYPROHEPTADINE)

Question 11

Serotonin. Mx if temp. >41,1C (106F)?

Answer 11

Immediate sedation, paralysis and intubation

Question 12

Withdrawal table.
Tremors, agitation, anxiety, delirium, psychosis.
Vitals: seizures, tachy, palpitations.

Substance?

Answer 12

ALCOHOL

Question 13

Withdrawal table.
Tremors, anxiety, perceptual disturbances, psychosis, insomnia
Vitals: seizures, tachy, palpitations.
Substance?

Answer 13

BZD

Question 14

Withdrawal table.
Nausea, vomiting, abdominal cramping, diarrhea, muscle aches.
Vitals: dilated pupils, yawning, pilorection, lacrimation, hyperactive bowel sounds.
Substance?

Answer 14

Opioids

Question 15

Withdrawal table.
Increased appetite, hypersomnia, intense psychomotor retardation, severe depression (,,crash”)
Vitals: no significant findings.
Substance?

Answer 15

Stimulants (cocaine, amphetamines)

Question 16

Withdrawal table.
Dysphoria, irritability, anxiety, increased appetite
Vitals: no significant findings.
Substance?

Answer 16

Nicotine

Question 17

Withdrawal table.
Irritability, anxiety, depressed mood, insomnia, decreased appetite.
Vitals: no significant findings.
Substance?

Answer 17

Cannabis

Question 18

Neuroleptic. Causative groups?

Answer 18

Antipsychotic medications (eg haloperidol)

Antiemetic (eg promethazine)

Withdrawal of Parkinson medications

Question 19

Neuroleptic. Pathophysiology?

Answer 19

Central dopaminergic receptor blockage (hyperthermia, dysautonomia)

Disruption of nigrostriatal dopamine pathways (rigidity)

Question 20

Neuroleptic. CP?

Answer 20

Fever
Altered mental status
Generalized muscle rigidity (lead-pipe rigidity)
Autonomin instability (abnormal vital signs, diaphoresis)
Elevated CK +/- renal failure

Question 21

Neuroleptic. Tx?

Answer 21

Stop antipsychotic OR restart dopamine agents

Supportive care (hydration, cooling), ICU

BZD

Bromocriptine or dantrolene if refractory