What is the clinical trial of SS
Altered mental status
Autonomic hyperactivity
Neuromuscular abnormalities
What receptors are associated with SS
5HT1 (activation)
and 5HT2 (antagonism )
5 drug classes associated with SS
SSRIs (fluoxetine)
anti-depressants
MAOIs (tumeric)
Anticonvulsants
Analgesics (fentanyl)
Presentation of SS
Hyperreflexia
Bruxism (grinding teeth)
Sweating
Tachycardia
Cog wheel rigidity
Vomit
Diagnosis of SS
O: Sudden <24 hours
V: T>41.1C, tachycardia
P: mydriasis
O: NM hyperactivity, diaphoresis, hyperactive bowel sounds
Supportive treatment of SS
Stop offending agent
IV fluids
Temp control
Hemodynamic stability
ECG monitoring
What class of agents may be used for sedation in SS
BZDs
What agents may be used for hypertension in SS
esmolol or nitroprusside
What agents may be used for hypotension in SS
NE, epinephrine, phenylephrine
What agents may be used for paralysis in SS
Rocuronium or vecuronium
What agent is used for agitation despite discontinuation of serotonergic agents, adequate sedation, and supportive care
Cyproheptadine
What three agents should be avoided in SS
Propanolol
Bromocriptine
Dantrolene
What syndrome is caused by an adverse drug reaction to medications with dopamine receptor antagonist or by rapid withdrawal from a dopaminergic medication
Neuroleptic malignant syndrome
Presentation of Neuroleptic malignant syndrome
F.A.R.M
Fever
Autonomic dysfunction
Rigidity
Mental status changes
Lead pipe muscle rigidity is associated with what disorder?
Neuroleptic malignant syndrome
What is the hallmark symptom of Neuroleptic malignant syndrome
Delirium
Neuroleptic malignant syndrome:
O: Slow, days to weeks
V: T>41.1C, tachycardia
P: Mydriasis or normal
Abnormal labs associated with Neuroleptic malignant syndrome
CK <600 UI/L
Possibly high SCr and BUN
WBC >10
Increased CRP, fibrinogen, ESR
What are the three major criteria of the Levenson criteria for Neuroleptic malignant syndrome
HRE
1. Hyperthermia
2. Rigidity
3. Elevated CPK >1000 UI/L
Three causative agents for Neuroleptic malignant syndrome
Haloperidol
Risperidone
Levodopa
What agent is a D2 receptor agonist and may be used in combination with supportive care, BZDs +/- dantrolene in patients with moderate to severe symptoms
Bromocriptine
What agent is a direct-acting skeleton muscle relaxant that interferes with release of Ca2+ from sarcoplasmic reticulum
Dantrolene
What is the BBW of Dantrolene
Hepatotoxicity
BBW of amantadine
ACUTE AND POTENTIALLY FATAL WITHDRAWAL SYNDROME!!
Which disorder is associated with general anesthesia
Malignant hyperthermia
due to the acceleration of metabolism in skeletal muscles
What gene is associated with Malignant hyperthermia
RyR1
Malignant hyperthermia is inherited as a dominant trait?
True (CHCT diagnostic test)
Unique signs of malignant hyperthermia
Hypermetabolic crisis
Metabolic and respiratory acidosis
Rhabdo
CK >10,000 is associated with what disorder
Malignant hyperthermia
Malignant hyperthermia
O: VERY SUDDEN, MINUTES TO HOURS
V: Temp as high as 46C
P: Normal
O: Hypoactive bowel sounds
Rising end-tidal CO2 is associated with what disorder
Malignant hyperthermia
Treatment of Malignant hyperthermia
Dantrolene
Other therapies that should be present in a malignant hyperthermia kit
Sodium bicarb
Dextrose
Insulin R
Calcium chloride
Lidocaine for injection
Refrigerated cold saline solution