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23 Cards in this Set
- Front
- Back
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Serotonin syndrome: Medication history, time to develop?
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Pro-serotonergic drug
<12 hours. |
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Serotonin syndrome: vital signs, pupil size, mucosa?
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Increased BP/HR/RR/T (>41°C)
wide pupils sialorrhea. |
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Serotonin syndrome: skin, bowel sounds, muscle tone?
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diaphoresis
increased BS increased muscle tone, especially legs |
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Serotonin syndrome: reflexes, MSE?
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Hyperreflexia, clonus (unless masked by increased muscle tone)
delirium |
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NMS: Medication history, time to develop?
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Dopamine antagonist
1-3 days |
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NMS: vital signs, pupil size, mucosa?
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Increased BP/HR/RR/T (>41°C)
Normal pupils sialorrhea. |
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NMS: skin, bowel sounds, muscle tone?
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pallor or diaphoresis
Normal or decreased BS lead-pipe rigidity in all muscles. stinky mnemonic: PD! ND! L-P-R! |
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NMS: reflexes, MSE?
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Bradyreflexia
delirium or mutism. |
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Anticholinergic toxidrome: Medication history, time to develop?
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Anti-cholinergic agent
<12 hours |
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Anticholinergic toxidrome: vital signs, pupil size, mucosa?
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mildly increased BP (mild)
Increased HR/RR/T (usually <38.8 °C) widened pupils dry mucosa. |
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Anticholinergic toxidrome: skin, bowel sounds, muscle tone?
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Erythema - Hot & dry (“red as a beet, hot as a hare, dry as a bone”)
decreased BS normal muscle tone. |
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Anticholinergic toxidrome: reflexes, MSE?
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Normal reflexes
delirium |
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Describe mild, moderate and severe Serotonin Syndrome.
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MILD: akathisia, tremor, no fever
MODERATE: confusion, clonus SEVERE: temp over 41.1, severe HTN, tachycardia, rigidity |
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mild to life-threatening toxicity: name six.
(top of graphic) |
Akathesia
Altered Mental Status Fever (commonly 40°) Hyperthermia (>41°), severe HTN, frank shock stinky mnemonic: AAF HHF |
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mild to life-threatening toxicity: name four.
(bottom of graphic) |
no fever
tremor inducible -> sustained clonus muscular hypertonicity stinky mnemonic: NT IS CMH |
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Name three analgesics that lead to serotonin syndrome.
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Demerol (meperidine)
Tramadol Fentanyl |
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Name a headache medication that lead to serotonin syndrome.
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Sumatriptan
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Name an antibiotic that lead to serotonin syndrome.
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Linezolid
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Name two mood stabilizers that lead to serotonin syndrome.
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Lithium
Depakote |
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Name a dietary supplement that lead to serotonin syndrome.
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St John’s Wort
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Name two abused substances that lead to serotonin syndrome.
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LSD
Ecstasy |
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Name a cough remedy that lead to serotonin syndrome.
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Dextromethorphan
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Summary of treatment of these syndromes?
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removal of causative agent
ICU for hemodynamic monitoring/support/treatment SS(mild): supportive care, BDZs for agitation SS(moderate): atypical antipsychotics with 5HT2A antagonism (e.g. olanzapine), Cryptoheptadine SS(severe): above with sedation/intubation, neuromuscular paralysis with nonpolarizing agents (e.g. vecuronium) NMS:dantrolene, bromocriptene, lorazepam |
