sany
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A depresed patient who is taking Paroxetine goes to ER with pain and is given meperidine .Shortly after ward he develops diaphoresis, myoclonus , muscle rigidity ,hyperthermia and seizures.What is the drug of choise ?
a)Dantrolene
b)Sumatriptan
c)Cryohepatdine
d)Bethanechol
e)Propranolol
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sany
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| me007
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meperedine is implicated in serotonine syndrome when used with ssri.
a.
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| po
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Management and Prevention
No specific therapeutic approach to the treatment of serotonin syndrome has been fully evaluated in the literature. The most common treatment involves the use of the benzodiazepines. In severe cases, the antiserotonergic agents cyproheptadine, methysergide, and propranolol have been used.3,6,11 In all cases the suspected agent should be discontinued. Over-the-counter drugs containing ingredients known to increase serotonin levels or exacerbate the patient’s condition, such as dextromethorphan, pseudoephedrine or phenylpropanolamine, also should be discontinued.
Initial treatment should consist of supportive measures aimed at reducing hypertension, tachycardia, hyperthermia and respiratory distress if these conditions are present. Lorazepam and diazepam have been shown to be effective in treating myoclonus associated with serotonin syndrome, and in mild cases, are usually the only treatment necessary. It is important to note that clonazepam has been found to be ineffective in treating serotonin syndrome. Unlike diazepam and lorazepam, clonazepam is not a potent agonist of the GABAB receptor.6 The more severe cases that do not respond to benzodiazepines may respond to dantrolene, which may be effective in relieving muscle rigidity and hyperthermia.1
Pharmacists should recognize potential problems associated with the concurrent use of certain medications, such as the MAOIs and the SSRIs and other agents that can cause serotonin syndrome. Due to the potentially serious nature of this condition, it seems prudent that pharmacists always monitor patients who are taking combinations of serotonergic drugs and be alert to the possibility of "serotonergic duplication" and notify physicians and other prescribers when the risk of drug adversity appears eminent. The use of therapeutic alternatives in certain instances could be life-saving
http://www.uspharmacist.com/oldformat.asp?url=new...
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| po
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looks like C is ans.
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| sany
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Hello po...correct c
The explanation that you brought is more than enough and have no much to add.If certain questions arise we can discuss more.As you have stated neurolepthic malignant syndrome is a D.Dx with a different mechanism...Dantrolene is the drug of choise for it .Cyprohepatidine is a5HT and H1 blocker and and RX for Serotonergic crisis.
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| arlete
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Thanks for the information. I think it's worth remembering dantrolene is used for malignant hyperthermia, too (halogenated volatile anaesthetics, succinylcholine).
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| new_n_lost
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Plz Make A correction Dantrolene is not the DOC for NMS there have been no studies that have proven its efficacy in ER or Otherwise. Bromocriptine or a Dopamine Agonist is prefered as a first line in NMS alongwith Amantadine = It Depends upon the Presentation of the Pt.
Furthermore Cyproheptadine is not Confirmed DOC in SS but still is used after the Benzodiazepenes have been administered. its 5 HT 2 n H1 blocker.
Reference NEJM http://content.nejm.org/cgi/content/full/352/11/1...
Lastly is this a NBME Q ??
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| new_n_lost
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Furthermore the aritcle above says Therapies such as propranolol, bromocriptine,and dantrolene are not recommended.
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| sany
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Hi new..
I don't agree with you for obvious reasons.This is clearly mentioned in standard text books and you should be able to read that .
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sany
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| sany
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Hi new ..please take it as malignat hyperthermia..I am very sorry!! I had reasons to post like that but not good to bring that to the attention of the forum..If that is OK let me know your e.mail Thank you. I will discuss more latter...now I am too occupied ..My test is tomorrow !!!!
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sany
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| sany
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Cyproheptadine.
Source...BUZZWORDS..FOR THE BOARDS 2005 page 281. I prepared the Q for discussion.
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sany
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| sany
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To arlete....
Dantrolene is also used for Neuroleptic Malignant Syndrome.....mentioned in so many places...
to mention one....FIRST AID FOR USMLE 2006 page 370. What happened was I was thinking the action mechanism of Dantrolene for Malignant hyperthermia when I saw the question first,,so thoght that others will also benefit from it.
Thank you
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| new_n_lost
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sany wrote:
Hi new..
I don't agree with you for obvious reasons.This is clearly mentioned in standard text books and you should be able to read that .
Plz Go thru Katzung i do consider it a Standard Textbook but do tell me which part do u disagree with ??
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| new_n_lost
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Sany ........... The Reason I wrote this Info is that if have a look thru Katzung n Different REsources Such as Emedicine, JAMA and NEJM u will find that Dantrolene for NMS is not recognised as the DOC but rather a drug used to relieve the spasicity resulting in it thus treating the symptom not the disease.
I will further continue the discussion with after ur exm the Q was good n the Choices very closely matched therefore i asked u the Source
Best of Luck on ur Exm Mate
For the rest of the ppl plz surely do comment on it
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| sany
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Thank you. I appreciate that.I usually use standard text books but ready to learn from updates. I will be back to continue with the discussion.
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sany
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| sany
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Hello again..
I am back from my test with mixed feelings. Loaded with Molecular Biology !!I was surprised when I encounter a q of serotonin syndrome and remembered all of you and the discussion.Any way I will check that and compare with my reference .I should do that when I am returning books as I don't have it now.It is not mentoned in the Katzung & Trevor's Road map.
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| lq2006
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Cyprohepatidine
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