Tag: Serotonin Syndrome

Serotonin Syndrome

SEROTONIN SYNDROME

Q. 1

Serotonin syndrome may be precipitated by all of the following medications, except:

 A

Chlorpromazine

 B

Pentazocine

 C

Buspirone

 D

Meperidine

Q. 1

Serotonin syndrome may be precipitated by all of the following medications, except:

 A

Chlorpromazine

 B

Pentazocine

 C

Buspirone

 D

Meperidine

Ans. A

Explanation:

Chlorpromazine is used in the treatment of serotonin syndrome.
It is a potent 5HT2 receptor antagonist and can reduce the level of serotonin thereby useful in serotonin syndrome.
 
Ref: The Diagnosis of Psychosis By Rudolf Cardinal, Edward Bullmore, Page 125; Blackwell’s Five-Minute Veterinary Consult Clinical Companion, Page 234.

 


Q. 2

Features of serotonin syndrome associated with SSRI & MAOIs are :

 A

Tremors

 B

Agitation

 C

Cardiovascular collapse

 D

All

Q. 2

Features of serotonin syndrome associated with SSRI & MAOIs are :

 A

Tremors

 B

Agitation

 C

Cardiovascular collapse

 D

All

Ans. D

Explanation:

A, B, C i.e. Tremors, Agitation, Cardiovascular collapse


Q. 3

Serotonin syndrome may be precipitated by all of the following medications, Except –

 A

Chlorpromazine

 B

Pentazocine

 C

Buspirone

 D

Meperidine

Q. 3

Serotonin syndrome may be precipitated by all of the following medications, Except –

 A

Chlorpromazine

 B

Pentazocine

 C

Buspirone

 D

Meperidine

Ans. A

Explanation:

Ans. is ‘a’ i.e., Chlorpromazine

Serotonin syndrome

o Serotonin syndrome refers to a dangerous and potentially fatal syndrome caused by excess synaptic serotonin levels due to use of serotonin potentiating drugs.

o This condition is associated confusion, altered conciousness, hyperthermia, tremors, myoclonus, rigidity and hyperreflexia.

o Drugs causing serotonin syndrome are :‑

1.     Inhibiting 5-HT metabolism :- MAO inhibitors (e.g. tranylcypromine, phenelzine, meclobemide, selegilline)

2.     Inhibit serotonin reuptake SSRls, TCAs, amphetamine, cocaine, pethidine (mepridine), Pentazocin, MDMA, tramadol, Nefazodone, dextromethrophon.

3.     Increase 5-HT release :- Amphetamine, cocaine, fenfluramine, MDMA, sibutramine.

4.     Serotonin Agonists Buspirone, lithium, LSD, Ergots (Dihydroergotamine), triptans (Sumitriptan), Piperazine.

5.     Other :- ECT, trazodone / Nafazodone, Carbamezapine.

Quiz In Between


Q. 4

All of the following statements about serotonin syndrome are true, except –

 A

It is not an idiosyncratic reaction

 B

Can be caused by SSRI

 C

Dantrone is the drug of choice

 D

Associated with hyperthermia and hypertension

Q. 4

All of the following statements about serotonin syndrome are true, except –

 A

It is not an idiosyncratic reaction

 B

Can be caused by SSRI

 C

Dantrone is the drug of choice

 D

Associated with hyperthermia and hypertension

Ans. C

Explanation:

Ans. is ‘c’ i.e., Dantrone is the drug of choice

  • Serotonin syndrome closely resembles neuroleptic malignant syndrome. However, in contrast to neuroleptic malig­nant syndrome it is not an idiosyncratic drug reaction and is generally dose related.
  • Serotonin syndrome is due to acute overstimulation of 5-HT2A receptors caused by serotonergic drugs like SSRI (Drugs causing serotonin syndrome have been explained)

Treatment of Serotonin Syndrome

o Treatment of patients with serotonin syndrome begins with supportive care and decreasing muscle rigidity.

o Because muscle rigidity is thought to be partly responsible for hyperthermia and death, external cooling in conjunc‑

tion with aggressive use of benzodiazepines should limit complication and mortality. In severe cases, neuromuscular

Mocker should be considered to achieve rapid muscle relaxation.

  • Use of Cyproheptadine in patients with mild/moderate serotonin syndrome has shown effective serotonin blockage and control of symptoms.
  • Other drugs that are antedotally reported to be successful for the treatement of symptoms of serotonin syndrome include methysergide, chlorpromazine, atypical antipsychotics and propranolol.
  • In most patients, the serotonin syndrome resolves within 24 hours after the offending drug is removed.

o Aggressive cooling and sedation with a benzodiazepine remain the basis of therapy.


Q. 5

Which of the following is true regarding 5-HT derivatives:          

March 2009

 A

Cisapride is selective 5-HT4 antagonist

 B

Ondansetron is a 5-HT3 agonist

 C

Cyproheptadine is 5-HT2A agonist

 D

Sumatriptan action is agonistically 5-HT 1B/1D receptor mediated

Q. 5

Which of the following is true regarding 5-HT derivatives:          

March 2009

 A

Cisapride is selective 5-HT4 antagonist

 B

Ondansetron is a 5-HT3 agonist

 C

Cyproheptadine is 5-HT2A agonist

 D

Sumatriptan action is agonistically 5-HT 1B/1D receptor mediated

Ans. D

Explanation:

Ans. D: Sumatriptan action is agonistically 5-HT 113/1D receptor mediated

Cisapride and renzapride are selective 5-HT4 agonists.

  • Ondansetron is a selective 5-HT3 antagonist which inhibits vomiting by blocking these receptors in brainstem as well as in gut wall.
  • Cyproheptadine is 5-HT2A antagonist and has additional H1 antihistaminic, anticholinergic and sedative properties.
  • Sumatriptan and other triptan are selective 5-HT 113/1D agonists, constricts cerebral blood vessels and has emerged as the most effective treatment of acute migraine attacks.

Q. 6

Cyproheptadine acts on all receptors except ‑

 A

D2

 B

H1

 C

Muscarinic

 D

5HT2A

Q. 6

Cyproheptadine acts on all receptors except ‑

 A

D2

 B

H1

 C

Muscarinic

 D

5HT2A

Ans. A

Explanation:

Ans. is ‘a’ i.e., D2

Cvproheptadine

  • It primarily blocks 5HT2A receptors and has additional HI antihistaminic, anicholinergic and sedative properties.
  • It is used in allergies and as antipuritic agent.
  • It increases appetiteand has been used in children and poor eaters to promote weight gain.
  • It is used in controlling intestinal manifestations of carcinoid and post gastrectomy dumping syndrome as well as in antagonizing priapism/ or orgasmic delaycaused by fluoxetine and trazodone.

Quiz In Between



Serotonin Syndrome

SEROTONIN SYNDROME


SEROTONIN SYNDROME

  • Condition associated with skeletal muscle contractions, hyperthermia, hyperreflexia, diarrhea, mydriasis, agitation, myoclonus & coma.
  • Due to excessive serotonin in synapse.

Etiology:

1. Due to 5HT metabolism inhibition:

  • Seen with MAO inhibitor.

2. Due to 5HT release inhibition:

  • Amphetamines
  • Cocaine
  • Fenfluramine
  • MDMA

3. Due to serotonin reuptake inhibition:

  • SSRI’s (High-risk factor):
    • Co-administration of SSRIs with MAO inhibitors.
    • SSRIs should be started at least 14 days after MAO inhibitor discontinuation.
    • To allow sufficient time for MAO regeneration.
  • TCA’s
  • Amphetamines, cocaine, MDMA, pethidine.

4. Due to serotonin receptor agonists

  • Buspirone
  • LSD
  • Sumatriptan

5. Due to non-specific increase in 5HT activity:

  • Lithium.
  • Electroconvulsive therapy.

6. Drug-induced:

  • Carbamazepine.
  • Nefazodone.
  • Tramadol.

Treatment for serotonin syndrome:

  • Cyproheptadine or chlorpromazine

Exam Important

  • The main high-risk factor involved in causing serotonin syndrome is co-administration of SSRIs with MAO inhibitors.
  • To prevent the risk of serotonin syndrome, SSRIs should be started at least 14 days after MAO inhibitor discontinuation.
  • Mechanisms by which serotonin syndrome is precipitated include 5HT metabolism inhibition, 5HT release inhibition, serotonin reuptake inhibition, serotonin receptor agonists, non-specific increase in 5HT activity & also drug-induced serotonin syndrome.
  • Cyproheptadine or chlorpromazine is used for treating serotonin syndrome.

 

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