Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening disorder associated with the use of dopamine receptor antagonists like antipsychotics. It is characterized by a tetrad of symptoms including hyperpyrexia, muscle rigidity, altered mental status, and autonomic dysfunction. Treatment involves immediate withdrawal of the offending agent, aggressive supportive care, and in severe cases, pharmacological interventions like dantrolene or bromocriptine. Prognosis is generally good if diagnosed and treated early, but mortality can result from complications and occurs in around 10% of cases.
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
A brief overview on Neuroleptic Malignant Syndrome presented for the PGs and the faculty of Dept. of Medicine, Govt. Medical College Kannur, Kerala, India
antipsychotics history, managment of psychosis,side effect of antipsychotics, mechanism of antipsychotics, atypical antipsychotics,2nd generation antipsychotics.
This presentation gives detailed description of symptoms of catatonia with its etiologies and differential diagnoses. It should help to differentiate catatonia in neurological and psychiatric disorders.
The use of Reglan, a drug used to treat diabetes and heartburn, has been linked to conditions such as Neuroleptic Malignant Syndrome (NMS).
Read more on: http://www.reglan-lawsuit-attorney.com/neuroleptic-malignant-syndrome/
Malignant Hyperthermia - Essential Charactistics:
>An inherited disorder of skeletal muscle triggered in susceptibles (human or animal) in most instances by inhalation agents and/or succinylcholine, resulting in hypermetabolism, skeletal muscle damage, hyperthermia, and death if untreated.
>Underlying physiologic mechanism – abnormal handling of intracellular calcium levels.
Psychotropic drugs are the drugs which affect the psychic behavior of an individual and they include all form of drugs which are dangerous in high dose and can be leathal
A compiled Power point presentation on "Antipsychotic drugs" suitable for Undergraduate level medical students and also PG students in the subject of Pharmacology.
Parkinson’s disease is a progressive disorder of the nervous system that, in the early stages, is characterized by mild signs that are often missed. These signs can be remembered by the mnemonic “SMART”
S = Shuffling-Gait
M = Mask-like Face
A = Akinesia
R = Rigidity
T = Tremor
Movement disorders are not only realm of chronic disorders that are treated without requiring emergent intervention, but also they can present acutely with more aggressive forms
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. INTRODUCTION
A severe disorder associated with
1. Increase in dose of dopamine
receptor antagonists. (mostly
antipsychotics)
OR
2.Rapid withdrawal of dopaminergic
agents.
Unpredictable
Potentially life-threatening.
3. 1956 - First case reported.
1960 – Current name was introduced in a
French study.
Rare.
• 1960-1997: Incidence 0.2-3.2%
• Current incidence : 0.01 – 0.02%
Mortality rate – 10%.
7. DEVELOPMENT AND COURSE
Heterogeneous in onset, presentation,
progression and outcome.
Onset – from hours to days.
16% : within 24hrs.
66% : within 1 week.
Virtually all cases : within 30 days.
Alteration in mental status and other
neurological signs typically precede systemic
signs. (>80%)
8. DEVELOPMENT AND COURSE
CONT..
Self-limited in most cases.
Mean recovery time : 7-10 days.
63% : within 1 week.
Nearly all : within 30 days.
Mortality results from :
respiratory failure
cardiovascular collapse
myoglobinuric renal failure
arrhythmias
DIC
9. RISK FACTORS
Concurrent medical and neuropsychiatric
issues
1.Dehydration
2.Psychomotor agitation
3.Encephalitis and traumatic brain injury
4.Mood disorders
5.Preexisting catatonia
6.History of NMS- in 15%-20% of cases.
7.Low serum iron
Younger age
Male gender
10. ANTIPSYCHOTIC-RELATED RISK
FACTORS
High potency conventional antipsychotics –
higher risk
Atypical antipsychotics: Less incidence.
Parental routes
Higher titration rates
Higher total doses
11. PATHOPHYSIOLOGY
Precise mechanisms are unproven.
Drug induced dopamine blockade, followed
by abrupt discontinuation of the drug
Sudden dopaminergic dysregulation
12. PATHOPHYSIOLOGY
Supportive evidence for this hypothesis:
1) All drugs associated are dopamine receptor
blockers.
2) Risk of NMS appears to be correlated with the
dopamine receptor binding affinity of drugs.
3) Dopaminergic drugs are used in the treatment of
NMS.
4) Patients with central dopamine tract lesions
develop similar syndromes.
5) Low levels of homovanillic acid (dopamine
metabolite) detected in patients with acute NMS.
13. PATHOPHYSIOLOGY CONT..
Also family clusters of NMS have found that A1
allele of dopamine D2 receptor gene may be over
expressed in these patients, this allele reduces
the density and function of the dopamine
receptor
18. MANAGEMENT
Immediate withdrawal of the offending agent.
Supportive care – mainstay of management
Aggressive fluid resuscitation
Monitoring and correction of electrolyte
imbalances.
Cooling measures (cooling blankets, ice packs, ice
water enema)
Monitoring for complications – cardiorespiratory
failure, renal failure, aspiration pneumonia,
coagulopathies.
Dialysis – renal failure
Ventilator support – respiratory failure
19. MANAGEMENT CONT..
Pharmacological management
No general consensus on use of pharmacological
therapies in uncomplicated cases.
Numerous anecdotal reports and meta-analyses
support the use of several empiric
pharmacological therapies in more severe cases.
May shorten the course and reduce mortality.
20. MANAGEMENT CONT..
Dopaminergic agents
Bromocriptine
Starting dose - 2.5mg bd/tds by mouth
Increase dose by 2.5mg every 24hrs.
Max. dose – 45mg/day
At least for 10 days (oral antipsychotics)
or 2-3 weeks (depot antipsychotics)
May worsen psychosis,hypotension and
induce emesis
22. MANAGEMENT CONT..
Dantrolene
Started with 1-2.5mg/kg initial IV bolus
Then 1mg/kg every 6hrly up to a max. dose of
10mg/kg/day for 8days
Switching to oral form after first few days for
another 7days
Discontinued once symptoms begins to resolve.
(Risk of hepatotoxicity)
23. MANAGEMENT CONT..
Benzodiazepines
May hasten the recovery in milder cases.
May control agitation.
Lorazepam
Starting test dose 1-2mg IM/IV, if effective
switch to mouth
Carbamazepine
Reported to have some effect.
Clonidine
24. MANAGEMENT CONT..
ECT - good outcome with both unilateral and
bilateral treatments
can be effective when,
1. Poor response to supportive care and
pharmacological management.
2. When idiopathic malignant catatonia
cannot be excluded.
3. Persistent residual catatonia and
parkinsonism after the resolution of
acute symptoms.
25. ANTIPSYCHOTIC USE AFTER NMS
Estimated risk of 30% of developing NMS again
with re-introduction of antipsychotics.
Precautions:
At least 2 weeks should be allowed from recovery
before rechallenge.
Low potency conventional antipsychotics/ atypical
antipsychotics.
Considering alternative therapies like ECT
Start with a low dose and titrate gradually
Careful monitoring for early signs of NMS.
26. RECOMMENDATIONS
Conservative use of antipsychotics.
Cautious use of antipsychotics in patients with
increased risk
Early diagnosis.
Prompt discontinuation of offending agents.
Early supportive care and medical management.