Serotonin syndrome 2
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This document discusses a case of potential serotonin syndrome and provides information about the condition. It describes the patient's symptoms, which match criteria for serotonin syndrome. Serotonin syndrome is caused by excessive serotonin activity and involves cognitive, autonomic, and neuromuscular abnormalities. Cyproheptadine, an antihistamine, is recommended for treatment as it blocks serotonin receptors and case reports show it effectively resolved patients' symptoms within hours. Other treatments discussed include benzodiazepines, chlorpromazine, propranolol, and dantrolene.
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Serotonin is a neurotransmitter found primarily in the gastrointestinal tract, blood platelets, and central nervous system. It plays various roles such as regulating mood, cognition, memory, appetite, sleep, and gastrointestinal motility. Serotonin acts through multiple receptor subtypes. Selective serotonin reuptake inhibitors are commonly used to treat depression and anxiety by blocking reuptake of serotonin. Potential side effects include nausea, sexual dysfunction, and serotonin syndrome, a rare but serious condition caused by dangerously high serotonin levels.
5-HT Pharmacology - drdhriti
Serotonin or 5-hydroxytryptamine (5-HT) is a monoamine neurotransmitter synthesized from tryptophan. It is present mainly in the gastrointestinal tract and blood platelets, with some in the central nervous system. Serotonin acts through multiple receptor subtypes and has diverse physiological effects including regulation of mood, appetite, sleep, and cardiovascular and gastrointestinal functions. Antagonists of serotonin receptors are used to treat conditions like migraine, hypertension, nausea/vomiting, and carcinoid syndrome. Common antagonists include cyproheptadine, ketanserin, ondansetron, and ergot alkaloids.
Antidepressants & side effects + serotonin syndrome vs
The document discusses several types of depression including major depressive disorder, dysthymic disorder, postpartum depression, seasonal affective disorder, and bipolar disorder. It then provides details on the prevalence, risk factors, causes, and screening tools for major depressive disorder. The remainder of the document discusses differential diagnoses, treatment options including pharmacotherapy and psychotherapy, specifics on different classes of antidepressants and their mechanisms of action, side effects, and drug interactions.
Allostasis
This file accompanies a YouTube clip. It distinguishes allostasis from homeostasis and provides a brief overview of the allostatic response and allostatic load - see facebook page for link to clip - ePsychVCE.com (or website of same name)
Surviving College: Booze, Drugs, & Neurobiology
This document summarizes information about commonly abused substances among college students such as alcohol, marijuana, MDMA, opioids, and stimulants. It describes the acute and long-term effects of these substances on health and neurobiology. It also discusses trends in substance abuse such as increasing prescription opioid overdose deaths. Laws regarding synthetic marijuana in Texas are outlined, classifying it as a Penalty Group 2A controlled substance. Throughout, health risks of each substance are emphasized.
Antipsychotic drugs
Antipsychotic drugs are primarily used to treat schizophrenia and other psychotic disorders by decreasing hallucinations, delusions, and permitting patients to function better. First-generation ("typical") antipsychotics like chlorpromazine work mainly by blocking dopamine receptors in the brain. Second-generation ("atypical") antipsychotics have fewer motor side effects and also block serotonin receptors. Clozapine was the first atypical drug and is effective for treatment-resistant cases but requires blood monitoring due to risk of agranulocytosis. Risperidone and olanzapine are also widely used atypical antipsychotics.
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Antidepressants & side effects + serotonin syndrome vs
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Organophosphorouspoisoning 160727123533
Organophosphorus (OP) poisoning is a major cause of morbidity and mortality in Nepal. OP compounds inhibit acetylcholinesterase, leading to accumulation of acetylcholine and overstimulation of nicotinic and muscarinic receptors. Common presentations include excessive sweating, salivation, vomiting, diarrhea, bronchospasm, bradycardia, hypotension. Treatment involves atropine to block muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on severity of cholinergic crisis, and intermediate syndrome occurring 1-4 days later can cause respiratory failure if not properly managed.
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Paracetamol overdose
A 34-year-old British woman presented to the emergency department 30 minutes after ingesting approximately 100 acetaminophen tablets with alcohol in a suspected suicide attempt. She was treated with activated charcoal and intravenous N-acetylcysteine. On the first day of admission she developed abdominal pain and vomiting. Her liver function tests remained normal during her 3-day admission before she discharged herself against medical advice to return to the UK. Paracetamol overdose is commonly seen and requires prompt treatment with N-acetylcysteine to prevent liver damage from toxic metabolite accumulation if ingestion exceeds toxic thresholds.
Antianxiety
This document discusses different types of anxiety disorders and treatments. It defines anxiety and lists common emotional and physical symptoms. The main types of anxiety disorders covered are generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and phobias. The document examines different classes of antianxiety drugs including benzodiazepines, SSRIs, tricyclic antidepressants, buspirone, beta blockers, and MAO inhibitors. It details the mechanisms of action, uses, and side effects of these drug classes for treating various anxiety disorders.
Intern Survival Skills 2018 - Common Pages
This document provides guidance on various topics for managing hospitalized patients including:
- Hypertensive urgency vs. emergency and appropriate treatment approaches
- Evaluating and treating chest pain
- Managing pain while hospitalized
- Addressing patients who want to leave against medical advice
- Assessing and treating agitation, delirium, electrolyte imbalances, nausea/vomiting, and seizures
The document emphasizes using oral medications when possible, thorough evaluation of new symptoms, reviewing medications that could be causing issues, and consulting with seniors/experts as needed for more complex cases.
Organophosphorous poisoning
This document summarizes organophosphorous (OP) poisoning. OP compounds are commonly used as agricultural insecticides and were historically developed as chemical warfare agents. They work by inhibiting the enzyme acetylcholinesterase, leading to excess acetylcholine in the body. Clinical effects range from acute cholinergic crisis to intermediate muscle weakness to delayed neuropathy. Diagnosis is based on history of exposure and clinical features. Treatment involves atropine to control muscarinic effects, pralidoxime to reactivate acetylcholinesterase, benzodiazepines for seizures, and supportive care. Prognosis depends on prompt diagnosis and treatment to prevent respiratory failure, intermediate syndrome, or delayed neuropathy.
Acetaminophen toxicity
This document provides information on the management of acetaminophen (APAP) toxicity. It discusses the history of APAP use, its widespread presence in over-the-counter medications, pharmacological actions, pharmacokinetics, toxicity risks, stages of poisoning, and treatment with N-acetylcysteine (NAC). It emphasizes the importance of timely NAC administration based on the Rumack-Matthew nomogram to prevent hepatic damage from APAP overdose. Two case studies demonstrate the application of these principles in clinical practice.
Hot flashes; Any non-hormonal help ?
- Hot flashes are characterized by excessive vasodilatation of peripheral vasculature in response to a small increase in core body temperature, resulting in sensations of heat. They can be managed through lifestyle changes like diet modification, exercise, and stress relief techniques.
- For mild cases, avoiding triggers and lifestyle changes may be sufficient. For moderate to severe cases, herbal medications like black cohosh can be tried. If ineffective, SSRIs/SNRIs like escitalopram are first-line pharmacological options. Gabapentin or clonidine may be used if SSRIs/SNRIs provide inadequate relief or side effects.
- Management involves identifying triggers, incorporating
Headache – practical scenario
This document discusses several key points about managing headaches and migraines:
- It describes a case of a 24-year-old woman experiencing episodic vertigo and asks what additional information would be useful to obtain.
- It then reviews treatment options for migraine-related vertigo and indicates that cinnarizine would be an appropriate initial treatment.
- Finally, it discusses the use of flunarizine for migraine prophylaxis, including its indications, contraindications, adverse effects, interactions, and evidence from clinical studies supporting its effectiveness in reducing migraine frequency and severity.
Pharmacotherapy of depression
This document provides an overview of the pharmacology of antidepressants. It discusses the history of antidepressant development beginning in the 1950s. It then classifies antidepressants and describes the mechanisms of action, pharmacokinetics, pharmacological actions, adverse effects and recent advances for various classes including tricyclic antidepressants, SSRIs, SNRIs, atypical antidepressants. It provides details on specific drugs within each class.
Pediatric Asthma Exacerbation Management
Basics of pediatric asthma exacerbation management, case presentation and clinical assessment points.
Management of migraine
Migraine is a common neurological disorder characterized by severe headaches. Common triggers include diet, hormones, environment, and stress. Migraine attacks involve a headache phase with throbbing pain that worsens with activity along with symptoms like nausea and sensitivity to light/sound. Some people experience an aura phase before the headache with visual or sensory disturbances.
Treatment involves managing triggers, acute treatments like triptans to stop headaches, and preventive medications for those with frequent attacks. Preventive options include beta blockers, anti-seizure medications, and antidepressants, with the goal of reducing attack frequency and severity. Proper acute and preventive treatment along with lifestyle modifications can help manage migraine.
Opioid Presentation
RS is a 62-year-old male presenting with worsening chest and rib pain. He has a history of chronic pain managed with oxycodone and fentanyl patches. In the ED, he received morphine with pain relief. He is now admitted and receiving IV hydromorphone via PCA in addition to his home medications. His vital signs have improved but he remains in pain. Labs show anemia. The note outlines the patient's medical history, pain assessment tools, opioid pharmacology and adverse effects management.
Antipsychotics LAST MINUTE REVISION NOTES
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Migraine
Dr. Shafi Ullah Khan presents information on migraine including diagnostic criteria, clinical features, classification, pathophysiology, treatment approaches, and future treatment options. Key points include the diagnostic criteria of recurrent headache lasting 4-72 hours with features of nausea/vomiting/photophobia, classification into types such as migraine with and without aura, the trigeminovascular system pathway in migraine pathophysiology, treatment approaches including abortive medications and preventive medications/procedures, and novel emerging treatments under investigation.
Ocd santhosh final
This document summarizes the biological treatments for obsessive compulsive disorder (OCD) according to the DSM-5 criteria. It discusses the neurobiology of OCD including structural changes in the brain, functional studies showing increased activity in certain areas, and neurotransmitter imbalances. FDA approved medications for OCD like SSRIs and clomipramine are outlined. Augmentation strategies and treatments for resistant cases are provided. Other somatic therapies explored include repetitive transcranial magnetic stimulation, deep brain stimulation, electroconvulsive therapy, and vagus nerve stimulation. Neurosurgical procedures are discussed as last line treatments for severe, long-standing OCD.
Antipsychotics
Typical antipsychotics are associated with extrapyramidal side effects and tardive dyskinesia. Atypical antipsychotics have fewer of these motor side effects due to their serotonin receptor antagonism. Clozapine is effective for treatment-resistant schizophrenia but carries risks of agranulocytosis and seizures. Newer atypicals like risperidone, olanzapine, and quetiapine have fewer motor side effects than typicals but can cause weight gain, hyperglycemia, and metabolic side effects. Aripiprazole is a partial dopamine agonist that has low risks of motor and metabolic side effects.
Uses of Quetiapine
Quetiapine is an antipsychotic drug used to treat schizophrenia, bipolar disorder, and major depressive disorder. It is effective in treating both manic and depressive episodes of bipolar disorder. The document outlines the clinical uses, dosages, and administration of quetiapine for various conditions including schizophrenia, bipolar mania and depression, adjunct treatment of major depression, insomnia, and others. Recent studies show quetiapine has robust efficacy in bipolar disorder and may improve working memory and outcomes in schizophrenia more than other antipsychotics.
Flunarizine for migraine prophylaxis
This document discusses the use of flunarizine for migraine prophylaxis. It covers the pharmacology, indications, contraindications, adverse effects, and evidence base. Flunarizine is a calcium channel blocker that is also antihistaminic and antidopaminergic. It has a long half-life and crosses the blood-brain barrier. Studies show it reduces migraine frequency by 50-75% compared to 30-50% for placebo. Common side effects include weight gain and sedation. While not licensed in the UK, some clinicians will prescribe it off-label for refractory migraine patients.
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This document discusses delirium, which is an acute disturbance of consciousness and cognition. It defines delirium and describes its subtypes. Delirium is associated with increased mortality, longer hospital stays, and permanent cognitive impairment in some patients. Risk factors include infection, withdrawal, metabolic abnormalities, trauma, and various medical conditions. Delirium results from neurotransmitter imbalances and inflammation in the brain. It should be monitored using scales like the Richmond Agitation Sedation Scale and Confusion Assessment Method. Treatment involves managing the underlying causes, minimizing sedation, promoting mobility, and in some cases using antipsychotics or dexmedetomidine. Delirium usually develops within the first 48 hours and can last up to two weeks.
Colistin colistin (polymyxin e)
Colistin is a polymyxin antibiotic produced by Bacillus polymyxa that is effective against most gram-negative bacteria. It fell out of favor due to nephrotoxicity but remains a treatment of last resort for multidrug-resistant infections. There are two forms, colistin sulfate and colistimethate sodium, which are dosed differently and have different mechanisms of action, pharmacokinetics, and toxicity profiles. Resistance can develop with use but remains relatively rare currently.
Cerebral monitoring
This document discusses various methods for monitoring the central nervous system (CNS) during and after surgery. It describes cerebral perfusion monitoring techniques like cerebral blood flow measurements, transcranial Doppler ultrasonography, near-infrared spectroscopy, and jugular bulb oximetry. Regional perfusion is also monitored using brain tissue partial oxygen tension. Cerebral metabolism is assessed using cerebral microdialysis. Cerebral function is evaluated with the bispectral index, approximate entropy, and auditory evoked potentials. The document provides details on how each technique is performed and what clinical information it provides about CNS oxygenation, blood flow, and function.
Ventricular tachycardia
This document discusses ventricular tachycardia (VT) clusters and incessant VT. It defines a VT cluster as 3 or more sustained VTs within 24 hours. Treatment options discussed include antiarrhythmic drugs, ablation, anesthesia, and LVAD. Amiodarone, lidocaine, and procainamide dosages are provided. Left stellate ganglion blockade is suggested as superior to antiarrhythmic drugs for electrical storms. The document also discusses therapies for VT including ablation and digitalis toxicity management.
Gaps in acid base balance in icu
This document discusses various calculations used to diagnose and distinguish between different types of acid-base disorders, including anion gap, delta gap, urine anion gap, and osmolar gap. It provides detailed explanations of how to calculate each value and what they indicate. The anion gap is useful for determining the cause of metabolic acidosis. The delta gap can identify mixed acid-base disorders. A negative urine anion gap suggests GI bicarbonate loss while a positive value suggests renal tubular acidosis. An increased osmolar gap may indicate ethylene glycol or methanol poisoning in the setting of an unexplained metabolic acidosis.
Chest x. ray interpretation and teaching
1. The document discusses various radiological signs seen on chest x-rays related to different disease processes and conditions. It provides descriptions of abnormalities indicative of conditions like pneumonia, lung cancer, tuberculosis, pulmonary edema and others.
2. Examples and descriptions are given for interpreting findings related to mediastinal masses, pleural effusions, atelectasis, pneumothorax and other lung abnormalities. Signs related to vascular structures like aneurysms are also outlined.
3. The document serves as a teaching guide for radiological interpretation and diagnosis, summarizing key signs and patterns seen for different diseases on chest x-rays.
Colistin colistin (polymyxin e)
Colistin is a polymyxin antibiotic produced by Bacillus polymyxa that is effective against most gram-negative bacteria. It fell out of favor due to nephrotoxicity but remains a treatment of last resort for multidrug-resistant infections. There are two forms, colistin sulfate and colistimethate sodium, which are not interchangeable. Dosing is complicated due to lack of standardization. Colistin works by disrupting bacterial membranes. While resistance is still rare, its increased use has led to some resistant strains emerging.
Chest x. ray interpretation and teaching
1. The document discusses various radiological signs seen on chest x-rays related to different disease processes and conditions. It provides descriptions of findings related to lung lesions, pleural diseases, pulmonary vascular abnormalities and other pathologies.
2. Examples of signs described include the appearance of mediastinal lesions, pleural effusions, lung opacities, findings associated with lobar collapse, and distributions of opacities related to specific conditions.
3. The document aims to aid in the interpretation of chest x-rays and teaching of radiological findings for different diseases. It covers topics such as cavitary lung lesions, mediastinal abnormalities, signs of pneumonia, and characteristics of vascular anomalies amongst other pathologies.
Cerebral monitoring
This document discusses various methods for monitoring the central nervous system (CNS) during and after surgery. It describes cerebral perfusion monitoring techniques like cerebral blood flow measurements, transcranial Doppler ultrasonography, near-infrared spectroscopy, and jugular bulb oximetry. Regional perfusion is also monitored using brain tissue partial oxygen tension. Cerebral metabolism is assessed using cerebral microdialysis. Cerebral function is evaluated with the bispectral index, approximate entropy, and auditory evoked potentials. The document provides details on how each technique is performed and what insights it provides about CNS oxygenation, blood flow, and electrical activity.
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, anacrotic notch, dicrotic limb, and dicrotic notch, which reflect events in the cardiac cycle and can be affected by conditions like vascular resistance.
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1) The document presents several radiographic signs seen on chest x-rays and CT scans related to various pulmonary and mediastinal abnormalities.
2) Examples include the deep sulcus sign indicating pleural free air, the air crescent sign seen in invasive aspergillosis, the silhouette sign depicting a pericardial cyst, and the CT halo sign associated with various conditions including invasive aspergillosis.
3) Accompanying each sign is an illustration and example chest x-ray or CT image, with a brief explanation of the clinical significance of each radiographic finding.
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The document provides updates on infectious diseases from Clostridium difficile infection to new vaccines and antimicrobial agents. It discusses the increasing severity and prevalence of C. difficile, new diagnostic tests and treatment options including fidaxomicin and stool transplants. New antimicrobial agents for gram-positive infections like daptomycin, linezolid and ceftaroline are mentioned. Vaccine recommendations are updated for herpes zoster, pertussis and pneumococcus.
Subarachnoid haemorrhage
1. Subarachnoid hemorrhage (SAH) is bleeding into the subarachnoid space between the brain's outermost layers caused by a ruptured aneurysm in 70% of cases.
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This document provides an overview and update on systemic lupus erythematosus (SLE). It discusses the definition and classification criteria for SLE, including revisions to the criteria. Genetic factors contributing to SLE susceptibility are described. Increased levels of interferon alpha are implicated in the disease pathogenesis. Clinical manifestations and leading causes of mortality in SLE patients are summarized. Current therapeutic approaches for SLE, including hydroxychloroquine, belimumab, and targeted therapies in development are outlined.
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This document defines key terms and concepts related to mechanical ventilation and interprets blood gas results to guide ventilator adjustments. It describes various ventilator modes, appropriate initial settings, priorities for weaning, and criteria for extubation. Volume control delivers a set tidal volume while pressure control uses a fixed pressure. Pressure-regulated volume control aims for a target minute ventilation. Complications include barotrauma, pneumonia, and cardiac/GI issues. Physical exams and pressure patterns can localize causes of acute deterioration. Neurologic, cardiovascular, and pulmonary status must be optimized before extubation.
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This document discusses new insights into treatment strategies for critically ill patients, including optimal antibiotic dosing and the potential benefits of extended infusion of antibiotics. It also reviews evidence on the use of aerosolized colistin, inhalation antibiotics, statins, probiotics, and prophylactic antibiotics in preventing infections like ventilator-associated pneumonia in ICU patients. While some studies found decreased infection rates, ICU stay, or ventilation time with these approaches, larger trials are still needed to determine clear effects on mortality or define best practices. The document emphasizes individualizing care based on pharmacokinetic factors and calls for more research on optimization of antibiotic use in critical illness.
Mixed connective tissue disease
Mixed connective tissue disease (MCTD) is a rare autoimmune disorder with features of lupus, scleroderma, rheumatoid arthritis, and polymyositis. It is characterized by high levels of antibodies against ribonucleic proteins. Diagnostic criteria require 3 of 5 clinical features plus positive serology. Over time, many patients evolve symptoms meeting criteria for other connective tissue diseases. Pulmonary, renal, and cardiac involvement are common complications. Prognosis depends on degree of organ involvement, with 5-year mortality of 8-19% reported.
Intracranial pressure 2015
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This document contains summaries of several research points related to critical care. It discusses findings that propofol may limit recovery after brain injury in adults, that cardiac dysfunction is associated with mortality after traumatic brain injury, that vitamin D deficiency predicts sepsis in critically ill patients, and that neuromuscular blocking agents are associated with lower mortality in mechanically ventilated sepsis patients. It also summarizes research showing that a bundle of measures was effective at reducing ventriculitis associated with external cerebral ventricular drainage. Finally, it finds that critical illness is characterized by reduced intestinal absorption of glucose and lower expression of glucose transporters and taste receptors.
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- 1. Serotonin syndrome SAMIR EL ANSARY
- 2. https://www.facebook.com/groups/1451610115129555/#!/groups/145 1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY
- 3. Case: I just want to die • 45yo male • OD on paxil, gravol, ibuprofen tonight • Smoked some crack • Recent abstinence from EtOH • Headache, fever X 1week • HR125 sinus • BP 165/105 • Temp 38.0 • RR20, sats 95% • C/S normal • Agitation • Pupils 6 mm • Hyperreflexic, clonus • Tremulous • Very diaphoretic • Neck stiff • No bowel sounds
- 4. Case Questions • Is this serotonin syndrome? • What is the differential dx? • What tests should be done? • What are the main treatments of serotonin syndrome? • Is there any evidence for the use of cyproheptidine?
- 5. What is Serotonin? • Neurotransmitter • Mood, personality, sleep, sex, motor, temp, pain functions • Very complex • 14 receptors • Excitatory and inhibitory functions
- 6. What is Serotonin Syndrome? • Serotonin syndrome is a constellation of findings related to excessive stimulation of serotonin receptors and is manifested by cognitive, autonomic, and neuromuscular abnormalities
- 7. CAN you diagnosis serotonin syndrome? C COGNITIVE CHANGES: Agitation, confusion, euphoria, insomnia, hypomania, hallucinations A AUTONOMIC CHANGES: Tachycardia, HTN, fever, diaphoresis, mydriasis, arrythmias, tachypnea N NEUROMUSCULAR CHANGES: Tremor, hyperreflexia, clonus, ataxia, incoordination, seizures
- 8. Sternbach’s Criteria • Addition or increased dose of a known serotonergic agent • At least three of the C.A.N. criteria • Other etiologies excluded – Withdrawl, sympathomimetics, anticholinergics, CNS infections, neuroleptic malignant syndrome • No neuroleptics that have been started or increased prior to the onset of symptoms
- 9. What causes serotonin syndrome? • SSRIs • SNRIs • MAOIs • Cocaine • Amphetamines • LSD • Lithium • Wellbutrin • And many more!!
- 10. How is Seritonin Syndrome Managed? • Supportive Care • Temperature control • Benzodiazepines • Fluids • Other therapies – Cyprohepatadine – Beta – blockers – Chlorpromazine – Dantrolene
- 11. What is Cyproheptadine? • Antihistamine with anticholinergic and antiserotonergic properties • Blocks 5HT1a and 5HT2 receptors • Used as antihistamine or for appetite stimulant in anorexia • Recommended dosage: 4 mg po tid • No intravenous formulation
- 12. Does Cyproheptadine work? DRUG DEATHS Cyproheptadine 5 mg/kg 5/5 Cyproheptadine 10 mg/kg 0/5 Dantrolene 20 mg/kg 6/6 Propranolol 10 mg/kg 5/5 Chlorpromazine 20 mg/kg 6/6 Chlorpromazine 40 mg/kg 0/5
- 13. Does Cyproheptadine work? –Case report – Seritonin syndrome of moderate severity – Symptoms subsided 30 min after a 4 mg po dose – Dose repeated in 3hrs for recurrence of symptoms
- 14. Does Cyproheptadine work? –Case report – Severe serotonin syndrome – Cyproheptadine 8 mg po – Level of consciousness promptly improved, hypertonia resolved, temperature normalized
- 15. Does Cyproheptadine work? –Case report – Moderate serotonin syndrome – Treated with cyproheptadine 8 mg po with no effect, repeat dose at 8 hours with no effect – Chlorpromazine 50 mg im and symptoms improved steadily over next 2hrs
- 16. Does Cyproheptadine work? • McDaniel. Ann Pharmacoltherapy 2001. –Case series of 4 patients – All mild to moderate serotonin syndromes – Dosing: 8 mg po and repeat q 8hr – Responses seen within hours – No serious side – effects noted (some anticholinergic effects)
- 17. Does Cyproheptadine work? –Case series of 5 patients – Generally moderate severities – Initial dose 4-8 mg po – A few got subsequent doses of 4 mg – Responses seen within 1-2 hours – No serious complicated reported
- 18. Does Cyproheptadine work? • May be • VERY little literature • Appears effective • Appears safe • Probably not much down side to trying
- 19. ? Other treatments for Serotonin Syndrome • Chlorpromazine • Propranolol • Dantrolene
- 20. https://www.facebook.com/groups/1451610115129555/#!/groups/145 1610115129555/ Wellcome in our new group ..... Dr.SAMIR EL ANSARY
- 21. GOOD LUCK SAMIR EL ANSARY ICU PROFESSOR AIN SHAMS CAIRO elansarysamir@yahoo.com