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Serotonin Syndrome

Serotonin Syndrome. SS life threatening emergency from excess CNS 5HT (serotonin) caused by combining 5HT enhancing drugs or giving SSRIs too close to discontinuation of MAOIs. Prozac is the SSRI most likely to cause the syndrome because of its long half-life. Serotonin Syndrome.

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Serotonin Syndrome

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  1. Serotonin Syndrome • SS life threatening emergency from excess CNS 5HT (serotonin) • caused by combining 5HT enhancing drugs or giving SSRIs too close to discontinuation of MAOIs. • Prozac is the SSRI most likely to cause the syndrome because of its long half-life

  2. Serotonin Syndrome • Confusion, disorientation, mania • Autonomic dysfunction • Neuromuscular activity • muscle rigidity • hyperreflexia • myoclonic jerking • Ataxia

  3. Common side effects SSRI • Insomnia, agitation • Headache • Weight loss • Sexual dysfunction

  4. Other side effects Priapism with trazodone (Desyrel) Prolonged penile erection. • Hepatic failure with nefazodone (Serzone) • Jaundice, anorexia, GI complaints

  5. Monoamine Oxidase Inhibitors (MAOI) • diet restrictions tyramine-containing foods • cheese, fermented or aged protein, pickled or smoked fish • Chianti & vermouth wines, draft beer • Yeast, liver, sausages, pepperoni, salami, canned ham

  6. MAOIs Hypertensive Crisis • Sudden elevation of b.p. • Explosive occipital headache • Head & face flushed • Palpitations, chest pain • Sweating, fever, nausea, vomiting • Dilated pupils, photophobia

  7. Treatment of MAOI crisis • Hold MAOI dose • Do not lie down • IM chlorpromazine (Thorazine) • IV phentolamine --blocks norpinephrine

  8. Mood Stabilizing Drugs • Lithium (1.0-1.5) for acute mania) • Renal • Thyroid • Physical, ECG, fasting bl. Sugar, CBC • (Diet adequate in salt)

  9. Lithium side effects • Drowsiness, dizziness, headache • Dry mouth, thirst • GI upset • Fine hand tremors • Hypertension • Polyuria, dehydration • Wt. gain

  10. Mood Stabilizing Drugs • Anticonvulsants • Carbamazepine (Tegretol) • Valproate (Depakote)

  11. Tegretol , Depakote, and Klonapin • inhibit kindling & enhance inhibitory neurotransmitter GABA • kindling: brain becomes sensitized to stressors & responds without event • bipolar • panic • craving

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