QuestionSBA
QuestionChoice
Simvastatin is not known to cause NMS
34294
e
Simvastatin 40 mg PO ON
QuestionChoice
Sertraline is not associated with NMS but an overdose of sertraline can cause serotonin syndrome, which share some similarities with NMS. Both NMS and serotonin syndrome can bring about hypertension, tachycardia and hyperthermia. However, NMS is different from serotonin syndrome in that it is associated with hyporeflexia, normal pupillary sizes and a gradual onset while serotonin syndrom is characterised by hyperreflexia, myadriasis and a rapid onset
34291
b
Sertraline 50 mg PO OD
QuestionChoice
Lisinopril is not known to casuse NMS
34293
d
Lisinopril 20 mg PO OD
QuestionChoice
The clinical picture described above is that of neuroleptic malignant syndrome (NMS). NMS is an uncommon but potentially fatal side effect of all antipsychotic drugs. Antipsychotic medications lead to NMS through their antagonism of dopamine D2 receptors. NMS is characterised by a tetrad of hyperthermia, changed mental status, muscle rigidity and autonomic instability
34290
a
Olanzapine 10 mg PO OD
QuestionChoice
Metformin is not known to casuse NMS
34292
c
Metformin hydrochloride 500 mg PO TDS
QuestionComment
one day i'll get NMS and serotonin syndrome the right way round 
61454
QuestionComment
"Neuroepeleptic" malignant syndrome = antipsychotic bad syndrome.
It has rise in CK, muscle ridgity - basically excess of motor side effects of antipsycotics anyway. + confusion and sweating
61915
User
subscriber
Lung Metastasis
User
subscriber
Epidermis Benign
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2801
Antipsychotic side effects
Topic
90
Psychiatry
6869
Case presentation: A 35-year-old man presents to the accident and emergency department with a two-day history of gradual onset confusion and muscle rigidity. He is highly agitated and sweats excessively.  

PMH: Schizophrenia, Depression, Type 2 Diabetes Mellitus, Hypertension, Hypercholesterolaemia
DH: Her current regular prescriptions are listed below
Observations: Temperature 40°C , blood pressure 181/95 mmHg, heart rate 100 bpm, respiratory rate 25; oxygen saturation 100% (on air)
On examination: Lead pipe rigidity. Normal pupillary sizes
Investigation: Negative urine toxicology screen

Question: Select the prescription that is most likely to be contributing to the clinical picture described above?
a