MEDizzy - A 33-year-old woman was brought to the emergency department

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NEUROLEPTIC DRUGS

A 33-year-old woman was brought to the emergency department with increased agitation and confusion. Physical examination revealed a temperature of 104°F (40°C), pulse of 125 bpm, labile blood pressure, profuse diaphoresis, sialorrhea, and muscle rigidity. The woman, recently diagnosed with schizophrenia, had started a therapy a few days previously. Which of the following drugs most likely caused the patient’s syndrome?

ExplanationThe correct answer is C. The clinical picture is typical of neuroleptic malignant syndrome (NMS), a rare but potentially lethal complication that may present in a sudden, unpredictable fashion. The etiology of NMS is unknown, but a proposed mechanism suggests that a neuroleptic-induced, excessively rapid blockade of dopaminergic receptors in the diencephalon may play a role. It is uncertain whether NMS is a specific entity or a variant of malignant hyperthermia. This latter disorder is most commonly associated with administration of halogenated inhalational anesthetics and depolarizing muscle relaxants. It has a shorter duration (3−5 days) than NMS (5−30 days). A, B None of these drugs cause NMS or malignant hyperthermia. D Although these drugs are not used to treat schizophrenia, if given in overdose or in combination with other serotonergic drugs, they could cause serotonin syndrome, which has signs and symptoms similar to those of NMS.