MEDizzy - A patient develops a profound fever, skeletal muscle

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The central nervous system 2

A patient develops a profound fever, skeletal muscle rigidity, and autonomic and systemic electrolyte imbalances as part of a severe adverse response to a psychoactive drug. The working diagnosis is a neuroleptic malignant syndrome. In addition to administering dantrolene in an attempt to restore some semblance of normal skeletal muscle function, which of the following other drugs is most likely to be given to help provide additional symptom relief?

ExplanationBromocriptine, an ergot derivative, is a direct-acting dopamine receptor agonist. Its main uses are for adjunctive management of Parkinson’s disease, and for management of amenorrhea and infertility (and, if present, galactorrhea) due to hyperprolactinemia. It is also used, long-term for management of some pituitary adenomas. However, it has gained acceptance as an important adjunct (usually along with dantrolene, as noted in the question) for the management of neuroleptic malignant syndrome (NMS). Recall that NMS is a rare but potentially fatal response to traditional neuroleptic/antipsychotic drugs (phenothiazines such as chlorpromazine and butyrophenones such as haloperidol). The newer, atypical antipsychotics (clozapine, olanzapine, and risperidone) may also cause NMS, but the clinical presentation seems not to include muscle rigidity that is usually an accompaniment of NMS caused by phenothiazines or butyrophenones.