Psych Question...NMS

[Kboy2]

Hey guys

About to take on my psych shelf and had a question.

Came across a Q that gave an obvious description of NMS. Had to pick between Dantrolene, or applying cooling blankets and supportive care + discontinuation of offending drug.

Now historically I would always choose bromocriptine or dantrolene and it would be correct. The Q above, Dantrolene was incorrect and the latter answer was correct. This Q came out of USMLERx CK Max bank (Yes, I use UW and had exhausted the psych Q's from this bank first)

Reading through my FA for psych, it says "Sodium dantrolene, bromocriptine and amantadine are infrequently used b/c of their own side effects and unclear efficacy."

So my question is then....If confronted b/w choosing amantadine/bromocriptine/dantrolene vs cooling blankets/fluids/supportive care what is the correct way to go?

Thanks

---

Members don't see this ad.

 

[da8s0859q]

Just happened to see this. For context, I'm an EM PGY-2.

Bottom line, real world: the data backing dantrolene as a specific treatment for NMS is flimsy in many ways. It MAY be useful, but you will find caveats like "only if NMS was due to monotherapy as causative agent" or "only in cases of 'severe' rigidity" when you try to look up various sources, as I recall. There have been accusations of increased mortality, and the agent is known to be potentially hepatotoxic.

The most up to date answer to the best of my knowledge is that supportive care is the most overall reasonable approach. Cooling, other things as needed, benzos as needed.

 

[Kboy2]

Just happened to see this. For context, I'm an EM PGY-2.

Bottom line, real world: the data backing dantrolene as a specific treatment for NMS is flimsy in many ways. It MAY be useful, but you will find caveats like "only if NMS was due to monotherapy as causative agent" or "only in cases of 'severe' rigidity" when you try to look up various sources, as I recall. There have been accusations of increased mortality, and the agent is known to be potentially hepatotoxic.

The most up to date answer to the best of my knowledge is that supportive care is the most overall reasonable approach. Cooling, other things as needed, benzos as needed.

Hey thanks much for your input. Just going to cross my fingers I dont come across this question, but I suppose if I do I will go with supportive care then!

Thank you!

 

[Kaustikos]

You're reading the question wrong. What would you do first? That's what they want.
You give them blankets/etc long before you give dantrolene.