CNS Pharmacology Basics 5

Question 1

A patient taking an SSRI is started on linezolid and develops agitation, hyperthermia, and clonus. What is the most likely diagnosis?

Accepted Answer

Serotonin syndrome

Answer

Linezolid is a weak MAO inhibitor, and combination with SSRIs can cause serotonin syndrome marked by clonus and hyperreflexia.

Question 2

Which feature best distinguishes neuroleptic malignant syndrome from serotonin syndrome?

Accepted Answer

Lead-pipe rigidity with bradyreflexia and slower onset

Answer

NMS develops over days with lead-pipe rigidity and decreased reflexes, while serotonin syndrome is rapid with hyperreflexia and clonus.

Question 3

What is the recommended first-line medication class for an actively seizing patient in status epilepticus?

Accepted Answer

Benzodiazepines

Answer

IV lorazepam, IM midazolam, or IV diazepam is first-line for status epilepticus per established guidelines.

Question 4

When administering IV phenytoin, which precaution is most important?

Accepted Answer

Infuse no faster than 50 mg/min with cardiac monitoring

Answer

Rapid phenytoin infusion can cause hypotension and arrhythmias, so rate is limited and it is mixed in normal saline.

Question 5

Fosphenytoin offers which advantage over IV phenytoin?

Accepted Answer

Lower risk of infusion-site injury such as purple glove syndrome

Answer

Fosphenytoin is a water-soluble prodrug that causes less tissue injury and can be infused faster, dosed in phenytoin equivalents.

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