Free Essay. Differentiating Nms, Serotonin Syndrome, and Malignant Hyperthermia

Neuroleptic malignant syndrome (NMS) and serotonin syndrome are disorders that are rare and induced by medicine ingestion in the body. While both share clinical features that are similar, like mental state changes, hypertonia, and pyrexia, they are different in the sale of treating the agents that cause them. Serotonin syndrome is mainly characterized by hyperreflexia and clonus, where the muscles contract and relax involuntarily (Foong, Patel, Kellar & Grindrod, 2018). On the other hand, NMS is indicated by hyporeflexia, hemodynamic dysregulation, and rigidity in the muscles (Patel, Lilly, Ajayi & Melvin, 2018). Malignant hyperthermia, on the other hand, results in the muscles being depolarized, hence rigidity in the muscles. Other effects include acidosis, hyperthermia, and tachycardia (Osman, Saba & Watson, 2018).

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Indications for Valproic Acid

Valproic acid is a drug that can be regarded as a single medication for most epileptic forms. Besides that, it is also used with a combination of other medication agents when treating epilepsy. When dealing with seizures in general, the drug is highly effective and the most suitable when used alone for therapy as most medics prefer it. It is most successful when dealing with absences, unlike ethosuximide, which it the best against seizures that are tonic-clonic in the same way as phenytoin and carbamazepine (Tudur Smith, Marson & Williamson, 2001). The drug is an asset and is highly efficient considering that it rarely has an impairing effect on the cognitive functions of a person. However, when using the drug the monitoring parameters include tremors or shakiness, hearing ringing in their ears, double or blurred vision, unsteadiness, and changes in weight. When they are extreme, one is advised to immediately see a doctor (Crowley, Urben, Hacobian & Geiger, 2018).

Monitoring Parameters for DexmethylphenidateDexmethylphenidate is a drug that is used for those suffering from attention deficit hyperactivity disorder (ADHD). There are various monitoring parameters for the drug when looking at toxicity and efficacy, and the first one is the rate of the heartbeat and blood pressure, especially when dealing with patients who are hypertensive. When using the drug it is of great essence to monitor them and conduct a cardiovascular risk. The second one is any indications of peripheral vasculopathy, like the digital changes that take place. Thirdly, any changes in weight and height when medicating children. The final one is any misuse or signs of addiction, considering that when taken one may develop a tendency of wanting to use it continuously even when the need is gone (Brown, Samuel & Patel, 2018).

Reason for Chest Pains when using Fentanyl IV

The administration of fentanyl IV results in difficulty in maintaining ventilation using a mask and bag, considering that the effect mainly occurs at the glottis. The drug causes the glottis muscles to contract and become rigid thereby closing the airway partially or in some cases completely. Besides that, it may also result in the reduction of the genioglossus activity which increases resistance within the upper airway system. On the other hand, fentanyl IV also causes the thoracic muscles which include the diaphragm and the intercostal muscles to become rigid, hence limiting the movement of the lungs when taking in and releasing air during the breathing process. Besides that, the heart also appears to be squeezed and as such the patient becomes fatigued quickly (Vahedi, Hajebi, Vahidi & Saeedi, 2019).

Bridging Warfarin with Heparin

Warfarin is bridged with heparin from the fact that there is a delayed anticoagulation period, besides the concern that introducing the same immediately may be harmful to the patient. The need for a delay is based on the anticoagulation period taking at least five days to complete, where the INR (Internal Normalization Ratio) (Hawes, 2018). Besides that, before the start of using warfarin, the patient needs to be in a thrombin state as the drug has a prothrombotic state where they have a reduced amount of protein C and S. The 5-day overlap helps in the recovery of the proteins that are necessary for the medication to work effectively (Witt et al., 2018).

INR for Disease States Treated using Warfarin

The diseases states that require to be treated with warfarin, including stroke and DVT do not require the same INR as the blood needs to have different levels "thickness" or "thinness" so as to allow the use of warfarin. The states of these diseases require that the INR is different so that the clots in the blood occur. For instance, stroke requires an INR of 2.5 to 3.5, while that of DVT is between 2.0 and 3.0 (Lamsam et al., 2018). In that case, they do not require having the same INR when using warfarin as the levels of the medication will vary depending on the thickness of the blood.

Indications for Apixaban

The indications of apixaban include situations where a person is at risk of getting blood clots in the brain (stroke) and the heart, a condition called atrial fibrillation. A person with the condition does not have any valvular-related issues in the heart. Besides that, it is also used when one has a pulmonary embolism and deep venous thrombosis, especially in cases where the patient may have had a replacement of the knee or the hip. The usual dosage for the condition is 5 mg two times a day through the mouth. The dosage is reduced by half for the elderly who weigh 60 kilograms and below. When dealing with DVT the dosage is double, with one taking 10 mg two times a day for up to a week, after which it is halved for another week (Hohnloser et al., 2019).

References

Brown, K., Samuel, S., & Patel, D. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: a review for practitioners. Translational Pediatrics, 7(1), 36-47. doi: 10.21037/tp.2017.08.02

Crowley, K., Urben, L., Hacobian, G., & Geiger, K. (2018). Valproic Acid for the Management of Agitation and Delirium in the Intensive Care Setting. Critical Care Medicine, 46(1), 430. doi: 10.1097/01.ccm.0000528901.85793.5a

Foong, A., Patel, T., Kellar, J., & Grindrod, K. (2018). The scoop on serotonin syndrome. Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 151(4), 233-239. doi: 10.1177/1715163518779096

Hawes, E. (2018). Patient Education on Oral Anticoagulation. Pharmacy, 6(2), 34. doi: 10.3390/pharmacy6020034

Hohnloser, S., Fudim, M., Alexander, J., Wojdyla, D., Ezekowitz, J., & Hanna, M...., Lopes, R. (2019). Efficacy and Safety of Apixaban Versus Warfarin in Patients With Atrial Fibrillation and Extremes in Body Weight. Circulation, 139(20), 2292-2300. doi: 10.1161/circulationaha.118.037955

Lamsam, L., Sussman, E., Iyer, A., Bhambhvani, H., Han, S., Skirboll, S., & Ratliff, J. (2018). Intracranial Hemorrhage in Deep Vein Thrombosis/Pulmonary Embolus Patients Without Atrial Fibrillation. Stroke, 49(8), 1866-1871. doi: 10.1161/strokeaha.118.022156

Osman, B., Saba, I., & Watson, W. (2018). A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis Affect a Patient's Insurability?. Case Reports In Anesthesiology, 2018(4), 1-5. doi: 10.1155/2018/6532821

Patel, K., Lilly, B., Ajayi, O., & Melvin, K. (2018). A Case of Neuroleptic Malignant Syndrome in a Profoundly Intellectually Disabled Patient with Successful Reintroduction of Antipsychotic Therapy with Quetiapine. Case Reports In Psychiatry, 2018(5), 1-4. doi: 10.1155/2018/7045106

Tudur Smith, C., Marson, A., & Williamson, P. (2001). Phenytoin versus valproate monotherapy for partial onset seizures and generalized onset tonic-clonic seizures. Cochrane Database Of Systematic Reviews, 25(2). doi: 10.1002/14651858.cd001769

Vahedi, H., Hajebi, H., Vahidi, E., & Saeedi, M. (2019). Comparison between intravenous morphine versus fentanyl in acute pain relief in drug abusers with acute limb traumatic injury. World Journal Of Emergency Medicine, 10(1), 27. doi: 10.5847/wjem.j.1920-8642.2019.01.004

Witt, D., Nieuwlaat, R., Clark, N., Ansell, J., Holbrook, A., & Skov, J. et al. (2018). American Society of Hematology 2018 guidelines for the management of venous thromboembolism: optimal management of anticoagulation therapy. Blood Advances, 2(22), 3257-3291. doi: 10.1182/bloodadvances.2018024893