Pain: serotonin syndrome: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Pain: serotonin syndrome

Sample item

A patient on an SSRI receives pethidine and develops agitation, fever, sweating, diarrhoea, hyperreflexia and inducible clonus. Which drug is used if benzodiazepines and supportive care are insufficient?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Cyproheptadine

The picture suggests serotonin syndrome from combining a serotonergic opioid with an SSRI. Treatment is to stop the offending drugs, give supportive care and benzodiazepines, and use cyproheptadine, a 5-HT2A antagonist, for moderate to severe cases. Dantrolene and bromocriptine are not recommended.

Option by option

  • A. Naloxone

    Naloxone does not reverse serotonergic toxicity.

  • B. Bromocriptine

    Bromocriptine can worsen serotonin toxicity and is used in neuroleptic malignant syndrome.

  • C. Dantrolene

    Dantrolene is used for malignant hyperthermia and is not recommended for serotonin syndrome.

  • D. Cyproheptadine (correct)

    Correct. Cyproheptadine blocks 5-HT2A receptors and is the recognised antidote.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Cyproheptadine. The picture suggests serotonin syndrome from combining a serotonergic opioid with an SSRI.

Why is "Naloxone" not the answer?

Naloxone does not reverse serotonergic toxicity.

Why is "Bromocriptine" not the answer?

Bromocriptine can worsen serotonin toxicity and is used in neuroleptic malignant syndrome.

Why is "Dantrolene" not the answer?

Dantrolene is used for malignant hyperthermia and is not recommended for serotonin syndrome.

What concept does this question test?

It tests Pain: serotonin syndrome in Anaesthesia. Treatment is to stop the offending drugs, give supportive care and benzodiazepines, and use cyproheptadine, a 5-HT2A antagonist, for moderate to severe cases. Dantrolene and bromocriptine are not recommended.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Pain: serotonin syndrome?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.