Question

A patient on haloperidol for psychosis develops fever, altered sensorium and labile hypertension. Drug useful in treating this patient is

• A. Cefotaxime
• B. Bromocriptine
• C. Largectil
• D. Propranolol

Hint:

Think about what class of drug can reverse haloperidol's effect on dopamine receptors.

Answer 1

The Correct Option is B

The clinical picture, fever, altered sensorium and swinging blood pressure in someone on haloperidol, is a textbook description of Neuroleptic Malignant Syndrome (NMS), and the question wants the correct treatment for it.

1. Cefotaxime: an antibiotic, useful only if infection were driving the fever. Nothing here points to sepsis, so this does not treat the actual problem.
2. Bromocriptine: a dopamine agonist. Since NMS is caused by haloperidol blocking dopamine receptors too strongly, giving a drug that directly stimulates those same receptors reverses the problem. This is a standard treatment for NMS.
3. Largectil (chlorpromazine): another strong dopamine blocking antipsychotic. Using it here would add to the dopamine blockade and make NMS worse, not better.
4. Propranolol: a beta blocker, useful for things like tremor, but it does nothing to correct the dopamine blockade that is driving this syndrome.

Only bromocriptine attacks the actual cause of NMS, which is excess dopamine receptor blockade from haloperidol.

Let's summarize:

• Fever, rigidity, autonomic instability and altered mental status on an antipsychotic points to Neuroleptic Malignant Syndrome.
• Treatment works by restoring dopamine activity, using a dopamine agonist like bromocriptine, along with supportive care.

So bromocriptine is the correct drug to treat this patient.