What is the first step in the management of neuroleptic malignant syndrome?

• A. Administer antidote
• B. Discontinue the drug and provide supportive care
• C. Initiate cooling measures
• D. Start muscle relaxants

Answer: (B)

The first step in the management of neuroleptic malignant syndrome (NMS) is to discontinue the antipsychotic medication that has precipitated this serious reaction and provide supportive care to the patient. NMS is characterized by symptoms such as hyperthermia, muscle rigidity, autonomic instability, and altered mental status, which are triggered by the use of neuroleptic medications.

By stopping the offending drug, the clinician addresses the root cause of NMS, preventing further progression of the syndrome. Supportive care includes monitoring vital signs, hydration, and addressing any complications that may arise. This foundational approach is essential before considering additional treatments such as muscle relaxants, cooling measures, or antidotes, which may be used later depending on the severity of the symptoms and the patient's condition. Immediate discontinuation of the causative medication and support helps stabilize the patient and is widely recognized as the priority in managing NMS.