scholarly journals Content Validation of an Algorithm for the Assessment, Management and Monitoring of Drug-Induced QTc Prolongation in the Psychiatric Population

2021 ◽  
Vol Volume 17 ◽  
pp. 3395-3405
Author(s):  
Monica Zolezzi ◽  
Athar Elhakim ◽  
Waad M Elamin ◽  
Shorouk Homs ◽  
Doaa E Mahmoud ◽  
...  
Keyword(s):  
Content Validation ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Psychiatric Population

scholarly journals An Online Module to Evaluate the Validity of an Algorithm to assess the Risk for DrugInduced Qtc Prolongation in the Psychiatric Population

2020 ◽  
Author(s):  
Iman Ashraf Qubaiah ◽  
Waad Abubaker Elamin ◽  
Doaa Elsayed Mahmoud ◽  
Shorouk Akram Homs ◽  
Enge Sherif Tawfik ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Online Education ◽  
Qtc Interval ◽  
Pilot Test ◽  
Interval Prolongation ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Qtc Interval Prolongation ◽  
Assessment Guidelines ◽  
Psychiatric Population

Introduction: QTc interval prolongation leads to serious complications making it a concern for all clinicians. Assessing the risk of QTc interval prolongation, especially in the psychiatric population, can be challenging for pharmacists due to the complexity of regimens in this population and the difficulty in retrieving the needed information for the risk assessment. Guidelines and protocols for QTc prolongation risk assessment may vary among clinicians and few algorithms exist that address the prevention, management or monitoring of drug-induced QTc prolongation in the psychiatric population. Hence, there is a need for a validated comprehensive algorithm that helps clinicians in with the assessment of the risk of QTc prolongation. Aim: The study aims to pilot an educational module that guides experts through an algorithm for the assessment, management and monitoring of drug-induced QTc prolongation in the psychiatric population. Methods: This study involved developing an online education module using Articulate Presenter® to introduce a comprehensive literature-based algorithm to subject-matter experts. The orientation was followed by an anonymous, self-administered survey with quantitative and qualitative components to assess the content validity of the QTc Prolongation Algorithm. Results: Feedback from the first pilot test with faculty members indicated that the module’s interface was crowded. The module was updated accordingly. The results from the second pilot test with cardiologists were that the module provided a thorough explanation of the algorithm steps and rationale. Furthermore, some cardiologists commented that the algorithm was time consuming, however, most supported the implementation of the algorithm saying that it is easy to use, systematic, stepbased and would be helpful if implemented. Conclusion/Future directions: The results show that the module was helpful in introducing cardiologists to the algorithm and that the implementation of the algorithm after minor alterations can prove to be useful as a tool for risk assessment of QTc prolongation

scholarly journals Reflex sympatho-vagal coactivation and concealed QTc prolongation: Lessons from hERG-blockers and long QT syndromes type 1 and type 2

2021 ◽  
Author(s):  
Pascal Champéroux ◽  
Raafat Fares ◽  
Sebastien Jude ◽  
Vincent Maleysson ◽  
Serge Richard ◽  
...  
Keyword(s):  
Stroke Volume ◽  
High Frequency ◽  
Torsades De Pointes ◽  
Pulse Contour ◽  
Contour Method ◽  
Qtc Prolongation ◽  
Compensatory Mechanisms ◽  
Drug Induced ◽  
Vagal Reflex ◽  
Pulse Contour Method

Background and Purposes: Several hERG blocking molecules known for their propensity in triggering Torsades de Pointes (TdP) were reported as increasing High Frequency QT oscillations (HFQT). This effect was found as reflecting a sympatho-vagal coactivation. The present work aims to characterise the mechanism(s) leading to this particular state of the autonomic nervous system. Experimental approach: Effects of 20 hERG blockers including 15 torsadogenic molecules were assessed by telemetry in beagle dogs. Electrocardiogram and stroke volume modelled from the pulse contour method were analysed at the first dose level causing either QTc prolongation and/or HFQT increase. Cardiac autonomic control was analysed using the High Frequency Autonomic Modulation (HFAM) model in dogs and in untreated genotyped LQT1 and LQT2 individuals, for comparison. Key results: The sympatho-vagal coactivation induced by torsadogenic molecules is elicited by reflex compensatory mechanisms in response to changes in stroke volume or cardiac output related to hemodynamic off-targets and/or QT prolongation. QTc prolongation was concealed or markedly blunted by the sympathetic component activation in a large proportion of tested torsadogenic drugs. Sympathetic reflex mechanisms in LQT patients similar to that found for dofetilide was also revealed in both patients exhibiting QTc prolongation and concealed QTc prolongation, irrespective to LQT type. Conclusions and implications: QTc prolongation and/or drug-induced hemodynamic side effects enhance beat to beat ventricular repolarisation variability via sympatho-vagal reflex compensatory mechanisms. Considering the sympathetic reflex component via analysis of HFQT oscillations dramatically improves prediction, sensitivity and specificity of drug induced Torsades de pointes risk assessment.

scholarly journals A clinical presentation of drug-induced cardiotoxicity event in an oncohematology patient: A case report

2020 ◽  
Author(s):  
Ainur Bilmakhanbetova ◽  
Meruyert Beisenbay ◽  
Daulet Marat ◽  
Gulnur Zhakhina
Keyword(s):  
Case Report ◽  
Acute Leukemia ◽  
Inpatient Treatment ◽  
Clinical Case ◽  
Clinical Presentation ◽  
Underlying Disease ◽  
Clinical Death ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Selection Of

This case report deals with a clinical case of a patient who underwent inpatient treatment of the underlying disease acute leukemia. In the selection of treatment for complications, medications of various groups were prescribed. This therapy led to the clinical death of the patient, caused by drug-induced QT/QTc prolongation.

scholarly journals A case study on escitalopram induced QTc prolongation and adverse drug reaction

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 357-359
Author(s):  
Mohammed Abdul Salaam ◽  
Kameswari K ◽  
Magesh ◽  
Arunachalam P
Keyword(s):  
Adverse Drug Reaction ◽  
Qt Prolongation ◽  
Caucasian Woman ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Dopamine Reuptake ◽  
Cardiology Clinic ◽  
Congenital Lqts

Antagonistic medication response (ADR) can be characterized as any toxic change which is suspected to be because of a medication, happens at dosages ordinarily utilized in man, requires treatment or decline in portion or shows alert later on the utilization of similar medication. Escitalopram is a medication which goes under the classification of particular serotonin reuptake inhibitors (SSRIs) (antidepressants). It is the S-enantiomer of the racemic subsidiary of citalopram, which specifically restrains the reuptake of serotonin with practically no impact on norepinephrine or dopamine reuptake. Practically all the antidepressants and antipsychotics have been connected to QT prolongation. In a patient with previously diagnosed congenital QTS, we present a drug-induced QT extension owing to the escitalopram overdose. A 15-year-old Caucasian woman was presented with an escalopram overdose after a suicide attempt. The patient has a lengthy QT period of torsade de point incidents. The patient was received and monitored in the telemetry facility. She proceeded to exhibit the persistently extended QT period after the resolution of torsades de punes. She was diagnosed with a congenital QT condition by the cardiology clinic. In this situation, an escitalopram overdose is seen to trigger an immediate QT extension for a patient who has congenital LQTS and the value of an electrocardiogram before SSRIs are started, particularly for those at high risk of QT prolongation.

Drug-Induced QTc-Interval Prolongation in the Intensive Care Unit: Incidence and Predictors

2010 ◽  
Vol 23 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Tien M. H. Ng ◽  
Keith M. Olsen ◽  
Megan A. McCartan ◽  
Susan E. Puumala ◽  
Katie M. Speidel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Beta Blockers ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Icu Patients ◽  
End Point ◽  
Increased Risk ◽  
Qtc Interval Prolongation

There is a paucity of information regarding QTc prolongation in critically ill patients. A prospective observational study was conducted to assess the incidence and predictors of QTc prolongation associated with medications in intensive care unit (ICU) patients. Consecutive adult patients prescribed prespecified QTc-prolonging medications were assessed for development of the combined incidence of QTc >500 ms at anytime and QTc increase >60 ms above baseline. Over 3 months, 200 consecutive patients (63 ± 18 years; 52% female; 73% Caucasian; baseline QTc 447.3 ± 51.5 ms) were evaluated. The primary end point occurred in 48% of the patients (QTc >500 ms 40%, QTc increase >60 ms 29%). The majority of patients experienced a QTc >470 or 450 ms (60.5%). Mean increase in QTc at 48 hours was 20 ± 35 ms. Upon multivariate analysis, length of stay [odds ratio 1.30, 95% confidence interval (1.15, 1.47)] and baseline QTc [1.01 (1.01, 1.02)] were associated with an increased risk for the primary end point, while beta-blockers [0.41 (0.20, 0.81)] were associated with a risk reduction. In conclusion, increased risk of proarrhythmia, as assessed by QTc prolongation, occurs in the majority of ICU patients when prescribed medications with electrophysiologic properties. Increased vigilance is warranted. The possible protective effect of beta-blockers requires confirmation.

Psychotropic drug-induced weight gain and other metabolic complications in a Swiss psychiatric population

2012 ◽  
Vol 46 (4) ◽  
pp. 540-548 ◽  
Author(s):  
Eva Choong ◽  
Guido Bondolfi ◽  
Manuela Etter ◽  
Françoise Jermann ◽  
Jean-Michel Aubry ◽  
...  
Keyword(s):  
Weight Gain ◽  
Psychotropic Drug ◽  
Drug Induced ◽  
Metabolic Complications ◽  
Psychiatric Population

Drug-Induced QTc Prolongation: What We Know and Where We Are Going

2021 ◽  
Vol 16 ◽  
Author(s):  
Erinn Mangona ◽  
Elisa Sandonato ◽  
Todd N. Brothers ◽  
Jayne Pawasauskas
Keyword(s):  
Torsades De Pointes ◽  
Clinical Decision ◽  
Mitigation Strategies ◽  
Qtc Prolongation ◽  
Drug Induced ◽  
Drug Classes ◽  
Malignant Arrhythmia ◽  
Alternative Agent ◽  
Risk Scoring ◽  
Scoring Tool

: Drug-induced QTc prolongation is a concerning electrocardiogram (ECG) abnormality. This cardiac disturbance carries a 10% risk of sudden cardiac death due to the malignant arrhythmia, Torsades de Pointes. The Arizona Center for Education and Research on Therapeutics (AzCERT) has classified QTc prolonging therapeutic classes such as antiarrhythmics, antipsychotics, anti-infectives, and others. AzCERT criteria categorizes medications into three risk categories: “known,” “possible,” and “conditional risk” of QTc prolongation and Torsades de Pointes. The list of QTc prolonging medications continues to expand as new drug classes are approved and studied. Risk factors for QTc prolongation can be delineated into modifiable or non-modifiable. A validated risk scoring tool may be utilized to predict the likelihood of prolongation in patients receiving AzCERT classified medication. The resultant risk score may be applied to a clinical decision support system which offers mitigation strategies. Mitigation strategies including discontinuation of possible offending agents with selection of an alternative agent, assessment of potential drug interactions or dose adjustments through pharmacokinetic and pharmacodynamic monitoring, and initiation of both ECG and electrolyte monitoring are essential to prevent a drug-induced arrhythmia. The challenges presented by the COVID-19 pandemic have led to the development of innovative continuous monitoring technology, increasing protection for both patients and healthcare workers. Early intervention strategies may reduce adverse events and improve clinical outcomes in patients identified to be at risk of QTc prolongation.

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