Aghaienia Nasim, Brahm Nancy C, Lussier Kyla M, Washington Nicole B
Department of Pharmacy Practice, Clinical and Administrative Sciences-Tulsa, University of Oklahoma College of Pharmacy, Tulsa, OK 74135, USA.
J Pharm Pract. 2011 Oct;24(5):506-12. doi: 10.1177/0897190011415683. Epub 2011 Aug 15.
QT prolongation can occur with both first- (FGA) and second-generation antipsychotics (SGA). QT prolongation was identified in an adult patient who presented to the emergency room with schizophrenia, fluid and electrolyte imbalances, and pneumonia. Quetiapine, an SGA, was a component of the pharmacotherapy regimen. Based on the Naranjo adverse drug reaction probability scale rating criteria, a probable causal association was made.
PubMed and Ovid were searched using the terms antipsychotic, psychotropic, QT interval, corrected QT interval (QTc) prolongation, and quetiapine. References were examined for additional articles related to antipsychotic drugs and the QT interval.
In this patient, the use of quetiapine was identified as a contributing factor in QT prolongation. Prior QT prolongation was experienced with ziprasidone, another SGA. The antidepressant and dose remained consistent throughout the inpatient course of treatment. Other risk factors in this patient included hypokalemia, dehydration, pneumonia, age, gender, and concurrent usage of an antidepressant. Dual psychiatric diagnoses, preexisting cardiovascular disease, and electrolyte disturbances may increase this risk potential.
Psychiatric patients may be more at risk of cardiovascular complications, such as QT interval prolongation. The pharmacist can help evaluate risk factors and provide input into the care of all patients, particularly those identified as at risk.
第一代抗精神病药物（FGA）和第二代抗精神病药物（SGA）均可导致QT间期延长。一名成年精神分裂症患者因出现液体和电解质失衡以及肺炎而前往急诊室就诊，发现其存在QT间期延长。喹硫平作为一种SGA，是药物治疗方案的组成部分。根据Naranjo药物不良反应概率量表评分标准，确定了可能的因果关联。
在PubMed和Ovid数据库中检索了抗精神病药物、精神药物、QT间期、校正QT间期（QTc）延长以及喹硫平等关键词。查阅参考文献以获取与抗精神病药物和QT间期相关的其他文章。
在该患者中，喹硫平的使用被确定为QT间期延长的一个促成因素。另一种SGA齐拉西酮也曾导致QT间期延长。在整个住院治疗过程中，抗抑郁药物及其剂量保持一致。该患者的其他风险因素包括低钾血症、脱水、肺炎、年龄、性别以及同时使用抗抑郁药物。双重精神疾病诊断、既往心血管疾病以及电解质紊乱可能会增加这种风险。
精神科患者可能更易出现心血管并发症，如QT间期延长。药剂师可协助评估风险因素，并为所有患者，尤其是那些被确定为有风险的患者的护理提供建议。
