Ralph J. Klotzbaugh is an assistant professor in the University of New Mexico College of Nursing in Albuquerque, N.M. Alejandra Martin is a physician assistant and clinical educator at Goodwin Community Health Center in Somersworth, N.H. J. Rick Turner is an adjunct professor in the Department of Pharmacy Practice at Campbell University College of Pharmacy and Health Sciences in Buies Creek, N.C. The authors have disclosed no potential conflicts of interest, financial or otherwise.
JAAPA. 2020 Feb;33(2):1-7. doi: 10.1097/01.JAA.0000651776.53223.e7.
Clinical practice includes contributions from physicians, pharmacists, NPs, and physician assistants. Drug safety considerations are of considerable importance. This article discusses drug-induced proarrhythmia, with a specific focus on torsades de pointes, a polymorphic ventricular tachycardia that typically occurs in self-limiting bursts that can lead to dizziness, palpitations, syncope, and seizures, but on rare occasions can progress to ventricular fibrillation and sudden cardiac death. A dedicated clinical pharmacology study conducted during a drug's clinical development program has assessed its propensity to induce torsades using prolongation of the QT interval as seen on the ECG as a biomarker.Identification of QT-interval prolongation does not necessarily prevent a drug from receiving marketing approval if its overall benefit-risk balance is favorable, but, if approved, a warning is placed in its prescribing information. This article explains why drugs can have a proarrhythmic propensity.
临床实践包括医生、药剂师、护士从业者和医师助理的贡献。药物安全性考虑非常重要。本文讨论了药物引起的致心律失常作用，特别是尖端扭转型室性心动过速，这是一种通常呈自限性阵发的多形性室性心动过速，可导致头晕、心悸、晕厥和癫痫发作，但在极少数情况下可进展为心室颤动和心源性猝死。在药物临床开发计划期间进行的专门临床药理学研究使用心电图上 QTc 间期延长作为生物标志物来评估其引起尖端扭转型室性心动过速的倾向。如果药物的总体获益风险平衡有利，那么 QTc 间期延长的识别并不一定能阻止药物获得上市批准，但如果获得批准，则在其说明书中会有警告。本文解释了为什么药物会有致心律失常倾向。
