Klotzbaugh Ralph J, Martin Alejandra, Turner John Rick
University of New Mexico College of Nursing, Albuquerque, New Mexico.
Goodwin Community Health Center, Somersworth, New Hampshire.
J Am Assoc Nurse Pract. 2020 Feb;32(2):128-135. doi: 10.1097/JXX.0000000000000348.
The clinical practice of pharmaceutical medicine includes contributions from physicians, pharmacists, nurse practitioners, and physician assistants. Drug safety considerations are of considerable importance. This article discusses drug-induced proarrhythmia, with a specific focus on Torsade de Pointes (Torsade), 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 Torsade using prolongation of the QT interval as seen on the surface electrocardiogram (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 and concludes with a case presentation.
药物医学的临床实践涵盖了医师、药剂师、执业护士和医师助理的贡献。药物安全考量至关重要。本文讨论药物诱发的心律失常，特别关注尖端扭转型室速（TdP），这是一种多形性室性心动过速，通常以自限性发作形式出现，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。在药物临床开发项目期间进行的一项专门临床药理学研究，已将体表心电图（ECG）上QT间期延长作为生物标志物，评估了其诱发TdP的倾向。如果药物的总体获益风险平衡有利，QT间期延长的识别并不一定会阻止其获得上市批准，但如果获批，会在其处方信息中给出警告。本文解释了药物为何会有致心律失常倾向，并以一个病例展示作为结尾。
