主要药物-药物相互作用、多种药物治疗、QT 间期延长药物使用和潜在不适当精神药物使用的风险因素分析，这些因素与老年精神科门诊患者有关。
Leading 20 drug-drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients.
机构信息
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Virbhadra Road, Rishikesh 249 203, Uttarakhand, India.
Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India.
出版信息
Ther Adv Cardiovasc Dis. 2021 Jan-Dec;15:17539447211058892. doi: 10.1177/17539447211058892.
BACKGROUND
Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients.
METHODS
This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions.
RESULTS
A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with 'known', 'possible', and 'conditional risk of TdP', respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015.
CONCLUSION
Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.
背景
精神药物会延长心电图（ECG）中的校正 QT（QTc）间期。接触 ⩾1 种精神药物的精神科患者具有明显的药物激活 QTc 延长风险。老年患者（年龄 ⁇ 60 岁）的 QTc 间期延长与全因和冠心病死亡风险增加有关。本研究旨在调查老年患者中 QT 间期延长药物的使用模式、QT 延长药物相互作用以及 QT 间期延长危险因子的流行情况。
方法
这是 2017 年 10 月 1 日至 2019 年 8 月 30 日在印度北阿坎德邦瑞诗凯诗的全印医学科学院（AIIMS）精神病学门诊部进行的一项横断面、前瞻性研究，采用相关处方进行研究。
结果
在上述研究期间，共调查了 832 名 60 岁或以上的老年患者。其中 420 名（50.5%）为男性，412 名（49.5%）为女性。832 名患者中，588 名（70.7%）正在使用具有产生尖端扭转型室性心动过速（TdP）能力的相互作用剂。共发现 1152 对相互扭转型致心律失常药物对。根据 AzCERT/CredibleMeds 分类，分别有 1016（48.8%）、724（34.8%）和 248（12%）种药物被确定为具有“已知”、“可能”和“TdP 有条件风险”的潜在相互作用的药物。常见的相互作用药物属于抗抑郁药（288）、质子泵抑制剂（364）、抗精神病药（340）、止吐药（184）、抗菌药（156）和 H 受体拮抗剂（60）治疗类别。根据 2019 年 Beers 标准，潜在不适当精神药物（PIP）的总给药频率为 62%（1343/2166），根据 2015 年 STOPP 标准，给药频率为 46%（997/2166）。
结论
许多老年患者使用了具有更高 QT 间期延长倾向的药物和药物组合。此外，可靠的循证在线药物知识资源，如 AzCERT/CredibleMeds 药物清单、Medscape 药物相互作用检查器、Epocrates Online Interaction Check 和 Drugs.com 药物相互作用检查器，可帮助临床专业人员为精神科患者选择药物。明智地选择药物对于预防严重的不良后果至关重要。因此，我们迫切需要采取预防安全措施，保持警惕，防止临床环境中的 QT 延长和 TdP。
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