Current Drug Safety - Volume 5, Issue 1, 2010

Medication safety is critical and complex area of improvement for health-care systems. The patient population of the intensive care unit (ICU) presents a unique challenge of constantly changing laboratory values, procedures, and medications. In a complex environment, several key factors play roles which are critical to the success of medication safety. One factor is the error analysis after an event has occurred. Encompass Read More

Medication errors are a common unfortunate occurrence in hospitals. One population that is particularly vulnerable are patients admitted to the Intensive Care Unit (ICU). ICU patients have a combination of rapidly changing medical conditions, laboratory values, and medications, which present a particular challenge for clinicians in practice in every aspect of patient care. Medication errors can occur in different phases (p Read More

Optimizing sustained use of ICU sedation in mechanically ventilated patients requires careful consideration of drug-specific characteristics (E.G. pharmacokinetics), consideration of potential adverse effects in susceptible patients, and utilization of sedationminimizing strategies. In the era of anxiolytic dosing protocols adjusted to specific patient behaviors as defined by sedation scales in conjunction with daily interruption, mid Read More

Medication errors have been increasingly recognized as a major cause of iatrogenic illness and system-wide improvements have been the focus of prevention efforts. Critically ill patients are particularly vulnerable to injury resulting from medication errors because of the severity of illness, need for high risk medications with a narrow therapeutic index and frequent use of intravenous infusions. Health information technology has Read More

Critically ill patients admitted to intensive care units (ICUs) often present with multiple medical or surgical problems requiring a high level of care. In addition to a patient's underlying illness, a number of known risk factors can predispose patients to episodes of hyperglycemia as well as hypoglycemia. The concept of glycemic control and its implication on morbidity and mortality has been welldescribed, along with the pot Read More

Guidelines on how to treat cancer patients receiving cytotoxic chemotherapy in the intensive care unit (ICU) are very limited. Recognizing the severity of the patient, their disease may require the need for chemotherapy whether for localized, metastatic, or hematological malignancies. It may be given alone or in combination with other cancer treatments such as radiation, or hormonal therapies. Nevertheless, the toxicitie Read More

The nutrition support clinician must understand and evaluate all components of parenteral nutrition (PN) to maximize benefits while avoiding unfavorable consequences for the patients in the intensive care unit. The various aspects in caring for the PN patient include appropriate patient selection, intravenous access choice and maintenance, and individualized PN prescription to meet each patient's unique macronutrient Read More

This issue of Current Drug Safety includes a review of scientific and regulatory implications of QT interval prolongation by drugs and the mechanisms involved for several drug classes: like cardiovascular, metabolic, endocrine, anti-infectives, antineoplastic chemotherapy, antihistamines, prokinetic agents and drugs affecting the Central Nervous System. In normal healthy subjects, the normal range of the Read More

The long QT syndrome (LQTS) is characterized by a prolonged QT interval, as well as a propensity to develop syncope and sudden cardiac death caused by the malignant polymorphic ventricular arrhythmia called torsades de pointes (TdP). The QT interval is measured from the onset of the QRS complex to the end of the T wave and can be affected by both ventricular conduction velocities as well as by the velocity of repolari Read More

The assessment about the proarrhythmic risk associated with a particular drug is a major requirement for drugs under development, since many drugs have been withdrawn from market or got under strict pharmacological vigilance because of such a risk. Predicting the development of a life-threatening arrhythmia is a hard task but, in the case of TdP (“Torsades de Pointes”), there are some useful markers. Among them, the Read More

Antihistamines are drugs frequently used. Several drugs in this family had to be withdrawn from the market or limited in their marketing due to potentially fatal adverse events. These events were related to the ability of some antihistamines to affect cardiac potassium channels and prolong the QT interval with an excessive risk of serious arrhythmias such as Torsades de Pointes (TdP). The presence of arrhythmias in the cour Read More

Acquired QT syndrome is mainly caused by the administration of drugs that prolong ventricular repolarization. On the other hand, the risk of drug-induced torsades de pointes is increased by numerous predisposing factors, such as genetic predisposition, female sex, hypokalemia and cardiac dysfunction. This adverse reaction is induced by different chemical compounds used for the treatment of a variety of pathologies, includ Read More

Prokinetic agents are a very large family of drugs with different mechanisms of action. Only QT prolongation by cisapride has made notable impact and deserved its partial restriction and/or withdrawal from the market. Postmarketing surveillance initially showed that cisapride was generally safe and well tolerated, but in the past decade, more recent data have shown some risk in the patient populations. QT prolongation by prokin Read More

QT interval represents the period between the initiation of depolarization and the end of repolarization of the ventricular myocardium. Excessive prolongation of this interval may drive to a potentially fatal ventricular tachyarrhythmia known as “torsades de pointes”. Agents used to manage many endocrine disorders have been linked with QTc alterations. Among them, oral antidiabetic agents, lipid lowering and anti-obesity dr Read More

QT interval prolongation is one of the most important causes of withdrawal of drugs from the market, due to its association with Torsades de Pointes (TdP), a potentially fatal arrhythmia. Although many antimicrobial drugs are capable of inducing this type of arrhythmia, the importance of this effect is usually underestimated. Macrolides, quinolones, azoles, pentamidine, protease inhibitors, antimalarial drugs and cotrimoxaz Read More

Anticancer drugs are sometimes associated with QT prolongation. Classical, new and candidate agents to treat cancer may affect ventricular repolarization through a set of different mechanisms. Interference on human ether-a-go-go-related gene potassium ion channels (HERG K+) seems to be a common mechanism for many of these drugs. Anthracycline chemotherapy is associated with electrocardiographic alterations i Read More

Psychotropics are among the most common causes of drug induced acquired long QT syndrome. Blockage of Human ether-ago- go-related gene (HERG) potassium channel by psychoactive drugs appears to be related to this adverse effect. Antipsychotics such as haloperidol, thioridazine, sertindole, pimozide, risperidone, ziprasidone, quetiapine, olanzapine and antidepressants such as amitriptyline, imipramine, doxepin, tr Read More

Several drugs acting on the nervous system have been implicated in the prolongation of the QT interval. Leaving aside the antidepressant and antipsychotic drugs, some have shown to prolong the QT interval in vivo. These include opioids, particularly methadone, inhalational anesthetics, and some preparations used for treatment of cough. These drugs have a narrow therapeutic interval or possible drug interactions that l Read More