Multifactorial QT interval prolongation

Acquired long QT interval has been widely reported to be a consequence of drug therapy and electrolyte disturbances. We describe two cases of multifactorial acquired QT interval prolongation and torsades de pointes. In the first case, the drugs venlafaxine, amiodarone and domperidone may have contributed to QT interval prolongation in a patient with hypokalemia and hypomagnesaemia. In the second case, QT interval prolongation occurred in a patient taking quetiapine and citalopram, and whose use of hydrocholorothiazide and history of chronic alcohol abuse likely contributed by rendering the patient hypokalemic. These cases highlight the potential risks associated with polypharmacy and demonstrate that though torsades de pointes is an uncommon arrhythmia, the combination of multiple factors known to prolong QT interval may precipitate this life-threatening arrhythmia. (Cardiol J 2010; 17, 2: 184-188

Case Report Multifactorial QT Interval Prolongation and Takotsubo Cardiomyopathy

A 71-year-old woman collapsed while working as a grocery store cashier. CPR was performed and an AED revealed torsades de pointes (TdP). She was subsequently defibrillated resulting in restoration of sinus rhythm with a QTc interval of 544 msec. Further evaluation revealed a diagnosis of Takotsubo Cardiomyopathy (TCM) contributing to the development of a multifactorial acquired long QT syndrome (LQTS). The case highlights the role of TCM as a cause of LQTS in the setting of multiple risk factors including old age, female gender, hypokalemia, and treatment with QT prolonging medications. It also highlights the multifactorial nature of acquired LQTS and lends support to growing evidence of an association with TCM

Evaluation of a Pharmacist-Led Proton Pump Inhibitor Deprescribing Process in an Acute Care Hospital

Pharmacy residents have the opportunity to complete a research project during their residency training, which provides them with skills on how to conduct and manage a research project. Projects often represent an area of interest and need that has been recognized by the host institution’s pharmacy department. Projects are presented as a poster at an annual CSHP Ontario Branch Residency Research Night, and many eventually go on to be published in a peer-reviewed journal.Rationale: The long term use of proton pump inhibitors (PPIs) has been associated with an increased risk of morbidity. The ongoing need for PPIs is often not reassessed in a timely fashion. The transition of care between the community and the hospital may present a suitable opportunity for the review of a patient’s medications, and hospital pharmacists have the potential to instigate the deprescribing process. Objectives: To determine the effectiveness and feasibility of the implementation of a systematic pharmacist-led PPI deprescribing process in an acute care setting. Methods: A prospective before and after study was conducted in patients newly admitted to the Internal Medicine service with a PPI as a part of their home medication regimen. The pre-intervention phase consisted of usual care, followed by the intervention phase where a pharmacist-led PPI deprescribing process was implemented. The PPI deprescribing tool created through the “Deprescribing Guidelines for the Elderly Project” was used to aid in the deprescribing process. Results: There was no statistically significant difference in the percentage of PPIs deprescribed on discharge between the pre-intervention and intervention phases (6.4% vs. 14.3%, p=0.373). In the intervention phase, 21 patients receiving a PPI prior to admission were assessed for appropriateness of deprescribing by the investigator. Deprescribing was appropriate for seven patients, of which six were agreeable to a deprescribing trial. Deprescribing was suggested to the physician by the clinical pharmacist for three patients, all of which were agreed to by the physician. At discharge, one patient’s PPI was deprescribed. The average time used by the investigator to determine the PPI indication and assess for appropriateness was nine minutes. Conclusion: The implementation of a pharmacist-led PPI deprescribing process in an acute care setting did not significantly impact deprescribing rates

Medication Prescribing Errors on a Surgery Service – Addressing the Gap with a Curriculum for Surgery Residents: A Prospective Observational Study

OBJECTIVES Educational interventions with proven effectiveness to reduce medication prescribing errors are currently lacking. Our objective was to implement and assess the effectiveness of a curriculum to reduce medication prescribing errors on a surgery service. METHODS This was a prospective observational cohort study at a Canadian academic hospital without an electronic order entry system. A pharmacist-led medication prescribing curriculum for surgery residents was developed and implemented over 2 days (2 h/day) in July 2019. Thirteen (76%) out of 17 surgery residents contributed pre-implementation data, while 13 (81%) out of 16 surgery residents contributed post-implementation data. Medication prescribing errors were tracked for 12 months pre-implementation and 6 months post-implementation. Errors were classified as prescription writing (PW) or decision making (DM). RESULTS There were a total of 1050 medication prescribing errors made in the pre-implementation period with 615 (59%) PW errors and 435 (41%) DM. There were a mean of 87.5 (SD  =  14.6) total medication prescribing errors per month in the pre-implementation period with 51.3 (11.9) PW and 36.3 (6.0) DM errors. There were a total of 472 medication prescribing errors made in the post-implementation period with 260 (55%) PW and 212 (45%) DM errors. There were a mean of 78.7 (10.3) total medication prescribing errors per month in the post-implementation period with 43.3 (9.5) PW and 35.3 (4.2) DM errors. In the first quarter of the academic year, there were significantly fewer mean total errors per month post-implementation versus pre-implementation (77.7(12.7) versus 107.3(8.1); P   =  .035), with significantly fewer PW errors per month (40.7(13.2) versus 68.7(9.3); P   =  .046) and no difference in DM errors per month (37.0(2.0) versus 38.7(5.7); P   =  .671). There were no differences noted in the second quarter of the academic year. CONCLUSION Medication prescribing errors occurred from PW and DM. Medication prescribing curriculum decreased PW errors; however, a continued education program is warranted as the effect diminished over time

Multifactorial QT Interval Prolongation and Takotsubo Cardiomyopathy

A 71-year-old woman collapsed while working as a grocery store cashier. CPR was performed and an AED revealed torsades de pointes (TdP). She was subsequently defibrillated resulting in restoration of sinus rhythm with a QTc interval of 544 msec. Further evaluation revealed a diagnosis of Takotsubo Cardiomyopathy (TCM) contributing to the development of a multifactorial acquired long QT syndrome (LQTS). The case highlights the role of TCM as a cause of LQTS in the setting of multiple risk factors including old age, female gender, hypokalemia, and treatment with QT prolonging medications. It also highlights the multifactorial nature of acquired LQTS and lends support to growing evidence of an association with TCM