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首页> 美国卫生研究院文献>Canadian Pharmacists Journal : CPJ >Drug-induced QT interval prolongation and torsades de pointes
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Drug-induced QT interval prolongation and torsades de pointes

机译：药物诱导的QT间隔延长和扭转

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Torsades de pointes (TdP) is a life-threatening arrhythmia associated with prolongation of the corrected QT (QTc) interval on the electrocardiogram. More than 100 drugs available in Canada, including widely used antibiotics, antidepressants, cardiovascular drugs and many others, may cause QTc interval prolongation and TdP. Risk factors for TdP include QTc interval >500 ms, increase in QTc interval ≥60 ms from the pretreatment value, advanced age, female sex, acute myocardial infarction, heart failure with reduced ejection fraction, hypokalemia, hypomagnesemia, hypocalcemia, bradycardia, treatment with diuretics and elevated plasma concentrations of QTc interval–prolonging drugs due to drug interactions, inadequate dose adjustment of renally eliminated drugs in patients with kidney disease and rapid intravenous administration. Pharmacokinetic drug interactions associated with the highest risk of TdP include antifungal agents, macrolide antibiotics (except azithromycin) and drugs to treat human immunodeficiency virus interacting with amiodarone, disopyramide, dofetilide or pimozide. Other important pharmacokinetic interactions include antidepressants (bupropion, duloxetine, fluoxetine, paroxetine) interacting with flecainide, quinidine or thioridazine. Pharmacists play an important role in minimizing the risk of drug-induced QTc interval prolongation and TdP through knowledge of drugs that are associated with a known or possible risk of TdP, individualized assessment of risk of drug-induced QTc interval prolongation, awareness of drug interactions most likely to result in TdP and attention to dose reduction of renally eliminated QTc interval-prolonging drugs in patients with kidney disease. Treatment of hemodynamically stable TdP consists of discontinuation of the offending drug(s), correction of electrolyte abnormalities and administration of intravenous magnesium sulfate 1 to 2 g.
机译：扭转性扭转性心律失常（TdP）是威胁生命的心律失常，与心电图上校正的QT（QTc）间隔延长有关。加拿大有100多种药物，包括广泛使用的抗生素，抗抑郁药，心血管药物和许多其他药物，可能会导致QTc间隔时间延长和TdP升高。 TdP的危险因素包括QTc间隔> 500 ms，距治疗前值增加QTc间隔≥60ms，高龄，女性，急性心肌梗塞，射血分数降低的心力衰竭，低钾血症，低镁血症，低钙血症，心动过缓，利尿剂和QTc区间血浆药物浓度升高，这是由于药物相互作用，肾脏疾病患者肾脏消除药物的剂量调整不足和快速静脉给药所致。与TdP最高风险相关的药代动力学药物相互作用包括抗真菌药，大环内酯类抗生素（阿奇霉素除外）和治疗与胺碘酮，双吡酰胺，多非利特或匹莫齐特相互作用的人免疫缺陷病毒的药物。其他重要的药代动力学相互作用包括与flecainide，quinidine或thioridazine相互作用的抗抑郁药（安非他酮，度洛西汀，氟西汀，帕罗西汀）。药剂师通过了解与已知或可能的TdP风险相关的药物，对药物引起的QTc间隔延长的风险进行个体化评估，对药物相互作用的认识，在使药物引起的QTc间隔延长和TdP的风险最小化方面发挥重要作用最有可能导致TdP，并注意减少肾脏疾病患者肾脏消除QTc间隔延长药物的剂量。血液动力学稳定的TdP的治疗包括终止有问题的药物，纠正电解质异常和静脉注射1至2 g硫酸镁。

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