scholarly journals Walk the Line—The Importance of Well-Informed Interpretation of QT Prolongation

2020 ◽  
Vol 55 (1) ◽  
pp. 123-126 ◽  
Author(s):  
Zachary R. Noel ◽  
Vincent Y. See ◽  
Alexander H. Flannery

Acute care pharmacists play an integral role in identifying drug-drug interactions that may predispose patients to QT prolongation. Although most pharmacists are equipped with a baseline understanding of drug interactions and the risks of QTc prolongation, few understand the limitations of QTc calculation and interpretation. In this commentary, we put forth the notion that at times health care providers, including pharmacists, place an overemphasis on the QTc interval. In the context of using the QTc to guide pharmacotherapy decisions, unintended consequences may include a cascade of effects leading to delays in treatment, suboptimal medication selection, alert fatigue, and overutilization of resources.

Author(s):  
Brandon H. Samson ◽  
James D. Scott

The prevalence of HIV infection is increasing in the older population. Because of other comorbidities, older patients infected with HIV may be taking multiple medications, which increases the risk of drug–drug interactions. Treatment of HIV in aging patients is based on the consideration of adverse effects associated by antiretroviral therapy (ART) with regard to renal, hepatic, cardiovascular, metabolic, and bone health, as well as the potential for increased drug–drug interactions. Because ART is associated with both beneficial and deleterious effects, health care providers should weigh the negative effects against the positive effects of viral suppression. Health care providers should routinely review patients’ medication lists to search for significant drug–drug interactions and perform drug interaction checks using available resources.


2018 ◽  
Vol 71 (1) ◽  
Author(s):  
Cynthia Cheng ◽  
Fatima Mithoowani ◽  
Thomas Ungar ◽  
Monica Lee

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>Interaction between alcohol and certain medications can lead to adverse consequences. Individuals with mental health disorders are particularly vulnerable because of their psychotropic medications, which are typically taken over extended periods and which are known to have pharmacokinetic and pharmacodynamic interactions with alcohol. It is unknown what education these patients receive from their health care providers and how such interactions are managed.</p><p><strong>Objectives: </strong>To determine whether individuals with mental health disorders are aware of alcohol–drug interactions and if so, how they use such information.</p><p><strong>Methods: </strong>A questionnaire was developed to explore the perceptions of mental health patients concerning alcohol–drug interactions. The questionnaire included questions in 3 domains: knowledge of potential alcohol–drug interactions, consumption of alcohol while taking psychotropic medications, and source of advice regarding the interactions. Attendees of an adult mental health day hospital program were invited to participate.</p><p><strong>Results: </strong>A total of 131 participants answered the questionnaire between July 2014 and February 2015; 31 of the questionnaires were incomplete and were excluded from analysis. Of the 100 participants included in the analyses, 75 reported having received counselling from a health care provider about alcohol–drug interactions, and 49 of these reported following the advice provided. The most common advice reported by participants was to avoid alcohol consumption while taking medications. Serious adverse effects, such as worsening of a psychiatric condition, admission to hospital, and increased drowsiness, were reported by 23 participants. Sixty-nine participants considered physicians to be the best source of information about these interactions.</p><p><strong>Conclusions: </strong>Most participants reported that they had received information about strategies to avoid negative consequences from alcohol–drug interactions. Nevertheless, consumption of alcohol occurred, and almost one-quarter of participants reported a serious adverse effect related to consuming alcohol. These self-reported data indicate that patients do not necessarily follow the advice of their health care providers. Future studies should explore reasons for the gap between advice and action and how to minimize it.</p><p><strong> </strong></p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>L’interaction entre l’alcool et certains médicaments peut mener à des conséquences cliniques. Les personnes atteintes de troubles mentaux y sont particulièrement vulnérables à cause des médicaments psychotropes qu’ils prennent d’habitude sur une période prolongée et pour lesquels les interactions pharmacocinétiques et pharmacodynamiques avec l’alcool sont notoires. On ne sait pas quels conseils ces patients reçoivent de leurs fournisseurs de soins de santé et comment de telles interactions sont gérées.</p><p><strong>Objectifs :</strong>Déterminer si les personnes atteintes de troubles mentaux sont conscientes des interactions entre l’alcool et les médicaments et, si oui, dévoiler comment elles agissent à la lumière de cette information.</p><p><strong>Méthodes : </strong>On a mis au point un questionnaire pour enquêter sur les perceptions qu’ont les patients atteints de troubles mentaux des interactions alcool-médicaments. Les questions y étaient regroupées en trois catégories : conscience des interactions potentielles alcool-médicaments, consummation d’alcool en prenant des psychotropes et source des conseils sur les interactions. Les participants à un programme hospitalier de jour pour adultes atteints de troubles mentaux ont été invités à participer à l’étude.</p><p><strong>Résultats : </strong>Au total, 131 participants ont rempli le questionnaire entre juillet 2014 et février 2015; 31 des questionnaires étaient incomplets et ont été exclus de l’analyse. Parmi les 100 participants inclus dans les analyses, 75 ont indiqué avoir reçu des conseils d’un fournisseur de soins de santé sur les interactions alcool-médicaments et 49 d’entre eux ont affirmé avoir suivi les conseils offerts. Le conseil le plus fréquent selon les répondants était d’éviter la consommation d’alcool lorsqu’on prend des médicaments. De graves réactions indésirables, telles que la deterioration d’un trouble psychiatrique, l’admission à l’hôpital et une somnolence accrue, ont été soulignées par 23 participants. Soixante-neuf participants considéraient les médecins comme les meilleures sources d’information à propos de ces interactions.</p><strong>Conclusions : </strong>La plupart des participants ont indiqué avoir reçu de l’information sur les stratégies permettant d’éviter les conséquences des interactions alcool-médicaments. Certains ont tout de même consommé de l’alcool et près du quart des participants ont signalé une reaction indésirable grave liée à la consommation d’alcool. Ces données autodéclarées révèlent que les patients ne suivent pas nécessairement les conseils de leurs fournisseurs de soins de santé. Des études ultérieures devraient se pencher sur les raisons expliquant l’écart entre les conseils et les actions et sur les solutions pour réduire cet écart.


Author(s):  
Tina Q. Tan, MD, ◽  
Melvin V. Gerbie, MD, ◽  
John P. Flaherty, MD,

Vaccines are an integral part of routine preventative health care for persons of all ages and play an integral role in protecting individuals against vaccine-preventable diseases. This handbook provides easy-to-understand, practical information on routinely recommended preventative vaccines for persons of all ages. It is written to be an informative, easily accessible, quick resource that addresses common vaccine issues that may be encountered by busy health-care providers in different specialties and at all different levels of training and practice. The “Did you know that” sections at the beginning of each chapter provide interesting facts on vaccines and vaccine preventable diseases. The FAQ section at the end of each chapter provides answers to commonly encountered situations in clinical practice involving vaccines. Exploring the different sections of this handbook will arm the reader with the tools needed to discuss the importance of vaccines and recommend the appropriate vaccines for their patients in order to optimally protect them against vaccine preventable diseases.


2020 ◽  
pp. 875512252095133
Author(s):  
Andrew Lang ◽  
Michael A. Veronin ◽  
Justin P. Reinert

Background: Health care providers routinely rely on tertiary drug information resources to affirm knowledge or proactively verify the safety and efficacy of medications. Though all patient care areas are affected, the reliability of these resources is perhaps nowhere as poignant as it is in high-acuity settings, including the emergency department and the intensive care unit. As providers seek to identify adjunctive analgesics for acute pain in these areas, they must be able to rely on the integrity to whichever resource their institution has granted access. Objective: To determine the congruency of drug-drug interaction information found on 3 tertiary drug resources. Methods: A drug-drug interaction analysis was conducted on Micromedex, Lexicomp, and Medscape. Adjunctive analgesics included dexmedetomidine and ketamine, which were compared with the intravenous opioid products morphine, fentanyl, and hydromorphone. Results: Significant discrepancies were appreciated with regard to the severity of drug-drug interactions. In addition, the heterogeneity in which reaction severity and likelihood are described by each respective resource makes direct comparisons difficult. Interaction warnings for dexmedetomidine and fentanyl included a “major interaction” from Micromedex, whereas Lexicomp did not identify a risk and Medscape only recommended increased monitoring on the grounds of respiratory and central nervous system depression. Conclusions: Health care providers must remain vigilant when reviewing tertiary drug information resources. Pharmacists possess the training and skills necessary to assist interdisciplinary medical teams in providing optimal patient care through evaluating and applying the information gleaned from these resources.


2005 ◽  
Vol 3 (2) ◽  
pp. 139-143
Author(s):  
Abe Macher ◽  
Deborah Kibble ◽  
Karen Bryant ◽  
Ana Cody ◽  
Todd Pilcher ◽  
...  

Educating Correctional Health Care Providers and Inmates About Drug-Drug Interactions: HIV-Medications and Illicit Drugs


2014 ◽  
Vol 10 (4) ◽  
pp. e255-e268 ◽  
Author(s):  
Eve M. Segal ◽  
Megan R. Flood ◽  
Robert S. Mancini ◽  
Robert T. Whiteman ◽  
Gregory A. Friedt ◽  
...  

Oral chemotherapies are associated with medication and food interactions. It is essential that health care providers evaluate patients' concurrent medications to provide accurate patient education, therapeutic monitoring, and alternative recommendations whenever oral chemotherapy is prescribed.


Author(s):  
Peter Kjær ◽  
Anne Reff Pedersen ◽  
Anja Svejgaard Pors

With the increased interest in communication in the fields of health care and health care management research, it is important to begin to explore and consider the consequences of this engagement with new ideas in communication. In this chapter we describe the expansion of organizational health communication, identifying three distinct types of communication ideas and tools: clinical communication, extra-clinical communication and corporate communication. In order to assess the wider implications of health communication, we elaborate a discursive perspective, illustrated by presenting exemplary analyses of a) the institutionalization of communication ideals, b) the communicative management of meaning and c) communication tools as organising technologies. The discursive perspective highlights that organizations and individual health care providers should not only look for the desired outcomes of communication initiatives but also focus on unintended consequences in terms of changes to management roles, challenges to professional values and the reshaping of demands on patients. Attention to those implications is a key task for health care managers.


2009 ◽  
Vol 37 (2) ◽  
pp. 280-291 ◽  
Author(s):  
Barbara A. Noah

Children deserve optimal medical care. Although prescription drugs play a prominent and essential role in pediatric health care delivery, health care providers often must make prescribing decisions for their young patients based on imperfect or absent safety and efficacy data for pediatric populations. Until relatively recently, the Food and Drug Administration (FDA) made surprisingly little effort to improve the quality or quantity of clinical research data for this patient group. Despite recent agency efforts to improve the situation, only one-third of drugs prescribed to children currently have been studied for safety and efficacy in pediatric populations. Moreover, recent agency initiatives to encourage pediatric drug research have generated mixed results and unintended consequences. The complex of issues surrounding the testing and prescribing of prescription drugs used for children will require that pharmaceutical companies, the FDA, and health care providers examine current practices, acknowledge their shortcomings, and consider cooperative, creative solutions.


2018 ◽  
Vol 53 (4) ◽  
pp. 419-429
Author(s):  
Renée Dagenais ◽  
Marianna Leung ◽  
Krishna Poinen ◽  
David Landsberg

Once renal transplant recipients are stabilized and require less frequent follow-up with their transplant team, health care providers outside of the transplant setting play an integral role in patients’ ongoing medical care. Given renal transplant recipients’ inherent complexity, these health care providers often seek consult regarding decisions that may affect transplant-related medications or outcomes. In this review, we discuss answers to 10 of the questions commonly posed to our renal transplant team by other health care providers.


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