scholarly journals Causes, Predisposing Factors and Prevention Directions of Drug-induced Bradycardia (Based on the Results of the Hospital Register of Oardiac Medications Overdoses STORM)

2021 ◽  
Vol 17 (3) ◽  
pp. 394-400
Author(s):  
N. N. Nikulina ◽  
S. V. Seleznev ◽  
M. B. Chernysheva ◽  
S. S. Yаkushin
Keyword(s):  
Antiarrhythmic Drugs ◽  
Beta Blockers ◽  
Hypertensive Crisis ◽  
Clinical Situation ◽  
Predisposing Factors ◽  
Self Medication ◽  
Drug Induced ◽  
Medication Dose ◽  
Result Management ◽  
Vascular Center

Aim. Analysis of drug-induced bradiarrhythmia (DIB) causes and predisposing factors, followed by the development of recommendations for practitioners on its prevention.Material and methods. The register included consistently all cases of hospitalization at the Regional Vascular Center (Ryazan) due to DIB in 2017 (n=114), 2018 (n=167), and retrospectively in 2014 (n=44). In total, 325 cases were reported: men - 26.1%, age 76.0 [68.0; 82.0] years; patients >65 years - 83.7%, and patients >75 years - 57.9%. The dose of medications with bradycardic action (BCA) taken the day before was known in 227 cases (69.8%), which allowed us to analyze the correctness of the intake regime in these cases.Results. The excess of a single and / or daily medication dose (absolute overdose, AOD) occurred only in 10.6% of cases and was associated with the patient's attempt to cope with the deterioration of the disease or an acute clinical situation on their own. In other cases, there was no formal violation of the Instructions, but there was an inhibition of the heart's conducting system activity, characteristic of an overdose of medication (the so-called "relative” overdose, ROD). It was due to the summation/potentiation of BCA of several medications or changes in the medication pharmacokinetics. There were no differences in the clinical and demographic characteristics of patients and the provision of medical care in the groups with AOD and ROD (p>0.05). The exception was a high frequency of bradycardia <40 beats / min in AOD group (75.0% vs 49.8%, p=0.019) and, as a result, - management in the conditions of the Intensive Care Unit (66.7% vs 39.9%, p=0.012). Frequency of pre-admission receiving medications in AOD and ROD groups also did not differ (p>0.05): beta-blockers - an average of 64.3%, antiarrhythmic drugs with BCA- 41.0%, cardiac glycosides 25.1% (frequency each of these medicationsin DIB cases over the 5-year period has not changed), an agonist of the 11-imidazoline receptors - moxonidine (12.3%, its frequency has increased 8.9 times in 5 years, p=0.004), non-dihydropyridine calcium antagonists - 7.9% (decrease frequency over 5 years 4.0 times, p=0.002), other - 16.7%. In 56.8% of cases, medications with BCA were used in combination. At admission, a decrease in glomerular filtration rate (GFR) <45 ml/min/1.73 m2 was registered in 56.8% of cases, <30 ml/min/1.73 m2 - in 31.8%, <15 ml/min/1.73 m2 -in 10.9% (differences between groups with p>0.05). Hospital lethality in the AOD group is 4.2%, in the ROD group- 5.4% (p>0.05).Conclusion. The main reasons of DIB are excess of the recommended dose, unrecorded summation/potentiation of BCA of several medications, and / or changes in the medication pharmacokinetics. Predisposing factors are self-medication of patients with worsening cardiovascular disease or acute clinical situations (e.g., hypertensive crisis), taking multiple medications with BCA, accession of heart disease, manifested by bradyarrhythmia, decrease in GFR, elderly and senile age.

scholarly journals Drug-induced bradycardia as a medical and social problem: data from the Cardiac Drug Overdoses Hospital Registry (STORM)

2020 ◽  
Vol 25 (7) ◽  
pp. 3918
Author(s):  
N. N. Nikulina ◽  
S. V. Seleznev ◽  
M. B. Chernysheva ◽  
S. S. Yаkushin
Keyword(s):  
Beta Blockers ◽  
Cardiac Pacing ◽  
Channel Blockers ◽  
Antiarrhythmic Agents ◽  
Social Significance ◽  
Drug Induced ◽  
Pharmacokinetic Properties ◽  
Drug Overdoses ◽  
Hospital Registry ◽  
Vascular Center

Aim. To analyze hospitalizations due to drug-induced bradyarrhythmia (DIB) over a 5-year period (2014-2018), its clinical characteristics, causes and outcomes.Material and methods. The analysis included all hospitalizations due to DIB at the Ryazan Regional Vascular Center in 2017 and 2018 and retrospectively in 2014.Results. A total of 325 cases of DIB were included in the analysis (age 76,0 [68.0; 82.0] years; men — 26,1%). The proportion of DIB as a hospitalization cause in 2017 increased by 4,3 times compared to 2014 (p<0,001), in 2018 compared to 2014 — by 6,3 times (p<0,001) and compared to 2017 — by 46,2% (p=0,001). We recorded the following manifestations of DIB: bradycardia (<40 bpm — 51,4%), atrioventricular (31,7%) and sinoatrial (29,2%) block, syncope (36,0%), Frederick’s syndrome (8,6%), pauses >3 s (5,9%). Management in intensive care was required in 42,2% of patients, temporary cardiac pacing — in 7,7%, permanent pacemaker — in 6,2%. Mortality rate was 6,2%. Before hospitalization, patients took beta-blockers (65,1%), antiarrhythmic agents (39,6%), cardiac glycosides (23,0%), ^-imidazoline receptor agonist moxonidine (13,5%, its prescription rate increased 8,9 times over 5 years, p=0,004), nondihydropyridine calcium channel blockers (7,9%), and other drugs (15,4%). In 60,1% of patients, ≥2 drugs with bradycardic action were used, in 22,0% — ≥3, in 8,1% — ≥4, in 10,6% — with an excessive single/daily dose.Conclusion. The medical and social significance of DIB have been demonstrated. DIB due to exceeding the recommended dose was associated with independent try of patients to manage the deterioration. In other cases, DIB was due to the summation/ potentiation of several drugs’ action, the comorbidities contributing to the development of bradyarrhythmia and/or changes in pharmacokinetic properties of drugs.

Drug-Induced Restless Legs Syndrome

2018 ◽  
Vol 52 (7) ◽  
pp. 662-672 ◽  
Author(s):  
Edna Patatanian ◽  
Melanie K. Claborn
Keyword(s):  
Restless Legs Syndrome ◽  
English Language ◽  
Case Reports ◽  
Data Extraction ◽  
Case Series ◽  
Predisposing Factors ◽  
Drug Induced ◽  
Restless Legs ◽  
Drug Classes ◽  
Study Selection

Objective: To review the literature on drug-induced restless legs syndrome (DI-RLS). Data Sources: The review included a search for English-language literature from 1966 to December 2017 in the MEDLINE, PubMed, and Ovid databases using the following search terms: restless legs syndrome (RLS), periodic limb movement, adverse effects, and drug-induced. In addition, background articles on the pathophysiology, etiology, and epidemiology of RLS were retrieved. Bibliographies of relevant articles were reviewed for additional citations. Study Selection and Data Extraction: All case reports, case series, and review articles of DI-RLS were identified and analyzed. There were only a small number of controlled clinical trials, and most data were from case reports and case series. Results: Several drugs and drug classes have been implicated in DI-RLS, with antidepressants, antipsychotics, and antiepileptics having the most evidence. In addition, RLS may be linked with a number of disorders or underlying predisposing factors as well. Conclusions: The prevalence of RLS is variable and ranges from 3% to 19% in the general population. There are many predisposing factors to RLS, but an emerging body of evidence suggests that there is an association between numerous drugs and RLS.

scholarly journals Drug-Induced Heart Failure (Part 2: Mechanisms of Development, Clinical Signs, Differential Diagnosis, Risk Factors, Treatment and Prevention)

2020 ◽  
Vol 8 (2) ◽  
pp. 57-65
Author(s):  
O. D. Ostroumova ◽  
I. V. Goloborodova
Keyword(s):  
Heart Failure ◽  
Beta Blockers ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Left Ventricular ◽  
Clinical Syndrome ◽  
Channel Blockers ◽  
Drug Induced ◽  
Treatment And Prevention ◽  
Developing Heart

Heart failure is a complex clinical syndrome caused by an impaired pumping function of the heart muscle, etiologically associated with cardiovascular disease and, in the vast majority of cases, requiring complex therapeutic regimens and simultaneous prescription of several drugs. To date, we know several classes of drugs (including those used for heart failure) which can induce development/progression of heart failure in both patients with left ventricular dysfunction, and in patients who do not have cardiovascular diseases. The aim of the study was to analyse and systematize data on development mechanisms, as well as methods of prevention and treatment of drug-induced heart failure when using diff erent groups of drugs. It has been established that drug-induced heart failure is most often associated with the use of calcium channel blockers (verapamil, diltiazem, nifedipine), beta-blockers, antiarrhythmic drugs (disopyramide, fl ecainide, propafenone, amiodarone, ibutilide, dofetilide, dronedarone), anthracyclines (doxorubicin) and other antitumor drugs (trastuzumab, bevacizumab, infl iximab), hypoglycemic drugs (thiazolidinediones, saxagliptin, alogliptin), and nonsteroidal anti-infl ammatory drugs, including selective cyclooxygenase-2 inhibitors. The study revealed various mechanisms of heart failure development following drug treatment. In some patients, heart failure development is associated with the cardiotoxic eff ect of a particular drug, in others with adverse eff ects on hemodynamics. Much depends on risks of developing heart failure, including specifi c risks attributable to groups of drugs and individual drugs. The identifi cation of drugs that can contribute to the development/ progression of heart failure, and possible clinical manifestations of drug-induced heart failure, as well as provision of timely information to physicians, and engagement of clinical pharmacologists with the aim of optimizing treatment of patients can facilitate timely diagnosis, treatment and prevention of drug-induced heart failure. 

Antagonism of drug-induced pulsus alternans in dogs

1960 ◽  
Vol 199 (1) ◽  
pp. 167-173 ◽  
Author(s):  
Charles H. Ellis
Keyword(s):  
Antiarrhythmic Drugs ◽  
Peripheral Resistance ◽  
Antiarrhythmic Activity ◽  
Sympathetic Nerves ◽  
Large Artery ◽  
Drug Induced ◽  
Intravenous Injections ◽  
Pulsus Alternans ◽  
Pharmacologic Agents ◽  
Procaine Amide

Pulsus alternans and pseudoalternans were produced in dogs anesthetized with pentobarbital by intravenous injections of moderate doses of one of several pharmacologic agents. Ventricular alternation was alleviated or abolished by a) drugs with positive inotropic action, b) drugs that reduced peripheral resistance, and c) drugs with antiarrhythmic activity. Digoxin and ouabain shortened the periods of drug-induced alternation. Norepinephrine and aminophylline promptly abolished pulsus alternans which had been experimentally established. Electrical stimulation of the cardiac sympathetic nerves resembled injected norepinephrine. Moderate does of nitroglycerin and large doses of histamine terminated pulsus alternans which had been evoked by methoxamine. Smaller doses of histamine were not always effective. Hexamethonium abolished alternation in the absence of marked vasoconstriction, but was ineffective against methoxamine-induced alternans. Hemorrhage from a large artery was effective. Quinidine promptly relieved pulsus alternans, as did two experimental antiarrhythmic drugs, o-methylcyclizine and B.W. 51–41. Procaine amide was not effective.

A Preliminary Report on the Use of Clomipramine in General Practice

1975 ◽  
Vol 20 (1_suppl) ◽  
pp. 67-71 ◽  
Author(s):  
L. W. Wootton ◽  
R. I. Bailey
Keyword(s):  
General Practice ◽  
Side Effects ◽  
Combined Treatment ◽  
Clinical Situation ◽  
Illustrative Case ◽  
Case Histories ◽  
Drug Induced ◽  
Practice Population ◽  
History Of ◽  
Continue Therapy

The use of clomipramine in a large suburban general practice is reviewed. Three hundred and fifty patients have been treated to date out of a total practice population of twenty-one thousand. It is argued that phobic anxiety states are much commoner than is normally supposed and that they are usually associated with a history of separation or rejection in childhood. A combined treatment regime is employed for one month thereafter clomipramine alone is used. Side-effects may initially present a problem although they may not all be truly drug induced. Some patients use side-effects to manipulate the clinical situation. However proper interpretative management of side effects can assist the clinicians in persuading patients to continue therapy. Some impressive results have been obtained with clomipramine therapy. Illustrative case histories are provided.

scholarly journals Drug-Induced Liver Injury and Individual Cell Models

2015 ◽  
Vol 33 (4) ◽  
pp. 486-491 ◽  
Author(s):  
Andreas Benesic ◽  
Alexander L. Gerbes
Keyword(s):  
Liver Injury ◽  
Individual Cell ◽  
Clinical Situation ◽  
Clinical Development ◽  
Cell Models ◽  
Drug Induced ◽  
In Vitro Susceptibility ◽  
Drug Induced Liver Injury ◽  
The Individual

Drug-induced liver injury (DILI) is the most common cause of acute liver failure and accounts for the majority of regulatory actions on drugs. Furthermore, DILI is a relevant cause for project terminations in pharmaceutical development. The idiosyncratic form of DILI is especially a threat in late clinical development phases and postmarketing, respectively. Even the occurrence of only a few idiosyncratic DILI cases in late clinical development or postmarketing may suffice to terminate or withdraw an otherwise promising therapy. Despite advances in preclinical assessment of dose-dependent toxicity, idiosyncratic DILI is still a big challenge for in vitro research: it not only requires individualized models but also a huge number of tests. We have developed and investigated MetaHeps®, a technology involving hepatocyte-like cells generated from peripheral monocytes without genetic modifications. These cells exhibit several hepatocyte-like characteristics and show donor-specific activities of drug-metabolizing enzymes. With MetaHeps we have performed in vitro investigations in patients with DILI suspicion. By investigating MetaHeps derived from DILI patients we could show increased in vitro susceptibility to the drugs involved in the individual patients. MetaHeps testing could also rule out DILI and help to identify other causes of acute liver injury. Moreover, MetaHeps identified the causative agent in polymedicated patients. In conclusion, in vitro research of idiosyncratic DILI requires individual cell models which produce results comparable to the clinical situation. We suggest the MetaHeps technology as a novel tool to cope with these challenges of DILI.

Electrophysiologic parameters and predisposing factors in the generation of drug-induced Torsade de Pointes arrhythmias

2001 ◽  
Vol 92 (2-3) ◽  
pp. 109-122 ◽  
Author(s):  
Marc A. Vos ◽  
Jurren M. van Opstal ◽  
Jet D.M. Leunissen ◽  
S.Cora Verduyn
Keyword(s):  
Torsade De Pointes ◽  
Predisposing Factors ◽  
Drug Induced

scholarly journals Arrhythmic storm in the acute coronary care unit

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Garcia-Arribas ◽  
S Rosillo ◽  
J Caro ◽  
E Armada ◽  
I Carrion ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Antiarrhythmic Drugs ◽  
Beta Blockers ◽  
Acute Myocarditis ◽  
Stellate Ganglion ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Channel Blockers ◽  
Left Ventricular Assist Devices ◽  
Vt Ablation

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Beca para la Formación e Investigación en Cuidados Críticos Cardiológicos concedida por la Asociación de Cardiopatía Isquémica y Cuidados Críticos Cardiológicos de la SEC Introduction Available data on arrhythmic storm (AS) is usually obtained from retrospective observational studies based on series of patients (pts) with ICD or who undergo ablation. Therefore, selection bias limits the evidence regarding mortality and prognosis of this entity. Purpose/ Methods Describe epidemiological and clinical characteristics, as well as therapeutic strategies and in-hospital mortality as main outcome of pts admitted between 2006 and 2020 for AS in the Acute Cardiac Care Unit (ACCU) of 2 tertiary hospitals in Madrid, Spain. Results A total of 190 episodes of AS in 169 pts were analysed. Baseline characteristics are depicted in Figure 1. Cardiovascular targeted treatments of pts included: betablockers (68.7%), ACEi or ARB (53.2%), ARNI (6.5%), AA (38.5%), group III antiarrhythmic drugs (27.1%) and digoxin (5.9%). Aetiology of the AS was determined in 68.6% of the episodes: myocardial ischemia 25.1%, STEMI 22.5%, acute myocarditis 0.5%, heart failure or cardiogenic shock 28.8%, infection 11%, Bradycardia and long QT interval 10%, ionic disturbances 6.3%, others 11.5%. Antiarrhythmic drugs used for the acute episode were: amiodarone (73.3%), procainamide (27.2%), sotalol (5.7%), other beta blockers (75.9%), calcium channel blockers (3.1%), quinidine (2.1%). Other therapies were performed as follows: sedative drugs 50.3%, endotracheal intubation 39,9%, correction of electrolyte disturbances 51.8%, therapeutic hypothermia 13.6%, intravenous temporary pacemaker insertion or ICD reprogramming (9.9%). In 45% of pts coronary angiography was performed, but only 25.7% required revascularization. Vasopressors and inotropic drugs were used in 51% of pts. Regarding mechanical support intra-aortic balloon pump was implanted in 16.2% of episodes, ECMO in 3.7% and other left ventricular assist devices in 3.1%. One patient was transplanted. Ventricular tachycardia (VT) ablation was performed in 38.7% of episodes and its efficiency was 69.4%. Three pts underwent stellate ganglion ablation and surgical sympathectomy, and in one pt sympathectomy alone was performed. ICD was implanted in 23 pts after the AS episode. Survival at discharge was 81.1%. Mortality in STEMI related AS was 44.2%, while in the rest of aetiologies was 6.1%. Mortality among patients with an ICD was 6.3%. Conclusion Patients with AS requiring admission to an ACCU have predominantly ischemic background (both acute and chronic). Most common therapeutics are beta-blockers, amiodarone, sedation and VT-ablation. In-hospital mortality differs depending on the aetiology being worst in STEMI related AS. Abstract Figure 1

Sign in / Sign up

Export Citation Format

Share Document