Torsades de pointes: Difference between revisions

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==Background==
==Background==
Drugs that inhibit P450
*Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds:
#erythromycin
**Procainamide
#biaxin
**Phenothiazine
#ketoconozole
**TCAs
#itraconozole
**Qunidine
 
**Disopyramide
*certain antihistamines like terfandadine or astemizole, inhibit the delayed rectifier potassium channel
*terfenadine is completely metabolized in liver. Once metabolized, has no cardiac activity
*unmetabolized terfenadine has quinidine- like activity- gives torsades
*if P450 enz inhibited by other drug, then will have increase in concentration of unmetabolized terfanadine.


==Treatment==
==Treatment==
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==Source ==
==Source ==
10/07 DONALDSON (adapted from Tintinalli, Lampe)
*Tintinalli


[[Category:Cards]]
[[Category:Cards]]

Revision as of 06:13, 26 March 2012

Background

  • Most commonly occurs in pts w/ prolonged QT due to heart diseaes or meds:
    • Procainamide
    • Phenothiazine
    • TCAs
    • Qunidine
    • Disopyramide

Treatment

  1. Magnesium
    1. 1-2gm IV over 1-2 min; then 1-2gm/hr gtt
  2. Overdrive pacing
    1. Goal HR 90-120
  3. Isoproterenol
    1. 2-8 mcg/min

See Also

Source

  • Tintinalli
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