Clinical pharmacists' opportunities to reduce inappropriate prescription of QT-prolonging medications: calls to action.
All biologically active agents carry the potential to lead to adverse reactions in certain individuals, including serious cardiac adverse reactions. Since 2005, there has been an international regulatory landscape governing the investigation of a new drug's propensity to lead to the polymorphic ventricular tachycardia Torsades de Pointes (Torsades), a rare but potentially fatal occurrence. When a regulatory agency considers it appropriate, warning information is placed in a medicine's patient information leaflet (label) concerning drug-induced QT interval prolongation, a phenomenon associated with Torsades. In busy hospital settings, however, prescribers, including cardiologists, make injudicious prescribing decisions that put patients at risk. The science of cardiac safety, including the clinical trials that generate the information about QT prolongation in patient information leaflets, is frequently not part of the curriculum at Schools of Pharmacy. Given that medication-induced cardiotoxicity is extremely serious, we advocate that schools integrate the science of cardiac safety into existing therapeutics/therapeutic medication monitoring courses. Given their expert knowledge of pharmacology, pharmacists working as part of a hospital's clinical team would then be even better placed to review prescribing decisions concerning medications that prolong the QT interval, and alert prescribers in cases where reassessing their decisions seems prudent. National pharmacy societies or other pertinent professional societies could create practice guidelines to support graduates once employed as clinical pharmacists. Clinical pharmacists are well placed to be influential arbiters of safer prescribing decisions. Cardiac safety education during their pharmacy training and practice guideline support from professional societies during their careers can optimize this role.
['Dhanani|Trusha C|TC|', 'Mantovani|Emily H|EH|', 'Turner|J Rick|JR|']
D004348:Drug Labeling D064420:Drug-Related Side Effects and Adverse Reactions D004512:Education, Pharmacy D006801:Humans D057970:Inappropriate Prescribing D008133:Long QT Syndrome D010348:Patient Care Team D010595:Pharmacists D010607:Pharmacy Service, Hospital D017410:Practice Guidelines as Topic D010818:Practice Patterns, Physicians' D024382:Professional Role D012957:Societies, Pharmaceutical D016171:Torsades de Pointes
Clinical Pharmacy < Clinical Practice Inappropriate Prescribing < Prescribing Professional Training < Education Ward Pharmacy