2024.05 Ep 2 Watch the QT in HD

In this episode, we will discuss drug-induced QT prolongation, specifically in patients receiving hemodialysis and how pharmacists can prevent drug-related harm.

Each month, APhA will release five, 5-minute podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care.  Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA pharmacist.com Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).

Tune in now on our website or subscribe via YouTube, Spotify, or Apple Podcasts.

Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.

Episode Transcript

(00:03):
Welcome to the First Fill.
My name is Katie Meyer, and I serve as the SeniorDirector of Content Creation here at APhA.
This month, we're reviewing recent updatesrelated to medication safety and are happy
to provide you with valuable medicationsafety CPE for listening.
Be sure to head to the Learning Libraryto ensure you don't miss out on your CPE credit.

(00:25):
In this episode, I'll be discussing a recent
cross-sectional study published in JAMAthat evaluates prescribing patterns
related to drugs and combinations of drugsthat are high risk for causing acute
prolongation leading to fatal Torsades de Pointes,
referred to as TDP from here on out.
Before we dive into the study,however, let's quickly refresh on mechanisms

(00:47):
related to drug induced prolongation of the QT.
On the electrocardiogram, the QT interval isa measure of ventricular repolarization.
Many factors influence the
pathophysiology behind repolarization,
including gender, age,heart rate, electrolyte concentrations,

(01:08):
comorbid diseases, and our focus today, drugs.
The most common mechanism behind drug induced
prolongation is the drug's ability to block IKr
which is a key potassium channel in the heartthat promotes repolarization.
In most cases, drug induced QTprolongation is reversible,

(01:29):
but unfortunately, in some rare instances,exaggerated QT
prolongation can provoke the polymorphicventricular tachycardia, TdP
leading to syncopeor more severely sudden cardiac death.
In the United States, approximately
500,000 people are currently on hemodialysis.

(01:51):
On average,these patients are cared for simultaneously
by clinicians from five different specialtiesand prescribed
10 to 12 medications daily.
Evidence has shown that peoplereceiving hemodialysis who take medications
that are known to prolong the QT with risk for TdPhave a higher
risk of experiencing sudden cardiac deathcompared to people not receiving hemodialysis.

(02:16):
So with that background, let's diveinto the study.
The study was a cross-sectional studywhich included patients 60 years
or older enrolled in Medicareand receiving in center
hemodialysis in 2019.
The study specifically looked at new prescriptionsfor the seven
most frequently filled QT prolonging medicationswith known TDP risk

(02:38):
and evaluatedthe timing related to acute care encounters.
type of prescribing clinician and pharmacythat dispensed the medication
and concomitant use of medications with known drug
drug interactions with those seven medications.
You're probably thinking, Well, Katie, just
what were those sevenmost frequently filled medications?

(03:00):
I'm not going to tell you just yet to keep you insuspense and listening a bit longer.
Overall, researchers evaluated
records from 20,761 individuals
who received hemodialysis in 2019 , 10,992
or 52% of which filled one of the seven drugs.

(03:21):
80% of these prescriptions
were filled outside of an acute care eventand were prescribed by non nephrologists.
16 to 26% of the prescriptionsoccurred with use of another QT
prolonging medicationmostly prescribed by different clinicians.
And the most important statistic to methat I'll provide you today

(03:43):
is that the majority of new use prescriptions
from 72 to 90% for acute prolonging medications
with known TdP risk, particularly in combinationwith an interacting drug,
was dispensed by a commercial retail pharmacy.
So bottom line,we as pharmacists can make an impact and intervene

(04:05):
to help keep our patients who are receivinghemodialysis safe from medication related harm.
I won't keep you in suspense any longer.
The seven most frequently filled medicationswith TDP risk in the study
population, were Azithromycin,
Ondansetron, Levofloxacin, Ciprofloxacin,

(04:26):
Amiodarone, Escitalopram and Fluconazole.
Drug drug interaction wisewe need to be on the lookout
for both pharmacodynamic interactions,so use of combinations of drugs that block IKr
and pharmacokinetic interactions,so use of drugs that reduce hepatic metabolism
and increase concentrationsof our drugs of high riskike

(04:49):
a CYP2C19 inhibitor in a patienttaking escitalopram.
In these situations where a simple callto the doctor to suggest a dose reduction
or alternative depending on the clinical scenariocould help save a life.
One nice resource I'd like to recommend that
I've used regularly in my practiceis Credible Meds.

(05:10):
With free registrationyou can get access your printable list
that includes all medicationsassociated with risk of causing TdP.
You can also dive into medications and evidenceat the individual drug level,
and the platform letsyou know if the risk associated is
known, possible or conditional.

(05:30):
It's a great resource.
If you'd like to look up information quickly
during your busy workdayto help inform your decision making.
Well, that's all I have for today.
Remember this month by logging into APhA’sLearning Library and completing a quick assessment
and survey,you'll earn a half hour of medication safety CPE.
I hope this helps you as you're workingthrough your licensure requirements.

(05:53):
Take care.