QuestionMultiA
QuestionChoice
33811
a
Risperidone;5mg;oral (PO);Daily
QuestionChoice
33812
b
Haloperidol;20mg;oral (PO);12-hourly
QuestionChoice
33813
c
Mirtazapine;30mg;oral (PO);Daily
QuestionChoice
33817
g
Mesalazine;2g;oral (PO);Daily
QuestionChoice
33816
f
Fluticasone;400micrograms;inhaled (INH);12-hourly
QuestionChoice
33815
e
Amlodipine;5mg;oral (PO); Daily
QuestionChoice
33814
d
Ramipril;10mg;oral (PO); Daily
QuestionComment
The explanation doesn't give the answer for question 1. What's the third medication causing prolonged QTc???
59514
QuestionComment
mirtazepine
59570
User
subscriber
Tazocin Embolism
User
subscriber
iona
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2715
Dosing error & drugs that prolong QT
Topic
89
Psychiatric Pharmacology
1. Typical (haloperidol), atypical (risperidone) antipsychotics and mirtazepine are known to increase the QTc interval.
2. Haloperidol, given to schizophrenic patients has a maximum dose of 20mg daily. The dose prescribed for this patient is likely to represent a transcription error of daily to 12-hrly.
6782
a b c
b
Case presentation: A 52-year-old man was brought into the Emergency Department by the police under Section 136 following an episode of auditory hallucination. PH Schizophrenia, Severe depression, Hypertension, Ulcerative Colitis. DH His current regular medications are listed (below).


**Investigation**
ECG shows a prolonged QTc interval 460ms (normal≤ 430ms)

Question 1: Select the THREE prescriptions that are most likely to be contributing to his prolonged QTc interval (mark them with a tick in column A)
Question 2: Select the ONE prescription that contains a serious dosing error (mark it with a tick in column B).