PDF(Pubmed)
Abstract：
Background: Initiation of dofetilide requires hospital admission because of its proarrhythmic risk. To reduce the risk of adverse events associated with dofetilide, our institution has a standard operating protocol for dofetilide initiation. Regardless, patients are sometimes admitted for dofetilide initiation with unaddressed pharmacotherapy concerns that may delay therapy initiation and/or increase the risk for adverse events. Objective: To characterize interventions associated with pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization. Methods: Patients scheduled for dofetilide initiation were evaluated by a pharmacist prior to admission. Identified interventions were categorized into the following recommendations: (1) against the use of dofetilide; (2) dofetilide starting dose adjustment; (3) appropriate washout of previous antiarrhythmic drug; (4) transesophageal echocardiogram prior to dofetilide initiation; (5) discontinuation or dose adjustment of interacting drug; (6) electrolyte supplementation upon discharge; (7) other intervention. The primary outcome measure was the frequency and types of identified and accepted interventions. Results: Twenty-two patients were evaluated during the 9-month study period. Fourteen interventions were identified, 13 of which were accepted by an electrophysiology provider. The most common intervention was for recommendation of a transesophageal echocardiogram prior to initiating dofetilide because of inadequate oral anticoagulation (n = 6). Other accepted interventions were for discontinuation or dose adjustment of interacting drug (n = 3), dofetilide starting dose adjustment (n = 2), electrolyte supplementation upon discharge (n = 2), and remeasurement of interventricular septal wall thickness (n = 1). Conclusion: Pharmacist evaluation of scheduled dofetilide admissions prior to hospitalization can serve to identify and resolve pharmacotherapy concerns related to dofetilide use.
摘要：
背景：多非利特的启动需要住院，因为它有致心律失常的风险。为了降低与多非利特相关的不良事件的风险，我们的机构有多非利特起始的标准操作方案。无论如何,患者有时接受多非利特治疗,但未解决药物治疗问题,这可能会延迟开始治疗和/或增加不良事件的风险.目的：描述住院前与药剂师评估计划的多非利特入院相关的干预措施。方法：计划开始使用多非利特的患者在入院前由药剂师进行评估。确定的干预措施分为以下建议：（1）反对使用多非利特；（2）多非利特起始剂量调整；（3）适当清除先前的抗心律失常药物；（4）多非利特开始之前的经食管超声心动图；（5）停用或剂量调整相互作用药物；（6）出院时补充电解质；（7）其他干预措施。主要结果指标是已识别和接受的干预措施的频率和类型。结果：在9个月的研究期间对22例患者进行了评估。确定了14项干预措施，其中13个被电生理学提供者接受。由于口服抗凝治疗不足，最常见的干预措施是建议在开始使用多非利特之前进行经食管超声心动图检查（n=6）。其他公认的干预措施是停用或调整相互作用药物的剂量（n=3），多非利特起始剂量调整（n=2），放电时补充电解质(n=2)，并重新测量室间隔壁厚度（n=1）。结论：药剂师在住院前对多非利特的预定入院进行评估可用于识别和解决与多非利特使用相关的药物治疗问题。
