July 01, 2010

MRCP 1 Question 8

Which of the following medications have the highest risk of producing the arrythmia known as torsades de pointes when the patient is also taking amiodarone?

a) Flecainide
b) Phenytoin
c) Propafenone
d) Amiodarone
e) Lidocaine

The correct answer is D


Common clinical features in drug-induced torsade de pointes include hypokalemia and cycle-length prolongation just prior to initiation of the arrhythmia.

Among these agents sotalol, which is a class III agent, has the highest risk of producing torsades, which is a polymorphic, pause-dependent ventricular tachycardia causing syncope and sudden cardiac death.

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