December 01, 2013

Concerning drugs and arrhythmias

Which of the following medications have the highest risk of producing the arrhythmia shown in the ECG below when the patient is also taking amiodarone?

Fig: An ECG report showing the arrhythmia
  1. Flecainide
  2. Phenytoin
  3. Propafenone
  4. Chloroquine
  5. Lidocaine

The correct answer is E

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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