Cardiac side effects

Question 1

Heart rate for which QTc estimate the QT interval

Answer 1

60 bpm

Question 2

Normal QTc in women

Answer 2

470ms

Question 3

Normal QTc in men

Answer 3

440ms

Question 4

QTc associated with an increased risk of torsades de pointes

Answer 4

> 500ms

Question 5

Type of arrhythmia seen in torsade de pointes

Answer 5

Polymorphic ventricular tachycardia

Question 6

Type of ventricular arrhythmia which is often self-terminating

Answer 6

Torsade de pointes

Question 7

Symptoms seen in torsade de pointes

Answer 7

Often asymptomatic
Syncope
Cardiac death if degenerates into VF

Question 8

Formula most often used to calculate QTc

Answer 8

Bazett’s formula

Question 9

Physiological causes of prolonged QTc

Answer 9

Extreme physical exertion
Stress
Extremes of age
Female sex
Bradycardia

Question 10

Metabolic causes of prolonged QTc

Answer 10

Hypokalaemia
Hypomagnesaemia
Hypocalcaemia

Question 11

Issues with using Bazett’s formula to measure QTc

Answer 11

Over-corrects at HR >100bpm

Under-corrects at HR <60bpm

Question 12

Medical causes of prolonged QTc

Answer 12

Hypothermia
MI
Anorexia nervosa
Raised ICP
Congenital long QT syndrome
Myocarditis
LVH

Question 13

Antipsychotic with high impact on QTc

Answer 13

Pimozide

Question 14

Antipsychotics with moderate effect on QTc

Answer 14

Haloperidol
Quetiapine
Chlorpromazine
Ziprasidone
Amisulpride

Question 15

Antipsychotics with low effect on QTc

Answer 15

Clozapine
Olanzapine
Risperidone
Aripiprazole
Palperidone

Question 16

Antipsychotic with no effect on QTc

Answer 16

Lurasidone

Question 17

SSRI which causes prolonged QTc

Answer 17

Citalopram

Question 18

Non-psychotropic medications which cause prolonged QTc

Answer 18

Ampicillin
Erythromycin
Clarithromycin
Amiodarone
Sotalol
Chloroquine
Quinine
Methadone
Tamoxifen
Amantadine

Question 19

Leads the QTc should be measured from

Answer 19

II
V5
V6

Question 20

Part of the ECG the QT measures

Answer 20

Beginning of the QRS complex to the end of the T wave

Question 21

Effect of SSRIs and mirtazapine on mortality post-MI

Answer 21

Neutral or positive

Question 22

Least cardiotoxic TCA

Answer 22

Lofepramine

Question 23

Antidepressants known to cause QTc prolongation at therapeutic doses

Answer 23

Trazodone

Citalopram

Question 24

Antipsychotic with highest risk of prolonged QTc which has now been discontinued

Answer 24

Thioridazine

Question 25

Medication used in addiction treatment associated with prolonged QTc

Answer 25

Methadone

Question 26

Effect of meclobamide on QTc

Answer 26

No effect at therapeutic doses | Prolongation in overdose

Question 27

Size of QTc effect of citalopram

Answer 27

Moderate

Question 28

Cardiac side effects associated with lithium therapy

Answer 28

``` PR prolongation T wave flattening Sinus node dysfunction Higher variation in QT (higher QT dispersion ratio) Unmasking of Brugada syndrome ```

Question 29

Cardiac side effects often associated with TCA treatment even at therapeutic levels

Answer 29

Prolonged QTc Flattened T wave Depressed ST segment Tachycardia