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Effects of various drugs on ECG Results - Commonly asked in MCQs

Author: RxPG, Posted on Tuesday, January 27 @ 18:34:42 IST by RxPG  

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AGENTMECHANISM ECG CHANGES
PenicillinRapid IV administration of the potassium salt may produce ECG changes characteristic of hyperkalemia; anaphylactic reactions also may produce a variety of ECG changes See hyperkalemia; prominent T waves and marked QT prolongation; ST segment changes, atrial fibrillation; junctional rhythm
PentamidineStructurally similar to procainamide; binds avidly to cardiac tissue, which may produce ECG changes after discontinuation of therapy QTc prolongation with associated torsade de pointes; T wave abnormalities and ST segment changes
ErythromycinMetabolic alterations occurring in ischemia or after digitalis administration may enhance the loss of potassium QT prolongation
QuinineQuinine is the l-isomer of quinidine; the cardiovascular effect of quinine is estimated at1/3 that of quinidine PR prolongation, QRS widening, QT prolongation, prominent U waves; overdose can cause asystole and ventricular tachycardia including torsade de pointes
AmantadineChemical structure and pharmacologic properties are similar to TCAs: hypotension, bradycardia, and arrhythmias Sinus tachycardia, PR, QRS, and QT prolongation, ectopic activity. Cardiac arrest, including ventricular tachycardia and torsade de pointes, may appear as long as 36 hours after ingestion of toxic doses
DoxorubicinDose-dependent irreversible cardiomyopathy may be due to free radical formation with release of cardiac histamine and other vasoactive substances; may also directly affect calcium ion channels, producing irreversible cell damage due to intracellular calcium overload Acute: supraventricular arrhythmias (rarely clinically significant); chronic: decreased QRS voltage
LithiumArtial displacement of intracellular potassium sinus node dysfunction with bradycardia T wave abnormalities; first degree AV block, paroxysmal left bundle branch block; at toxic doses, may see QTc prolongation
TCAsPossess anticholinergic activity, exert a direct myocardial depressant activity, and block noradrenaline reuptake in the heart Similar to those produced by the phenothiazines and class I antiarrhythmics: increased heart rate, prolongation of the PR interval, intraventricular conduction disturbances, increase in QTc interval, and flattening of T waves
CarbamazepineShortens action potential duration Sinus bradycardia, AV conduction disturbances may occur with therapeutic or modestly elevated plasma concentrations; tachycardia occurs in overdose; older patients or those with pre-existing conduction abnormalities are particularly vulnerable
ProbucolUnknown mechanism Reversible prolongation of QTc interval; Probucol is eliminated slowly, so abnormality may persist after discontinuation of therapy
CotrimoxazoleUnknown mechanism QT prolongation



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