Which drugs do you prescribe the most?

[Aesculapius]

It seems like every other week a new drug gets implicated in causing QT prolongation. Yet people don't seem to be dropping left and right from zofran and azithromycin... what gives?

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[Arcan57]

It seems like every other week a new drug gets implicated in causing QT prolongation. Yet people don't seem to be dropping left and right from zofran and azithromycin... what gives?

A 7ms increase in QT buys you the designation of QT prolongation, but has no practical effect on 99.99% of the population.

 

[WilcoWorld]

While I agree that QTc prolongation is often overblown, I'd exercise caution with Azithro in patients with VF/VT/CHF histories. I've seen it result in VT in my own experience and have been reading about it with increased frequency lately. This prevalence probably has something to do with the rampant overuse of the drug.

As I type this I'm thinking that I may want to find a lay press article about sudden death from a Z-pack to give to the viral URI's that demand antibiotics (and seem to report a PCN allergy about 80% of the time).

 

[RPedigo]

It seems like every other week a new drug gets implicated in causing QT prolongation. Yet people don't seem to be dropping left and right from zofran and azithromycin... what gives?

Probably what Arcan said. Also interestingly, something I didn't know until I listened to the April 2012 EM:RAP episode is that the amount of QT prolongation often does not often have a direct relationship to the risk of torsades. (e.g., there are drugs that prolong the QT interval by 10 ms and yet have a relatively higher risk of torsades compared with drugs that prolong the QT interval by significantly more.)

 

[deleted109597]

Correct. I don't fear QT prolongation per se (see my droperidol recommendations). However, I am giving another reason not to use a drug that I don't like, namely azithromycin. Don't get me started on the people that prescribe it for sinusitis.

 

[ToxicChic]

Doxy:

Kills staff
Kills strep
Kills MRSA
Treats pneumonia (CAP, anyway)
Kills chlamydia
Can be used for UTIs in young sexually active females.
Cheap as dirt

What's not to like?

Agree- its free around here.

My list is very similar to most, Vicodin probably tops the list followed by doxy, bactrim, keflex, Pen vk, Percocet, zofan (approximate order).

Agree with mcninja except we don't keep our shut the hell up in the warmer.

 

[la gringa]

While I agree that QTc prolongation is often overblown, I'd exercise caution with Azithro in patients with VF/VT/CHF histories. I've seen it result in VT in my own experience and have been reading about it with increased frequency lately. This prevalence probably has something to do with the rampant overuse of the drug.

As I type this I'm thinking that I may want to find a lay press article about sudden death from a Z-pack to give to the viral URI's that demand antibiotics (and seem to report a PCN allergy about 80% of the time).

lmfao me too.

90% of pcn allergies, at minimum, are total bs. here's some flonase, your sinusitis will go away in the next 3-5 days no matter what you do.

 

[xaelia]

That azithromycin article is crap, btw.

Hell, in 2005, the NEJM had a randomized trial in which high-risk cardiac patients took azithromycin for a year because they thought it would treat the chlamydia present in atherosclerotic plaques and confer a survival advantage - and there was no difference between groups (~4000 in each group).

So, I'm happy for an article that cuts down on azithromycin usage for other reasons, but I'm not impressed the article itself.