Propofol-associated QTc prolongation.

OBJECTIVES: Propofol is a preferred agent for sedation in patients in the intensive care unit (ICU) due, in part, to its established safety profile. Despite this, recent case reports have suggested a potential for prolongation of the corrected QT interval (QTc) in ICU patients receiving propofol, though limited empirical work has been conducted to evaluate this association. As such, the purpose of this study was to assess the relationship between propofol infusion and QTc prolongation in a historical cohort of ICU patients. METHODS: A single-center, historical, observational, pre-post cohort analysis of medical records from admitted patients ⩾18 years old with cardiovascular disease was conducted, involving cases who received propofol infusion for ⩾3 hours with sequential electrocardiogram monitoring from 2006 to 2012. A multivariable, generalized linear model regression was employed to assess the primary outcome of on-propofol QTc interval (QTc2), controlling for various demographic and clinical factors. RESULTS: A total of 96 patients met inclusion criteria, averaging 56.1 ± 14.1 years of age and 86.1 ± 25.0 kg, with 37.5% being female. A mean prolongation in QTc interval of 30.4 ± 55.5 ms (p < 0.001) was observed during the propofol infusion, with 43.8% of cases exhibiting an on-infusion QTc2 of ⩾ 500 ms. Regression analyses suggested that prolongation in on-propofol QTc was independently associated with baseline QTc interval and amiodarone use, while weight as inversely associated with QTc2 (p < 0.05). CONCLUSION: This historical cohort analysis of adult ICU patients receiving propofol suggests that on-infusion QTc prolongation was associated with increasing baseline QTc interval and with amiodarone use. Further research is needed to evaluate the clinical significance and cause-and-effect relationship between potential QTc changes and propofol use in the ICU.

Key articles and guidelines in the management of acute coronary syndrome and in percutaneous coronary intervention: 2012 update.

More than 1 million people in the United States experience an acute coronary syndrome (ACS) every year, and almost 600,000 undergo percutaneous coronary intervention (PCI) for treatment of cardiovascular disease. There is a large amount of evidence-based literature to guide appropriate management of these patients. There have been a number of advances in the treatment of these patients over the last several years. Due to the large amount of rapidly available literature concerning the care of patients with ACS or undergoing PCI, clinicians can often find it difficult to keep up with the information needed for optimizing care of these patients. Therefore, we provide the second update to the first compiled bibliography of key articles and guidelines relative to patients with ACS published in Pharmacotherapy in 2004. The initial update was published in Pharmacotherapy in 2007 and also included bibliographies concerning management of patients undergoing PCI. A number of guidelines and practice-changing literature have been published since the update in 2007. Specific areas included in this review are updated summaries of clinical practice guidelines and clinical trials of anticoagulants, antiplatelets, platelet aggregation testing, pharmacogenomics testing in patients taking clopidogrel, clopidogrel loading dose comparisons, clopidogrel and proton pump inhibitor drug interactions, the impact of bleeding in ACS, and statins. As with previous versions of this document, we hope that this compilation will serve as a resource for pharmacists, physicians, nurses, residents, and students responsible for the care of patients with coronary heart disease.

An advanced teaching certificate program for postgraduate year 2 residents.

PURPOSE: The rationale, structure, and elements of a teaching certificate program for second-year pharmacy residents are described. SUMMARY: Evidence suggests that postgraduate year 2 (PGY2) pharmacy residents generally have limited options for the continued development of their teaching skills after the completion of a postgraduate year 1 (PGY1) teaching certificate program. To expand those options, the University of Oklahoma College of Pharmacy developed a program (implemented during the 2005-06 residency year and formalized during the 2010-11 residency year) of advanced teaching-skills development that allows PGY2 residents to build on the foundational skills acquired in its PGY1 teaching certificate program; the new program also has been adapted to meet the needs of incoming PGY2 residents who earned PGY1-level teaching certificates at other institutions. The teaching certificate program comprises eight modules of instruction in advanced topic areas (e.g., course coordination, grading, active learning, teaching with technology) designed to prepare PGY2 residents for future faculty and preceptor positions. Among other required and optional activities, residents in the PGY2 certificate program receive hands-on instruction in course-coordination duties through a shadowing experience, serve as preceptors to fourth-year pharmacy students under the guidance of the residency director, and redeliver refined versions of lectures originally presented as PGY1 residents. CONCLUSION: A teaching certificate program specifically designed for PGY2 residents has allowed participants to continue to develop and refine their teaching skills through learning activities beyond those provided in the PGY1 program.