Initiation and monitoring of class III antiarrhythmic agents.
Initiation and Monitoring of Class III Agents. Dofetilide is a Class III antiarrhythmic agent that is approved by the United States Food and Drug Administration (FDA) for use in the conversion of atrial fibrillation, as well as in the maintenance of normal sinus rhythm. Because of the risk of torsades de pointes associated with dofetilide, the FDA mandated in-hospital initiation of therapy and initially restricted dofetilide's availability to institutions and prescribers who completed appropriate educational forums. The use of dofetilide within health care systems requires specific procedures for prescribing, dispensing, and monitoring, as well as a format for educating personnel who will be involved in the care of these patients. Several models have demonstrated success in initiating dofetilide and are also used for sotalol, which also can cause torsades de pointes. The utilization of nonphysician personnel, such as nurse practitioners and clinical pharmacists, in conjunction with a team approach were essential components for the success of these models. Preprinted order forms or procedural guidelines, as well as computer-assisted dosing programs, can be utilized to prevent inappropriate or miscalculated dosing of these agents, which potentially can cause life-threatening ventricular arrhythmias.
Freeland
Scott
S
From the Department of Pharmacy Services, St. Vincent Hospital and Health Services, Indianapolis, Indiana 46260, USA. safreela@stvincent.org
Worthy
Christine
C
Zolnierz
Michael
M
D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000451:nursing / Q000517:prevention & control*; D004334:Drug Administration Schedule; D017277:Drug Approval; D004348:Drug Labeling; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D006801:Humans; D010346:Patient Care Management / Q000379:methods* / Q000592:standards; D010348:Patient Care Team; D010627:Phenethylamines / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards; D017410:Practice Guidelines as Topic; D013015:Sotalol / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects / Q000592:standards; D016171:Torsades de Pointes / Q000209:etiology / Q000517:prevention & control
D000889:Anti-Arrhythmia Agents; D010627:Phenethylamines; D013449:Sulfonamides; D013015:Sotalol; C063533:dofetilide