Describe an unplanned event or activity that enabled you to learn something new or refresh your knowledge or skills
Whilst conducting a medicines usage review (MUR) the patient mentioned that he had recently been experiencing an increased incidence of palpitations and missed heart beats. The patient was a 49 year old male, did not smoke, took moderate exercise and was not overweight. He said he had no previous cardiac history. I checked his blood pressure and it was within the normal range. He explained that the problem came and went but had recently got worse and thought it might be linked to stress at work.
We discussed his medication. He took amitriptyline daily for prophylactic management of migraine and cluster headaches and had recently increased the dose to manage the headaches. I recalled that amitriptyline might have cardiac side effects but wanted to check the details.
BNF: Amitriptyline [unlicensed indication] – ‘arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side effects include postural hypotension, tachycardia and ECG changes’.
Online literature search:
- PJ 15th October 2014. Thomson, C and Wright, P. “Long QT syndrome”
- BMJ 29 Jan 2013:346:F288. Castro, VM et al. “QT interval and antidepressant use: a cross-sectional study of electronic health records”
The references confirmed that amitriptyline could cause long QT syndrome, primary symptoms may include palpitations and that symptoms were dose related. I concluded that his symptoms might be linked to either stress/dose-related side-effect of his amitriptyline, contacted the patient, informed him of my conclusions and suggested that he should be referred to his doctor for a more thorough assessment.
Give an example of how has this learning benefited the people using your services.
This CPD benefited the patient directly. He visited his GP and was referred to a cardiologist. He was found to have some abnormalities with his ECG and was diagnosed with ectopic heartbeats, which may not necessarily have been caused by the medication but could have been exacerbated. The patient is now under the care of the cardiologist and was grateful for the advice I provided.
This example record is copyright to the General Pharmaceutical Council and reproduced with permission from “Example records - For revalidation for pharmacy professionals” 2017.