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This figure illustrates the time course of the medications that the patient took.{Monahan} In relation to when the symptoms started, the most recently prescribed drug was ketoconazole. Ketoconazole has not been associated with development of torsades de pointes when used by itself.
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How did ketoconazole interact with terfenadine to cause QT prolongation and torsades de pointes in this patient? That question will be answered during the course of this module.
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Monahan BP, Ferguson CL, Cleave ES, Lloyd BK, Troy J, Cantilena LR. Torsade de pointes occurring in association with terfenadine use. JAMA 1990; 264:2788-2790.
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