Amiodarone Flashcards
Generic Name for Codarone?
Amiodarone HCL
Trade name for amiodarone HCL?
Codarone
What is the drug classification for amiodarone?
Benzofuran derivative, Ventricular & Supraventricular antiarrhythmic (class IIIVW)
How is amiodarone supplied?
50 mg/mL
MOA (2 major points) of amiodarone?
❑ Prolongs the action potential and refractory period (repolarization inhibition). Noted in the QT interval of the ECG
❑ With prolonged therapy, the effective refractory period increases in atria, ventricles, AV node, His-Perkinje system, plus bypass tracts ❑ conduction slows in the atria, AV node, His-Perkinje system and ventricles;
❑ SA node automaticity decreases.
❑Inhibits adrenergic stimulation and decreases peripheral vascular resistance (PVR)
Indications (3) for amiodarone use?
❑ VF/pVT unresponsive to shock delivery, CPR, and a vasopressor
❑ Recurrent, hemodynamic unstable VT (second line treatment after cardioversion X 3)
❑ With expert consultation amiodarone may be used for tx of some atrial (SVT) and ventricular arrhythmias
What is the dose for amiodarone?
VF/pVT - 300 mg IVP (recommend dilution in 20 to 30 mL D5W or NS); 2nd dose if needed 150 mg IVP in 3-5 minutes
Recurrent Life-threatening Arrhythmias -
Rapid Infusion: 150 mg/10 minutes q 10 minutes (until suppression of arrhythmia or max cumulative dose is reached). Mix 150mg in 100ml bag of NS or D5W (Concentration: 1.5 mg/ml)
Slow Infusion (Immediately post suppression of arrhythmia): 1 mg/min over 6 hours (360 mg) Maintenance Infusion: 0.5 mg/min over 18 hours (540 mg) *Note: Max cumulative dose of 2.2 gms/24 hrs
Pediatric: use 5 mg/kg doses x 3 over 20 to 60 minutes up to a max of 300 mg IV/IO diluted in 5 mL NS
Contraindications (4 points) to amiodarone use?
❑ SA node dysfunction. AV block, pre-existing 2nd or 3rd degree block (without artificial pacemaker)
❑ Bradycardia resulting in syncope
❑ Sensitivity to amiodarone or iodine (contains iodine)
❑ Cardiogenic shock if you haven’t tried cardioversion X 3 first
Precautions when using amiodarone
❑ Avoid use with patients receiving beta-blockers or calcium channel blockers
❑ Use with caution in patients with hepatic failure and thyroid disease
❑ hypotension
How would you treat amiodarone overdose?
May require beta-adrenergic agonists (isoproterenol) or TCP. Hypotension must be treated with positive inotropes (dopamine, dobutamine) or vasopressors (epinephrine, norepinephrine).
Your patient is receiving an amiodarone infusion and you notice the QRS has widened 50% of baseline and they’re hypotensive. What is your next step?
Stop the infusion
During administration of amiodarone you noticed prolongation of the QT interval. What do you do?
Decrease the infusion rate
If the amiodarone infusion will exceed 2 hours, how should it be prepared?
With D5W in glass
What effect might beta blockers or calcium channel blockers have when using amiodarone?
They may potentiate bradycardia, sinus arrest, and AV block.
Should amiodarone be given concurrently with procainamide?
No. Amiodarone may prolong the QT interval and so should not be administered concurrently with other drugs, like procainamide, that have the same effect as this may induce torsade’s de pointes.
