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Drugs - CPT Sem 4 > Amiodarone > Flashcards

Amiodarone Flashcards

1
Q

What is the mechanism of action of amiodarone?

A
  • Blocks sodium, calcium, and potassium channels

- Blocks alpha and beta adrenergic receptors

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2
Q

What is the result of amiodarone blocking sodium, calcium, and potassium channels?

A

It prolongs the cardiac action potential and slows the heart rate

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3
Q

What is the result of amiodarone blocking alpha and beta adrenergic receptors?

A

It decreases the heart rate and blood pressure

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4
Q

What are the routes of delivery of amiodarone?

A

IV
PO

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5
Q

What is the problem with administration of amiodarone?

A

It is highly irritant to the skin

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6
Q

What is done because of amiodarone being highly irritant to the skin?

A

If a patient requires repeated or continuous infusion of amiodarone, it is recommended to site a central venous catheter

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7
Q

What are the indications for amiodarone?

A
  • CPR
  • Rhythm control in AF
  • Atrial flutter and tachycardia in WPW
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8
Q

When should amiodarone be given in CPR?

A

Non-shockable rhythms, or following 3 successful DC shocks

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9
Q

What dose of amiodarone is given for CPR?

A

300mg IV (diluted in 20ml glucose 5%), then 150mg if required, then IV infusion 900mg/24 hours

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10
Q

What dose of amiodarone is given for arrhythmias?

A

Initially 5 mg/kg IV, to be given over 20–120 minutes with ECG monitoring, subsequent infusions given if necessary according to response; maximum 1.2 g per day.

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11
Q

What are the contraindications to amiodarone?

A
  • Sinus bradycardia
  • Sinoatrial heart block
  • Thyroid dysfunction
  • Iodine sensitivity
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12
Q

When should amiodarone be used with caution?

A
  • Hypokalaemia
  • Severe bradycardia
  • Heart failure
  • Elderly
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13
Q

What might amiodarone interact with?

A
  • Warfarin
  • Digoxin
  • Beta blockers
  • Calcium channel blockers
  • Lithium
  • TCAs (SSRIs, amitriptyline etc.)
  • Grapefruit juice
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14
Q

What might happen if amiodarone is given with warfarin?

A

Increased anticoagulant effect

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15
Q

What might happen if amiodarone is given with digoxin?

A

Increased plasma concentration of digoxin

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16
Q

What might happen if amiodarone is given with beta blockers?

A

Increased risk of bradycardia and heart block

17
Q

What might happen if amiodarone is given with calcium channel blockers?

A

Increased risk of bradycardia and heart block

18
Q

What might happen if amiodarone is given with lithium?

A

Increased risk of ventricular arrhythmias

19
Q

What might happen if amiodarone is given with TCAs?

A

Increased risk of ventricular arrhythmias

20
Q

What might happen if amiodarone is given with grapefruit juice?

A

Increased exposure to amiodarone

21
Q

What should be remembered when considering the interactions of amiodarone?

A

It has a long half-life, and drug interactions may occur for several weeks or months after treatment cessation

22
Q

What monitoring is required with amiodarone?

A
  • Baseline CXR before starting treatment
  • Baseline TFTs and LFTs before starting treatment, and re-checked every 6 months

obvs if they’re about to die just go for it yolo

23
Q

Why is a baseline CXR required before starting treatment with amiodarone?

A

Due to risk of pulmonary fibrosis

24
Q

Why is baseline TFTs and LFTs required before starting treatment with amiodarone?

A

Due to risk of thyroid disease and hepatotoxicity

25
Q

What are the common side effects of amiodarone?

A
  • Bradycardia
  • Thyroid dysfunction
  • Pulmonary fibrosis
  • Photosensitivity
  • Corneal microdeposits
  • Peripheral neuropathy
  • Jaundice
  • Hepatotoxicity
  • Vomiting
  • Tremor
  • Taste disturbances
26
Q

What are the less common side effects of amiodarone?

A
  • Peripheral neuropathy and myopathy (reversible)
  • Conduction disturbances
  • Worsening arrhythmias
27
Q

What are the very rare side effects of amiodarone?

A
  • Alopecia
  • Optic neuritis
28
Q

What counselling needs to be given before treatment with amiodarone? -

A
  • About serious adverse effects
  • Photosensitivity
  • Optic neuritis
29
Q

What counselling is required regarding the adverse effects of amiodarone?

A

Inform the patient of the adverse effects, and emphasise the importance of complying with monitoring

30
Q

What counselling is required regarding photosensitivity with amiodarone?

A

Advise patient to protect skin from direct sunlight

31
Q

What counselling is required regarding optic neuritis with amiodarone?

A

Counsel patients about signs and symptoms of optic neuritis, and warn them that amiodarone must be stopped immediately as blindness can occur

Drugs - CPT Sem 4 (81 decks)

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