Amiodarone

Question 1

class

Answer 1

antiarrythmic agent

Question 2

mechanism of action

Answer 2

 Multiple effects on sodium, potassium and calcium channels.
 Prolongs action potential, refractory period.
 Ventricular automaticity (potassium channel blockade).
 Slows membrane depolarization and impulse conduction (sodium channel blockade).
 Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic
activity (calcium -blockade).
 -adrenergic blocking action.

Question 3

indications for use

Answer 3

 Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide
complex tachycardia of uncertain origin.
 Control hemodynamically stable ventricular tachycardia when cardioversion
unsuccessful.
 Adjunct to cardioversion of SVT and PSVT.
Rate control in atrial fibrillation or flutter.

Question 4

contraindications

Answer 4

 Bradycardia
 Second or third degree heart block unless a functioning pacemaker is present
 Cardiogenic shock
 Hypotension
 Pulmonary congestion

Question 5

adverse reactions

Answer 5

 Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block
 Torsades de Pointes (prolongs QTc interval), congestive heart failure
 GI & Hepatic: nausea, vomiting, abnormal liver function tests
 Skin: slate-blue pigmentation
 Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia

Question 6

incompatibilities/drug interactions

Answer 6

 Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can
be proarrhythmic when given in combination with Amiodarone due to similar
mechanisms of action.
 Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium
bicarbonate, furosemide, and heparin.

Question 7

adult dose

Answer 7

VF/Pulseless VT
300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with
cardioversion
150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes
Maintenance Infusion Post Resuscitation/Conversion
After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then
up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams
Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and
run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min
For Other Maintenance infusion
Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

Question 8

peds dose

Answer 8

VF/Pulseless VT
5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a
total maximum of 15 mg/kg/day
Probable VT with pulse
5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15
mg/kg/day

Question 9

route of administration

Answer 9

IV/IO bolus, IV/IO infusion

Question 10

onset of action

Answer 10

variable

Question 11

peak effects

Answer 11

variable

Question 12

duration of action

Answer 12

half-life may exceed 40 days

Question 13

AZ drug box minimum

Answer 13

optional 300 mg

Question 14

special notes

Answer 14

 Amiodarone is mixed in a soap-like vehicle in glass or special plastic and is subject to
excessive foaming. Draw from ampule with at least an 18 ga. needle. Mix with 20 – 30
mL of D5W prior to administration.
 Use with caution if hepatic failure is present or if administered in combination with other
drugs.
 Patient must be on a cardiac monitor–monitor heart rate and rhythm.
 Must be administered on an IV infusion pump during interfacility transports.
 Temperature control is required to carry this drug. Temperature may not exceed 77
degrees F. where the drug is stored.
 Special polyolefin bag is required for maintenance infusion. Regular bags will absorb
Amiodarone.
 Amiodarone may not be given via ET Tube.
 Amiodarone is an optional drug.