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Pharmacology - CVS > Amiodarone > Flashcards

Amiodarone Flashcards

1
Q

When is amiodarone indicated for use?

A

Tachyarrythmias

  • AF
  • Atrial flutter
  • SVT
  • VT
  • Refractory VF
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2
Q

What is the mechanism of action of amiodarone?

A

Class III antiarrythmic

Many effects:

  • Blockade of sodium, calcium and potassium channels
  • Antagonism of α- and β-adrenergic receptors

These effects reduce spontaneous depolarisation (automaticity), slow conduction velocity, and increase resistance to depolarisation (refractoriness), including in the atrioventricular (AV) node.

  • Primary MOA: antiarrhythmic effect via blockage of voltage-gated potassium channels → prolonged repolarization of the cardiac action potential
  • Secondary MOA: inhibits β-receptors and sodium and calcium channels → decreases conduction through the AV and sinus node
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3
Q

How does amiodarone stop re-entry SVT?

A

If it involves the AV node, amiodarone may break the circuit and restore sinus rhythm

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4
Q

What are adverse side effects of amiodarone in the lung?

A

Pulmonary toxicity

  • Pulmonary fibrosis
  • Chronic interstitial pneumonitis
  • Organizing pneumonia
  • ARDS
  • Solitary pulmonary mass
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5
Q

What are adverse side effects of amiodarone on the thyroid gland?

A
  • Hypo/hyoperthyroidism
  • May aggravate thyroid conditions
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6
Q

Why can amioderone cause thyroid abnormalities?

A

It is structurally similar to thyroid hormone, and contrains idoine

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7
Q

When should amiodarone be avoided?

A

Patients with

  • Severe hypotension
  • Heart block
  • Active thyroid disease
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8
Q

What is important to remember when considering prescribing amiodarone?

A

Always requires a senior review

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9
Q

When is amiodarone used in cardiac arrest?

A

VF or pulseless VT - immediately after 3rd shock

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10
Q

How is amiodarone given in cardiac arrest?

A

Bolus injection through best IV cannula available, followed by saline/glucose flush (20 mL)

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11
Q

What is the dose of amiodarone given in cardiac arrest?

A

300mg/mL

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12
Q

What is the preferred access for administration of amiodarone?

A

PICC line

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13
Q

Why should repeated or continuous IV infusions of amiodarone be given via a central line rather than a peripheral cannula?

A

IV administration causes significant phlebitis

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14
Q

What is the maximum dose of amiodarone that can be given IV in 24 hours?

A

1.2 grams

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15
Q

What investigations would you consider doing in someone you are considering giving amiodarone (outside of a cardiac arrest)?

A
  • CXR
  • LFTs
  • TFTs
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16
Q

If someone is on long-term amiodarone and develops a cough or shortness of breath, what would you consider doing?

A

May indicate serious pulmonary toxicity - Withdraw immediately

17
Q

If someone on amiodarone long term developed new neurological symptoms, what would you do?

A

Stop amiodarone immediately - likely neurotoxicity

18
Q

If someone on amiodarone long term develops blurred vision and visual haloes, what might you consider doing?

A

Refer to opthalmologist

19
Q

How often should you repeat LFTs and TFTs in someone on long term amiodarone?

A

6-montlhy

20
Q

What are adverse side effects of amiodarone on the liver?

A

Deranged liver function

21
Q

What are adverse side effects of amiodarone on the heart?

A
  • Bradycardia
  • AV block
  • Proarrythmia
22
Q

What are adverse effects of amiodarone on the eyes?

A
  • Corneal micro-deposits
  • Optic neuritis
23
Q

What adverse side effects does amiodarone have on the GI tract?

A
  • Nausea
  • Anorexia
  • Constipation
24
Q

What adverse side effects does amiodarone have on the skin?

A
  • Photosensitivity
  • Blue discolouration of the skin
25
Q

What are adverse side effects of amiodarone on the nervous system?

A
  • Peripheral neuropathy
  • Ataxia
  • Parastheasias
  • Sleep disturbances
  • Impaired memory
  • Tremor
26
Q

What are adverse side effects of amiodarone on genitourinary system?

A
  • Epidydimitis
  • Erectile dysfunction
27
Q

What systems does amiodarone affect in terms of adverse effects?

A
  • CNS
  • Lungs
  • Heart
  • GU tract
  • Skin
  • Eyes
  • GI tract
  • Thyroid disease
  • Liver
28
Q

How long does it take for IV amiodarone take to reach peak effect?

A

15 minutes

29
Q

How is amiodarone metabolised?

A

Metabolized in the liver by CYP3A4 with biliary excretion

Pharmacology - CVS (27 decks)

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