Amiodarone

Question 1

what type of drug is amiodarone?

Answer 1

anti-arrhythmic

Question 2

when is amiodarone most commonly used?

Answer 2

in AF and atrial flutter

Question 3

what is amiodarone indicated to be used in?

Answer 3

• paroxysmal supraventrciular
• nodal + ventricular tachycardia
• AF + flutter
• ventricular fibrillation
• tachyarrhythmia’s associated with Wolf-parkinson-white syndrome

Question 4

when should amiodarone only be initiated?

Answer 4

in a hopsital or under specialist supervision

Question 5

what is the mechanism of action of amiodarone?

Answer 5

• blocks K+ channels, therefore prolonging the refractory period
• also effective at blocking Na+, having a high affinity for inactivated channels
• Anti-adrenergic effects by non-competitively blocking alpha and beta receptors
• also weak Ca2+ blocking effect

Question 6

what does amiodarone do?

Answer 6

slows down sinus rate and AV conduction and slightly prolongs the QT interval, also causes peripheral vasodilation

Question 7

what are the contraindications of amiodarone?

Answer 7

• severe conduction disturbances (unless pacemaker fitted)
• sinus node disease (unless pacemaker fitted)
• iodine sensitivity
• sino atrial heart block
• sinus bradycardia
• thyroid dysfunction

Question 8

what are the side effects of amiodarone?

Answer 8

• corneal micro deposits
• thyroid function (amiodarone contains iodine so can cause thyroid function disorders)
• hepatotoxicity
• pulmonary toxicity
• peripheral neuropathy
• pregnancy - risk of neonatal goitre.

Question 9

which monitoring tests should be done with amiodarone?

Answer 9

• TFT - before and every 6 months
• LFT - before and every 6 months
• serum K+ before
• chest X-ray before
• patients with high risk of bradycardia should be monitored for 48 hours
• patients taking amiodarone with daclatasvir and sofobuvir should be monitored especially in week 1
• patients who stopped amiodarone in last few months and need to start daclatasvir and sofobuvir should be monitored
• IV amiodarone - use ECG and resuscitation facilities must be available. monitor liver transaminases.

Question 10

what should patients be counselled about when starting amiodarone?

Answer 10

possible phototoxic reactions. should be advise to shield skin from sun during treatment and several months once treatment has been discontinued.