Amioderone

Question 1

Amioderone is highly effective but typically limited to short term treatment because of its ____?

Answer 1

Side effect profile

Question 2

Before initiating amiodarone, what should be done? (What tests?

Answer 2

Baseline ECG
CXR
ophthalmic exam
Thyroid, liver, and pulmonary function tests

Question 3

Thyroid and liver function test should be monitored how often?
-An ECG should be done how often?

Answer 3

3-6 months
Annually

Question 4

What’re some pulmonary adverse effects of amiodarone?

Answer 4

Pulmonary fibrosis
Chronic interstitial pneumonitis
Organizing pneumonia
ARDS (Acute respiratory Distress Syndrome)

Question 5

What’re some thyroid adverse effects of amiodarone?

Answer 5

Hypo/hyperthyroidism
Thyrotoxicosis
Exacerbation of current thyroid condition

Question 6

What’re some hepatic adverse effects of amio?

Answer 6

AST and ALT > 2x normal
Hepatitis and cirrhosis

Question 7

Cardiac adverse effects of amio?

Answer 7

Proarrhythmia
Bradycardia and AV block
Hypotension

Question 8

Ocular adverse effects of amio?

Answer 8

Corneal micro deposits
Optic neuritis

Question 9

Dermal adverse effects of amio?

Answer 9

Photosensitivity
Blue discoloration

Question 10

CNS adverse effects of amio?

Answer 10

Peripheral neuropathy
Ataxia
Paresthesia (abnormal pins and needles feeling)
Sleep disturbance
Impaired memory
Tremor

Question 11

What leads to the most deaths associated with amiodarone therapy?

Answer 11

Amiodarone induced pulmonary toxicity

Question 12

Treatment of amiodarone toxicity?

Answer 12

Quit amiodarone therapy and start corticosteroid therapy

Question 13

Amiodarone causes thyroid dysfunction in ___% of patients receiving long term therapy

Answer 13

10

Question 14

Amiodarone induced hypothyroidism:
-Pathophysiology
-Treatment

Answer 14

-Patho: elevated iodine content of amio causes inhibition of thyroid hormone biosynthesis
- Treatment: thyroid hormone substitution

Question 15

The inhibition of thyroid hormone biosynthesis caused by elevated levels of iodine is known as what effect?

Answer 15

Wolff-Chaikoff effect

Question 16

Amiodarone induced thyrotoxicosis:
-How many types?
-Pathophys of types?
-Treatment

Answer 16

-Type 1: elevated iodine causing increased thyroid hormone synthesis and release (Jod-Basedow phenomenon)
-Treatment of type 1: anti thyroid therapy; if resistant, radioiodine treatment or surgical thyroidectomy

-Type 2: drug induced damage of follicular cells leading to destructive thyroiditis causing elevated thyroid hormones
-Treatment of type 2: glucocorticoid therapy

Question 17

Amiodarone consists of approximately how much iodine? (What percent)

Answer 17

~37%

Question 18

What other drugs have interactions with amiodarone?

WAR FOR us SIMs DIGItally and CYCLicly through FLEx, PROCAmpIng, QUItting and eventual SILicon

Answer 18

Warfarin
Simvastatin
Digoxin
Cyclosporine
Flecainide, procainamide, quinidine
Sildenafil

Question 19

Mixing warfarin and amiodarone can have what effect?

Answer 19

Risk of bleeding

Question 20

Mixing simvastatin with amiodarone causes what effect?

Answer 20

Increased risk of rhabdomyolysis

Question 21

Mixing amiodarone with any of the interaction drugs is wrong as amiodarone is a _____ of cytochrome P450 enzymes which causes _______ clearance of those drugs.

Answer 21

Inhibitor
Decreased