anti-arrhythmic drugs, amiodarone

Question 1

Can be classified clinically based on where they act. E.g. this one acts on SV arrhythmias

Answer 1

verapamil

Question 2

Can be classified clinically based on where they act. E.g. this one acts on SV and V arrhythmias

Answer 2

amiodarone

Question 3

Can be classified clinically based on where they act. E.g. this one acts on V arrhythmias

Answer 3

lidocaine

Question 4

Vaughan Williams classification is based on their effects on electrical behaviour of myocardial cells during activity
Class 1,2,3,4:

Answer 4

○ Class 1: membrane stabilising drugs (e.g. lidocaine, flecainide)
○ Class 2: BB
○ Class 3: amiodarone, stalaol (also class 2)
○ Class 4: CCBs (incl verapamil but not dihydropyrodines)

Question 5

What is usually the treatment of choice for terminating paroxysmal SVT

Answer 5

adenosine

very short duration of action, so most SE are short lived. but prolonged in people taking dipyridamole

Question 6

this drug is preferable to adenosine in people who have SV arrhythmia but have asthma

Answer 6

verapamil

Question 7

Cardiac glycosides are contraindicated in SV arrhythmias associated with…

Answer 7

accessory conducting pathways (e..g Wolff-Parkinson-White syndrome)

Question 8

IV administration of BB (e.g. …(2)) can achieve rapid control of ventricular rate

Answer 8

esmolol
propranolol

Question 9

what can be given in cardiopulmonary resuscitation for ventricular fibrillation or pulseless tachycardia refractory to defibrillation

Answer 9

IV amiodarone

Question 10

Amiodarone - MHRA

It can cause serious adverse reactions affecting the …..7…. that may persist for a month or longer after treatment discontinuation.

Answer 10

eyes, heart, lung, liver, thyroid gland, skin, and peripheral nervous system

Question 11

MHRA amiodarone - Patients to seek medical advice if they experience these symptoms with amiodarone. what should HCP do?

Answer 11

new or worsening respiratory symptoms develop

HCP should consider using computerised tomography (CT) scans if pulmonary toxicity is suspected.

Question 12

4 important SE with amiodarone

Answer 12

Corneal microdeposits
Thyroid function
Hepatotoxicity
Pulmonary toxicity

Question 13

amiodarone - corneal microdeposits

Answer 13

Reversible on withdrawal of treatment.
However, if vision is impaired or if optic neuritis or optic neuropathy occur, amiodarone must be stopped to prevent blindness and expert advice sought.

Question 14

Patient on amiodarone has corneal microdeposits. Do they need to stop

Answer 14

Corneal microdeposits associated with amiodarone are a common side effect of this medication, and they typically do not require discontinuation of therapy unless there are other significant ocular symptoms or complications.

Corneal microdeposits can lead to visual symptoms such as blurriness, halos, or glare, especially in bright light conditions. Microdeposits can particularly impact night driving, leading to difficulties with glare and seeing at night, which could pose safety risks.

Question 15

amiodarone - thyroid disorders

Answer 15

Amiodarone contains iodine and can cause disorders of thyroid function; both hypothyroidism and hyperthyroidism can occur. Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone if it is essential; careful supervision is required.

Question 16

Pt has hypothyroidism which is amiodarone induced. Should you stop amiodarone

Answer 16

Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone if it is essential; careful supervision is required.

Question 17

Amiodarone - hepatotoxic or nephrotoxic?

Answer 17

Amiodarone is associated with hepatotoxicity and treatment should be discontinued if severe liver function abnormalities or clinical signs of liver disease develop.

Question 18

amiodarone - pulmonary toxicity

Answer 18

If new or progressive shortness of breath or cough develops in patients taking amiodarone (or recently stopped), pulmonary toxicity should always be suspected. Pulmonary toxicity is usually reversible following early withdrawal of amiodarone.

Question 19

amiodarone - phototoxicity

Answer 19

Shield the skin from light during treatment and for several months after discontinuing amiodarone; a wide-spectrum sunscreen to protect against both long-wave ultraviolet and visible light should be used.

Question 20

amiodarone monitoring

Answer 20

LFTs tests before treatment and then every 6 months.

Serum potassium concentration should be measured before treatment.

Thyroid function tests should be performed before treatment, then at 6-monthly intervals, and for several months after stopping treatment (particularly in the elderly).

Chest x-ray required before treatment.

Question 21

What to do if thyroid dysfunction suspected with amiodarone

Answer 21

Thyroid stimulating hormone levels should be measured if thyroid dysfunction is suspected. Consult specialist if thyroid function is abnormal.

Question 22

Avoid concomitant use of amiodarone and Hep C sofosbuvir regimens unless other antiarrhythmics cannot be given. If not, what do you need to monitor

Answer 22

patients should be closely monitored, particularly during the first weeks of treatment. Patients at high risk of bradycardia should be monitored continuously for 48 hours in an appropriate clinical setting after starting concomitant treatment.

Question 23

monitoring amiodarone IV use

Answer 23

ECG monitoring and resuscitation facilities must be available.

Monitor liver transaminases closely.

Question 24

Which drug can cause slate grey skin

Answer 24

amiodarone can cause slate-gray skin discoloration, also known as blue-gray hyperpigmentation. The discoloration appears on areas of the body exposed to sunlight

Question 25

amiodarone driving and skilled tasks

Answer 25

Patients and carers should be cautioned on the effects on driving and performance of skilled tasks—corneal microdeposits may be associated with blurred vision

Question 26

what must you provide to pt taking amiodarone

Answer 26

A patient alert card should be provided.

Question 27

Amiodarone + BB interactions

Answer 27

Amiodarone is predicted to increase the risk of cardiovascular adverse effects when given with BB. Manufacturer advises use with caution or avoid.
Also increased risk of hypotension.

For sotalol: also QT interval porlongation, avoid

Question 28

Amiodarone + CCs, B2 agonists, loop and thiazides, theophylline interactions

Answer 28

They are predicted to cause hypokalaemia (potentially increasing the risk of torsade de pointes) when given with Amiodarone.

Question 29

Amiodarone causes…

Answer 29

Qt interval prolongation

avoid other drugs e.g. citalopram, erythromycin, anti-arrhtymics, antipsychotics, hydrozyzine, methadone etc

Question 30

amiodarone + RLCCB

Answer 30

Amiodarone is predicted to increase the risk of cardiodepression when given with Verapamil. Manufacturer advises avoid. Also bradycardia

Question 31

flecainide + amiodarone dose adjustment

Answer 31

Manufacturer advises reduce dose by half with concurrent use of amiodarone.

Question 32

digoxin dose adjustment with concurrent use of amiodarone, dronedarone and quinine.

Answer 32

reduce digoxin dose by half

Question 33

Important info re sotalol

Answer 33

• Can prolong the QT interval, and it occasionally causes life threatening ventricular arrhythmias
• Manufacturer advises particular care is required to avoid hypokalaemia in patients taking sotalol—electrolyte disturbances, particularly hypokalaemia and hypomagnesaemia should be corrected before sotalol started and during use

Question 34

What effect can IV admin of sotalol have, and how can you counteract this

Answer 34

With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate.

Question 35

Therapeutic OD with BB can cause….

Answer 35

Therapeutic overdosages with beta-blockers may cause lightheadedness, dizziness, and possibly syncope as a result of bradycardia and hypotension; heart failure may be precipitated or exacerbated. With administration by intravenous injection, excessive bradycardia can occur and may be countered with intravenous injection of atropine sulfate.

Question 36

which type of BB are present in breast milk more than others

Answer 36

water soluble - CANS celiprolol, atenolol, nadolol, sotalol

Question 37

sotalol - monitoring of pt parameters

Answer 37

Measurement of corrected QT interval, and monitoring of ECG and electrolytes required; correct hypokalaemia, hypomagnesaemia, or other electrolyte disturbances.

Question 38

What should you correct before starting sotalol

Answer 38

hypoK
hypoMg

Question 39

MOA amiodarone

Answer 39

Class 3 antiarrhythmic (like sotalol)
Mechanism: Primarily potassium channel blockade.

Question 40

Dose amiodarone
Treatment of arrhythmias, particularly when other drugs are ineffective or contra-indicated (including paroxysmal supraventricular, nodal and ventricular tachycardias, atrial fibrillation and flutter, ventricular fibrillation, and tachyarrhythmias associated with Wolff-Parkinson-White syndrome) (initiated in hospital or under specialist supervision)

Answer 40

200 mg 3 times a day for 1 week, then reduced to 200 mg twice daily for a further week, followed by maintenance dose, usually 200 mg daily or the minimum dose required to control arrhythmia.

Question 41

label for amiodarone

Answer 41

Protect your skin from sunlight—even on a bright but cloudy day. Do not use sunbeds

Question 42

amiodarone and statins

Answer 42

increases exposure to statins and also hepatotoxicity

simvastatin max dose 20mg