Anti-arrhythmic HIGH RISK Flashcards
What is the usual maintenance dose for Amiodarone?
200mg or less.
How is amiodarone loaded for treatment of arrhythmias?
How is amiodarone loaded for treatment of ventricular fibrillation IV?
If hypothyroidism is present in clinically euthyroid patients (TSH greater than …Y.) taking amiodarone-what is the intervention?
TSH level greater than 4.5 mU/L; introduce levothyroxine
What are common side effects of amiodarone?
What are long term use side effects of amiodarone?
What side effects would cause the cessation of amiodarone?
- Pulmonary toxicity
- Corneal microdeposit compromising
- Hepatotoxicity
- Hyperthyroidism
What are C/I seen with Amiodarone ?
What pathology/clinical test are required before Ptx starts Amiodarone?
Which one is not test required for amiodarone use in stable patient at their 6 month review?
A. Chest X-ray
B. TFT
C. LFTs
D. U&Es
A. Chest X-ray and ECG at annual review
Once patient is stable what testing is required, considered and then done if there’s a particular symptoms suspected in patient taking Amiodarone?
After stopping Amiodarone what testing should still be continued?
After stopping amiodarone, continue TFT testing for up to 12 months. This is particularly important in the elderly.
Why does Amiodarone cause corneal deposits?
Corneal microdeposits result secondary to the secretion of amiodarone by the lacrimal gland with accumulation on, and absorption by, the corneal epithelium. Approximately 10% of these patients become symptomatic with glare and halos; however, that alone is usually not enough to precipitate intervention. [DOI: 10.1016/j.optm.2005.12.002].
After 5 years discontinuation of therapy would be considered
Why does Amiodarone cause pulmonary toxicity?
Amiodarone is lipophilic in nature and itself and it’s metabolite desethylamiodarone tend to concentrate in the lung. It then goes on to directly attack the lungs( cytotoxic effect) and indirectly by an immunological reaction (9,12). The latter is supported by the finding of cytotoxic T cells in bronchoalveolar lavage (BAL) fluid from patients with diagnosed APT.
Why does Amiodarone cause blueish discoloration?
It is caused by accumulation of amiodarone and its metabolites in the skin (lipophilic in nature so it will accumulate in tissue layers under the skin).
Why does Amiodarone cause hepatotoxicity?
Amiodarone and it’s metabolite desethylamiodarone tend to concentrate in the liver due to increase in tissue density, secondary to the accumulation of iodide. Hepatotixicty is due to iodine accumulation in liver-free oxygen radical–> tissue death.
Which one is common S/E associated with amiodarone?
A. Constipation
B. Altered smell sensation
C. Hot flushes
D. Anaemia
(A)
Which one is a long term use side effect associated with amiodarone?
A. Corneal microdeposit
B. Angioedema
C. Constipation
D. Altered smell sensation
(a) Corneal deposits
Which one is reversible long-term side effect once Amiodarone is withdrawn?
A. Hypothyroidism
B. Constipation
C. Corneal microdeposit
D. Neutropenia
(C) Corneal microdeposit are reversible once cessation of amiodarone
Which one is dose-related side effect associated with Amiodarone?
A. Photosensitivity
B. Altered smell sensation
C. Decreased libido
D. Hypothyroidism
E. Bradycardia
(E)
Patient Information: Age: 65. Gender: Male. Medical History: Hypertension, Type 2 Diabetes Mellitus, Atrial Fibrillation. Current Medications: Amiodarone 200mg orally daily, Metformin 1000mg orally twice daily, Lisinopril 20mg orally once daily
Chief Complaint: The patient presents with worsening dyspnea, non-productive cough, and mild fever for the past two weeks.
History of Present Illness: The patient, a 65-year-old male with a history of atrial fibrillation, has been taking amiodarone for the past six months to manage his arrhythmia. Over the past two weeks, he has noticed increasing shortness of breath, especially with exertion, accompanied by a non-productive cough. He denies any chest pain, wheezing, or hemoptysis. Additionally, he reports a mild fever but denies chills or night sweats. The symptoms have progressively worsened despite compliance with his medications.
* Vital Signs: Blood pressure 130/80 mmHg, Pulse rate 90 beats per minute, Respiratory rate 20 breaths per minute, Temperature 37.8°C (100.0°F)
* General: The patient appears uncomfortable due to dyspnea but is alert and oriented.
How would you manage this patient?
A. Continue on Amiodarone
B. Treat with phenoxymethylpenicillin
C. Withdraw Amiodarone
D. Withdraw Amiodarone and send to A&E
D
Which drug when co-administered with Amiodarone potentiates Hypokalemia and thus arrythmias?
A. Donepezil
B. Senna
C. St John’s Wart
D. Simvastatin
B; stimulant laxatives potentiates Hypokalemia thus increase risk of arrythmias.
Which drug increases the risk of Supraventricular tachyarrhythmia in elderly population?
A. Digoxin
B. Verapamil
C. Amiodarone
D. Diltiazem
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