Group 3 - Amiodarone

Question 1

Amiodarone

Drug Class?

Answer 1

Amiodarone Drug Class:

• Antiarrhythmic Agent

Question 2

Amiodarone

Mechanism of Action (MOA)?

Answer 2

Amiodarone Mechanism of Action (MOA)?

• Prolongs action potential, refractory period
• Potassium channel blockade - decreased ventricular automaticity
• Sodium channel blockade - slows depolarization and impulse conduction
• Calcium channel and ß-blockade - negative chronotropic activity (rate reduction)
• Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action

Question 3

Amiodarone

Indications?

Answer 3

Amiodarone Indications:

• Defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin
• Hemodynamically stable VT (VT with a pulse) when cardioversion unsuccessful
• Adjunct to cardioversion of SVT/PSVT
• Rate control in atrial fibrillation and atrial flutter

Question 4

Amiodarone

Contraindications?

Answer 4

Amiodarone Contraindications:

• Cardiogenic Shock
• Hypotension
• Pulmonary congestion

Question 5

Amiodarone

Adverse Reactions?

Answer 5

Amiodarone Adverse Reactions:

• CV: bradycardia, hypotension, asystole/cardiac arrest, AV block, Torsades, CHF
• GI: nausea, vomiting, abnormal liver function tests
• Skin: slate-blue pigmentation
• Other: fever, headache, dizziness, flushing, salivation, photophobia

Question 6

Amiodarone

Adult Dose?

Answer 6

Amiodarone Adult Dose:

• VF/Pulseless VT: 300 mg IV push over 30 - 60 seconds, may repeat in 3 - 5 minutes with a 150 mg IV push
• Wide-Complex Tachycardia, Atrial Flutter, Atrial Fibrillation, SVT: 150 mg IV over 10 minutes (mix in 50 ml bag of D5W) may repeat every 10 minutes
• Maintenance Infusion Post Resuscitation/Conversion: 1 mg/min IV infusion for 6 hours, then 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams. Mix 450 mg in 250 ml of D5W

Question 7

Amiodarone

Pediatric Dose?

Answer 7

Amiodarone Pediatric Dose:

• VF/Pulseless VT: 5 mg/kg IV push (max 300 mg single dose), may repeat in 5 minutes two times to a total maximum of 15 mg/kg/day
• VT with a pulse: 5 mg/kg IV administered over 20 minutes, may repeat two more times to a total of 15 mg/kg/day

Question 8

Amiodarone

Onset of Action?

Answer 8

Amiodarone Onset of Action:

• Variable

Question 9

Amiodarone

Peak Effects?

Answer 9

Amiodarone Peak Effects:

• Variable

Question 10

Amiodarone

Duration of Action?

Answer 10

Amiodarone Duration of Action:

• Half-life may exceed 40 days

Question 11

Amiodarone

AZ Drug Box Minimum Supply?

Answer 11

Amiodarone

AZ Drug Box Minimum Supply:

• 300 mg

Question 12

Amiodarone

Special Notes?

Answer 12

Amiodarone Special Notes:

• Draw from ampule with at least and 18 ga needle. Amiodarone is mixed in a soap-like vehicle and is subject to excessive foaming
• Patient must be on a cardiac monitor
• Administer on an IV infusion pump during interfacility transports
• Temperature may not exceed 77 degrees F where the drug is stored