Questions and Answers
What is amiodarone?
An antiarrhythmic drug used to treat heart rhythm problems.
Which of the following are common brands of amiodarone?
What is the pregnancy category of amiodarone?
D
What is the primary purpose of amiodarone?
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What types of administration are used for amiodarone?
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Which of the following are indications for the use of amiodarone?
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Amiodarone belongs to the __________ class of antiarrhythmic drugs.
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What are the main actions of amiodarone?
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Match the following conditions with their association with amiodarone:
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What is the half-life of amiodarone?
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Amiodarone is contraindicated in patients with severe sinus node dysfunction.
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What should be monitored when administering amiodarone?
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Which drug interaction is a concern when using amiodarone?
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For adults, the initial oral dosage of amiodarone ranges from __________ mg per day.
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Hypersensitivity to amiodarone or __________ is a contraindication.
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What is the reported efficacy rate of amiodarone in pediatric patients for treating SVT?
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Amiodarone is often used as the first line treatment for pediatric arrhythmias.
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What is the dosage of amiodarone for adults during the first 7 to 14 days?
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Amiodarone can suppress ventricular __________ and improve left ventricular ejection fraction (LVEF) in heart failure patients.
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What should be monitored in patients with hepatic impairment when using amiodarone?
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Which of the following conditions is a contraindication for amiodarone?
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What is one common adverse reaction of amiodarone?
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Amiodarone does not have any effect on mortality in heart failure patients.
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What is a key nursing implication when administering amiodarone?
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What instructions should be given to patients regarding grapefruit juice while taking amiodarone?
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The dosage of amiodarone is __________ mg PO for children during the first 10 days.
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Match the following terms with their definitions:
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What is a potential side effect related to vision when taking amiodarone?
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Amiodarone is safe for use in pregnant women without any precautions.
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What should be done if a patient misses two doses of amiodarone?
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Study Notes
Amiodarone Overview
- Amiodarone is an antiarrhythmic medication used to treat life-threatening ventricular arrhythmias.
- Common brand names include Cordarone, Pacerone, and Nexterone.
- Available in both oral (PO) and intravenous (IV) forms.
Pregnancy and Classification
- Classified under Pregnancy Category D, indicating potential risks to the fetus.
- Belongs to Vaughan-Williams Class III antiarrhythmics.
Therapeutic Use
- Primarily indicated for life-threatening ventricular arrhythmias unresponsive to other treatments.
- Also used for management of supraventricular tachyarrhythmias.
- Included in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines for managing specific cardiac emergencies.
Pharmacodynamics and Mechanism of Action
- Prolongs action potential duration and refractory period in myocardial cells.
- Slows heart rate by inhibiting adrenergic stimulation and decreasing peripheral vascular resistance.
- Also mimics actions of other antiarrhythmic classes (Ia, II, and IV).
Dosage Information
- Oral Dosage for Adults: Initial 800-1600 mg/day for 1-3 weeks, then maintenance at 400 mg/day.
- Intravenous Dosage for Adults: Initial 150 mg IV over 10 minutes, followed by a continuous infusion.
- Conversion from IV to oral dosing is based on the duration of IV therapy.
Associated Conditions
- Effective for conditions like nonvalvular atrial fibrillation, tachycardia, recurrent ventricular fibrillation, and unstable ventricular tachycardia.
Contraindications and Precautions
- Contraindicated in patients with cardiogenic shock, severe sinus node dysfunction, and significant AV block.
- Caution required in patients with history of heart failure, thyroid disorders, and severe pulmonary or liver disease.
Interactions
- Caution with other drugs that prolong QT interval (e.g., fluoroquinolones, macrolides).
- Significant drug-drug interactions with digoxin, warfarin, and statins, requiring dose adjustments.
- Avoid grapefruit juice, as it may increase amiodarone levels.
Clinical Studies and Efficacy
- Clinical trials (CAMIAT and EMIAT) showed that amiodarone did not increase overall mortality in post-myocardial infarction patients.
- Studies suggest its efficacy in maintaining sinus rhythm compared to other agents in atrial fibrillation cases.
Pediatric Use
- Important for treating pediatric patients with life-threatening arrhythmias, with dosage based on body surface area.
- Long-term use should be approached cautiously due to potential adverse effects.
Summary of Key Dosing Guidelines
- For ventricular arrhythmias, adults may require initial high doses with gradual reduction to maintenance.
- Administration can be tailored for children based on age and body surface area, with careful monitoring for responses and side effects.### Dosage Guidelines
- PALS guidelines recommend 5 mg/kg bolus for pulseless VF/VT in children and infants.
- For perfusion tachycardia, a loading dose of 5 mg/kg is given over 20-60 minutes, with a maximum of 15 mg/kg/day.
- In adults, oral dosing for supraventricular tachycardia starts at 600-800 mg/day for one week, reducing to 400 mg/day for three weeks, then maintenance of 200-400 mg/day.
- Children’s oral dosing is 10 mg/kg/day for 10 days, followed by 5 mg/kg/day for several weeks, and can be reduced to 2.5 mg/kg/day for maintenance.
Dosing Considerations
- Hepatic impairment necessitates cautious dosage reduction and monitoring due to hepatic metabolism of amiodarone and its metabolite.
- No dosage adjustments are required for renal impairment or during intermittent hemodialysis.
Administration Details
- Amiodarone administration should be done under close monitoring, especially for patients with life-threatening arrhythmias to prevent medication errors.
- Administer only through appropriate IV setups to avoid drug instability.
Contraindications and Precautions
- Contraindicated in patients with cardiogenic shock, heart failure, and electrolyte imbalances.
- Regular monitoring for visual disturbances and thyroid dysfunction is essential due to potential side effects.
- Special attention is needed for electrolyte balance, especially for patients on diuretics or with severe diarrhea.
Adverse Reactions
- Common side effects include bradycardia, AV block, cardiac arrest, and various arrhythmias.
- Serious reactions may involve pulmonary complications, liver failure, or Stevens-Johnson syndrome.
Nursing Implications
- Essential to continuously monitor ECG, heart rate, and signs of pulmonary toxicity.
- Be vigilant for bradycardia or worsening arrhythmias during therapy and assess for neurotoxicity and signs of thyroid dysfunction.
- Monitor liver and thyroid function regularly throughout the treatment course.
Patient Education
- Instruction on adherence to prescribed dosage, monitoring pulse daily, and avoiding grapefruit juice is crucial.
- Advise patients about potential delayed side effects requiring ongoing communication with healthcare providers.
- Emphasize the need for regular follow-up exams, including chest x-rays and pulmonary function tests.
Evaluation
- Desired outcomes include the cessation of life-threatening ventricular arrhythmias, requiring up to four months for adverse effects to resolve post-treatment.
Drug Purpose
- Amiodarone is prescribed for treating serious irregular heartbeats, specifically to restore normal heart rhythm and maintain a steady heartbeat as an anti-arrhythmic medication.
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Test your knowledge of amiodarone with these flashcards. This quiz covers its definition, purpose, and various brands. Perfect for students or professionals in the medical field.
