Amiodarone

Question 1

Generic Name:

Answer 1

Amiodarone

Question 2

Trade Name:

Answer 2

Cordarone

Question 3

Class:

Answer 3

Antiarrhythmic Agent

Question 4

Mechanism of Action:

Answer 4

• Multiple effects on sodium, potassium and calcium channels.
  - Prolongs action potential, refractory period.
  - Ventricular automaticity (potassium channel blockade).
  - Slows membrane depolarization and impulse conduction (sodium channel blockade).
  - Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and B-blockade).
• Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action

Question 5

Indications for use:

Answer 5

• Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin.
• Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful.
• Adjunct to cardioversion of SVT and PSVT.
• Rate control in atrial fibrillation or flutter.

Question 6

Contraindications:

Answer 6

• Bradycardia
• Second or third degree heart block unless a functioning pacemaker is present
• Cardiogenic shock
• Hypotension
• Pulmonary congestion

Question 7

Adverse Reactions:

Answer 7

- Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block

•  Torsades de Pointes (prolongs QTc interval), congestive heart failure
•  GI & Hepatic: nausea, vomiting, abnormal liver function tests
•  Skin: slate-blue pigmentation
•  Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia

Question 8

Incompatibilities/Drug Interactions:

Answer 8

• Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with Amiodarone due to similar mechanisms of action.
•  Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate, furosemide, and heparin.

Question 9

Adult Dosage: VF/Pulseless VT:

Answer 9

300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push

Question 10

Adult Dosage: Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion:

Answer 10

150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes

Question 11

Adult Dosage: Maintenance Infusion Post Resuscitation/Conversion:

Answer 11

• After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 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 (special polyolefin bag), concentration 1.8 mg/mL, and run at 33.3 mL/hr for 1 mg/min or 16.7 mL/hr for 0.5 mg/min

Question 12

Adult Dosage: For Other Maintenance Infusion:

Answer 12

Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

Question 13

Pediatric Dosage: VF/Pulseless VT

Answer 13

5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day

Question 14

Pediatric Dosage: Probable VT with pulse:

Answer 14

5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

Question 15

Routes of Administration:

Answer 15

IV/IO bolus, IV/IO infusion

Question 16

Onset of Action:

Answer 16

Variable

Question 17

Peak Effects:

Answer 17

Variable

Question 18

Duration of Action:

Answer 18

Half-life may exceed 40 days

Question 19

Arizona Drug Box Minimum Supply:

Answer 19

Optional 300mg

Question 20

Special Notes:

Answer 20

•  Amiodarone is mixed in a soap-like vehicle in glass or special plastic and is subject to excessive foaming. Draw from ampule with at least an 18 ga. needle. Mix with 20 – 30 mL of D5W prior to administration.
•  Use with caution if hepatic failure is present or if administered in combination with other drugs.
•  Patient must be on a cardiac monitor–monitor heart rate and rhythm.
•  Must be administered on an IV infusion pump during interfacility transports.
•  Temperature control is required to carry this drug. Temperature may not exceed 77 degrees F. where the drug is stored.
•  Special polyolefin bag is required for maintenance infusion. Regular bags will absorb Amiodarone.
•  Amiodarone may not be given via ET Tube.
•  Amiodarone is an optional drug.

Question 21

Supplied:

Answer 21

150mg/3mL pre-filled syringe or vial