Amiodarone

Question 1

Amiodarone Name

Answer 1

Amiodarone

Question 2

Amiodarone Class

Answer 2

Antiarrhythmic Agent

Question 3

Amiodarone Mechanism of Action

Answer 3

• 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 β-blockade).
• Dilates coronary arteries due to calcium channel and alpha-adrenergic blocking action

Question 4

Amiodarone Indications

Answer 4

• 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 5

Amiodarone Contraindications

Answer 5

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

Question 6

Amiodarone Adverse Reactions

Answer 6

• 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 7

Amiodarone Incompatibilities/Drug Interactions

Answer 7

• 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 8

Amiodarone Adult Dosage

Answer 8

• VF/Pulseless VT: 300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push
• Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion: 150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes
• Maintenance Infusion Post Resuscitation/Conversion: 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
• For Other Maintenance infusion: Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams

Question 9

Amiodarone Pediatric Dosage

Answer 9

• VF/Pulseless VT: 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
• Probable VT with pulse: 5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

Question 10

Amiodarone Routes of Administration

Answer 10

IV/IO bolus, IV/IO infusion

Question 11

Amiodarone Onset

Answer 11

Variable

Question 12

Amiodarone Peak Effects

Answer 12

Variable

Question 13

Amiodarone Duration

Answer 13

Half-life may exceed 40 days

Question 14

Amiodarone AZ Drug Box Minimum

Answer 14

Optional 300 mg