AMIODARONE HYDROCHLORIDE
GENERIC NAME: Amiodarone Hydrochloride
BRAND NAMES: Cordarone, Pacerone
DRUG CLASSES: Antiarrhythmic, Adrenergic blocker
Pregnancy Category D
MECHANISM OF ACTION
As type III antiarrhythmic it acts directly on cardiac cell membrane; prolongs repolarization and refractory period; increases ventricular fibrillation threshold; it also acts on peripheral smooth muscle to decrease peripheral resistance.
INDICATIONS
Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias that do not respond to other antiarrhythmics or when alternative agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug
CONTRAINDICATIONS
This drug is contraindicated with hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation. This drug should be used cautiously with thyroid dysfunction, pregnancy.
SIDE EFFECTS
CNS: Malaise, fatigue, dizziness, tremors, ataxia, paresthesias, lack of coordination
CV: Cardiac arrhythmias, cardiac arrest, CHF, hypotension
EENT: Corneal microdeposits (photophobia, dry eyes, halos, blurred vision); ophthalmic abnormalities including permanent blindness
ENDOCRINE: Hypothyroidism or Hyperthyroidism
GI: Nausea, vomiting, anorexia, constipation, abnormal LFTs, liver toxicity
RESPIRATORY: Pulmonary toxicity - pneumonitis, infiltrates (shortness of breath, cough, rales, wheezes)
OTHER: Photosensitivity, angioedema
DRUG-DRUG INTERACTIONS
1. Increased digitalis toxicity with digoxin;
2. Increased quinidine toxicity with quinidine;
3. Increased procainamide toxicity with procainamide;
4. Increased flecainide toxicity with amiodarone;
5. Increased phenytoin toxicity with phenytoin, ethotoin;
6. Increased bleeding tendencies with warfarin; and
7. Potential sinus arrest and heart block with beta blockers, calcium channel blockers.
DRUG-LAB TEST INTERACTIONS
1. Increased T3 levels, increased serum reverse T3 levels
NURSING CONSIDERATIONS
Assessment
History: Hypersensitivity to amiodarone, sinus node dysfunction, heart block, severe bradycardia, hypokalemia, lactation, thyroid dysfunction, pregnancy
Physical: Skin color, lesions; reflexes, gait, eye examination; P, BP, auscultation, continuous ECG monitoring; R, adventitious sounds, baseline chest x-ray; liver evaluation; LFTs, serum electrolytes, T4, and T3
Interventions
1. Monitor cardiac rhythm continuously;
2. Monitor for an extended period when dosage adjustments are made;
3. Monitor for safe and effective serum levels (0.5–2.5 mcg/mL);
4. Doses of digoxin, quinidine, procainamide, phenytoin, and warfarin may need to be reduced one-third to one-half when amiodarone is started;
5. Give drug with meals to decrease GI problems;
6. Arrange for ophthalmologic examinations; reevaluate at any sign of optic neuropathy;
7. Arrange for periodic chest x-ray to evaluate pulmonary status (every 3–6 mo); and
8. Arrange for regular periodic blood tests for liver enzymes, thyroid hormone levels.
Teaching points
1. Drug dosage will be changed in relation to response of arrhythmias; you will need to be hospitalized during initiation of drug therapy; you will be closely monitored when dosage is changed;
2. Have regular medical follow-up, monitoring of cardiac rhythm, chest x-ray, eye examination, blood tests;
3. You may experience these side effects: Changes in vision (halos, dry eyes, sensitivity to light; wear sunglasses, monitor light exposure); nausea, vomiting, loss of appetite (take with meals; eat small, frequent meals); sensitivity to the sun (use a sunscreen or protective clothing when outdoors); constipation (a laxative may be ordered); tremors, twitching, dizziness, loss of coordination (do not drive, operate dangerous machinery, or undertake tasks that require coordination until drug effects stabilize and your body adjusts to it); and
4. Report unusual bleeding or bruising; fever, chills; intolerance to heat or cold; shortness of breath, difficulty breathing, cough; swelling of ankles or fingers; palpitations; difficulty with vision.
REFERENCES:
Karch, Amy M. Lippincott Williams & Wilkins. 2007 Nursing Drug Guide.
HOME | A-B | C-D | E-F | G-H | I-J | K-L | M-N | O-P | Q-R | S-T | U-V | W-X | Y-Z | HOME
This is a free website hosted by weebly.
This is created for Student Nurses by blue_identity.
