AMIODARONE

Question 1

Generic Name?

Answer 1

Amiodarone

Question 2

Class?

Answer 2

Antiarrhythmic agent

Question 3

Trade Name

Answer 3

Cardarone

Question 4

Mechanism of Action?

Answer 4

Multiple effects on sodium, potassium & calcim channels.
Prolongs action potential, refractory period.
Ventricular automaticity (potassium channel blockade)
Slows membrane depolarization & impulse conduction (sodium channel blockade)
Negative chronotropic activity in nodal tissue, rate reduction, & antisympathetic activity
Adrenergic blocking action.

Question 5

Indications?

Answer 5

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

Question 6

Contraindications?

Answer 6

Bradycardia
2nd or 3rd degree heart block unless a functioning pacemaker is present.
Cardiogenic shock
Hypotension
Pulmonary congestion

Question 7

Side effects?

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

Drug Interactions?

Answer 8

Beta blockers, calcium channel blockers, & other antiarrhythmics are additive & can be proarrhythmic when in combo 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 Dose?

Answer 9

VF/Pulseless VT
- 300 mg IV push over 30-60 seconds, 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) Repeat every 10 minutes.
Maintenance Infusion Post Resuscitation/Conversion
- After successful defribillation, follow with up to 1 mg/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 1 mg/min. Max daily dose
2.2 grams.

Question 10

Pediatric Dose?

Answer 10

VF/Pulseless VT
- 5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes 2x to a total max 15 mg/kg/day.
Probable VT with Pulse
- 5 mg/kg IV administered over 20 minutes, repeat 2x to total 15 mg/kg/day.

Question 11

Onset?

Answer 11

Onset of Action: Variable
Peak Effects: Variable
Duration of Action: Half-life may exceed 40 days
- IV/IO BOLUS, IV/IO INFUSION

Question 12

Special Notes?

Answer 12

Amiodarone is mixed in a soap like vehicle in glass or special plastic & is subject to excessive foaming. Draw from ampule with at least 18G needle. Mix with 20-30 ml of D5W prior to administration.
Use with caution if hepatic failure is present or if administered in combo 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 trx.
Temperature control is required. <77 degrees F.
Special polyolefin bag required for maintenance infusion. Regular bags will absorb Amiodarone.
Amiodarone not given via ET Tube.
Amiodarone is an optional drug.