Antiarrythmics 4 (Amiodarone monitoring)

Question 1

Monitoring for which side effect of amiodarone?

1. CXR (baseline, and then every 12 months)
2. PFTs (baseline and then if sxs develop)
3. high resolution CT (if sxs develop)

Answer 1

Pulmonary fibrosis

Question 2

How should you manage Pulmonary fibrosis (SE of amiodarone)

Answer 2

• Discontinue amiodarone immediately
• may consider corticosteroid therapy

Question 3

what is the monitoring recommendation for hyper and hypothyroidism, a side effect of amiodarone

Answer 3

TFTs (baseline, and then every 6 months)

Question 4

what is the management recommendation for hypothyroidism, a side effect of amiodarone

Answer 4

thyroid hormone supplementation (ex: levothyroxine)

Question 5

what is the management recommendation for hyperthyroidism, a side effect of amiodarone

Answer 5

Antithyroid drugs (ex: methimazol, propylthiouracil) or corticosteroids

may need to discontinue amiodarone

Question 6

what is the monitoring recommendation and management for optic neuritis/neuropathy, a side effect of amiodarone

Answer 6

monitoring: opthalmologic exam

Management: discontinue amiodarone immedietly

Question 7

what is the monitoring recommendation and management for corneal microdeposits, a side effect of amiodarone

Answer 7

monitoring: slit lamp exam (routine monitoring not necessary)
management: no tx necessary

Question 8

what is the monitoring recommendation and management for hepatotoxicity, a side effect of amiodarone

Answer 8

monitoring: LFTS
management: lower dose or discontinue if LFTs >2x upper limit of nml

Question 9

what is the monitoring recommendation and management for Bradycardia/heart block, a side effect of amiodarone

Answer 9

Monitor: ECG (baseline, then Q3-6mo)

management: lower dose or discontinue if severe (or continue amiodarone and implant permanent pacemaker)

Question 10

Which 2 side effects of amiodarone are monitored with history and physical exam each office visit

Answer 10

Tremor, ataxia, peripheral neuropathy, photosensitivity/blue-gray skin discoloration

Question 11

What is the reccomended management of tremor, ataxia, peripheral neuropathy, side effects of amiodarone?

Answer 11

lower dose, or discontinue amiodarone if severe

Question 12

What is the reccomended management of photosensitivity/blue-gray skin discoloration; side effects of amiodarone?

Answer 12

lower the dose; advise patients to wear sunblock outside