Anti-Arrhythmic Drug

Question 1

Amiodarone

Class III

Answer 1

Treatment: 200 mg TDS for 7 days, 200 mg BD for 7 days and 200 mg OD as maintenance
S/E:
- Eyes (blindness),
- Skin (photo toxicity, slate-grey skin),
- Nerves (numbness, tingling),
- Lungs (SOB, dry cough),
- Hepatotoxicity (jaundice, N+V, Abdo Pain)
- Thyroid dysfunction (AmIODarone contains IODine)
Hyperthyroidism eg weight loss, tachy ——> GIVE CARBIMAZOLE
Hypothyroidism eg weight gain, brady ——> GIVE LEVOTHYROXINE

Monitoring

1. ) Annual Eye Test
2. ) Chest X-ray before treatment
3. ) Liver Function tests every 6 months
4. ) Monitor TSH, T3, T4 before treatment and every 6 months
5. ) BP and ECG
6. ) Serum potassium

Interaction

1. ) Grapefruit juice
2. ) Enzyme inhibitor - Warfain, Phenytoin, Digoxin
3. ) Statins - increase risk of myopathy
4. ) beta blockers, CCBs - Bradycardia
5. ) QT prolongation - Quinolones, Macrolides, TCAs, SSRIs, Lithium, Anti- Malarials, Antipsychotics, Quinine, Hydroxvhloroquine

Question 2

Digoxin

High Risk Drugs

Answer 2

2 KIDNEYS

2 -

K - POTASSIUM -
I - Inotrope ( positive)
D - Digitalis Toxicity (low potassium high digoxin)
N - Nausea
E - Emesis (Vomitting)
Y - Yellow Vision/ Blurred Vision
S - Potassium Sparing Diuretics (helps prevent reduction in K+)

Dose

• LOADING DOSE (has a long half life)
• MAINTENANCE DOSE
  - Af and non paroxysmal Af in sedentary patients: 125 - 250 mcg
  - Worsening or server HF - 62.5 - 125 mcg
• Different dosage forms have different bioavailabilities