Mindanao State University – Iligan Institute of Technology Student: SALIMBAGAT, CHRISTINE.
P Section: 262
COLLEGE OF NURSING
PHARMACOLOGY DRUG STUDY
Brand Name: Cordarone Generic Name: Amiodarone Drug Classification: Antiarrhythmics (class III)
Dosage, Route & Frequency
Drug-Drug & Drug-Food Side Effects Adverse Reactions (By
Prescribe Drug Action Indications Contraindications
Recommended Interactions (By System) System)
d
Arrhythmias Structurally Drug: Significantly Prophylaxis Hypersensitivity to CNS: confusional CNS: Peripheral
Adult: PO Loading Dose 800–1600 related to increases digoxin levels; and treatment amiodarone, or benzyl states, disorientation, neuropathy (muscle
mg/d in 1–2 doses for 1–3 wk PO thyroxine. Class III enhances pharmacologic of life- alcohol; cardiogenic hallucinations, weakness, wasting
Maintenance Dose 400–600 mg/d antiarrhythmic; effects and toxicities threatening shock, severe sinus dizziness, fatigue, numbness,
in 1–2 doses IV Loading Dose 150 also has of disopyramide, procain ventricular bradycardia, advanced malaise, headache, tingling), fatigue, abnor
mg over 10 min followed by 360 antianginal and amide, quinidine, flecaini arrhythmias AV block unless a insomnia. mal gait,
mg over next 6 h IV Maintenance antiadrenergic de, lidocaine, lovastatin, and pacemaker is available, EENT: corneal dyskinesias, dizziness, p
Dose 540 mg over 18 h (0.5 properties. Totally simvastatin; anticoagulan supraventricul severe sinus-node microdeposits, aresthesia, headache.
mg/min), may continue at 0.5 unrelated to other t effects of ORAL ar dysfunction or sick sinus abnormal sense of CV: Bradycardia, hypote
mg/min Convert IV to antiarrhythmics. ANTICOAGULANTS enhan arrhythmias, syndrome, bradycardia, smell, dry eyes, optic nsion (IV), sinus arrest,
PO Duration of infusion <1 wk use Acts directly on all ced; verapamil, diltiazem, particularly congenital or acquired neuritis, optic cardiogenic shock, CHF,
800–1600 mg PO, 1–3 wk use cardiac tissues. BETA-ADRENERGIC with atrial QR prolongation neuropathy, arrhythmias; AV block.
600–800 mg PO, >3 wk use 400 Prolongs duration BLOCKING AGENTS may fibrillation. syndromes, or history of photophobia. Special Senses: Corneal
mg PO of action potential potentiate sinus torsade de pointes; Resp: ADULT microdeposits, blurred
Child: PO Loading Dose 10–15 and refractory bradycardia, sinus arrest, severe liver disease, RESPIRATORY vision, optic neuritis,
mg/kg/d or 600–800 mg/1.73 period without or AV block; may children. Safety during DISTRESS SYNDROME optic neuropathy,
m2/d, in 1–2 divided doses for 4– significantly increase phenytoin levels pregnancy (category D) (ARDS), PULMONARY permanent blindness,
14 d cycle or until adequate affecting resting 2- to 3- or lactation is not FIBROSIS, corneal degeneration,
control of arrhythmia PO membrane fold; cholestyramine may established. PULMONARY macular degeneration,
Maintenance Dose 5 mg/kg/d or potential. decrease amiodarone Cautious Use TOXICITY. photosensitivity.
200–400 mg/1.73 m2/d once levels; fentanyl may Hepatic disease, CV: CHF, WORSENING GI: Anorexia, nausea,
daily, may be able to reduce to 2– cause bradycardia, cirrhosis; Hashimoto's OF ARRHYTHMIAS, vomiting,
5 mg/kg/d 5 d per week hypotension, or thyroiditis, goiter, bradycardia, constipation, hepatotoxi
decreased output; may thyrotoxicosis, or history hypotension. city.
increase cyclosporine lev of other thyroid GI: anorexia, Metabolic: Hyperthyroid
els and dysfunction; CHF, left constipation, nausea, ism or hypothyroidism;
toxicity; cimetidine may ventricular dysfunction; vomiting, abdominal may cause neonatal
increase amiodarone hypersensitivity to pain, abnormal sense hypo- or
levels; ritonavir may iodine; older adults; of taste,qliver hyperthyroidism if taken
increase risk of Fabry disease, especially enzymes. during pregnancy.
amiodarone toxicity, with visual disturbances; GU:plibido, Respiratory: (Pulmonary
including cardiotoxicity. electrolyte imbalance, epididymitis. Derm: toxicity) Alveolitis,
Herbal: Echinacea possibl hypokalemia, TOXIC EPIDERMAL pneumonitis (fever, dry
e increase in hypomagnesemia, NECROLYSIS (rare), cough, dyspnea),
hepatotoxicity. hypovolemia; preexisting photosensitivity, blue interstitial pulmonary
lung disease, COPD; open discoloration. fibrosis, fatal gasping
heart surgery. Endo: syndrome with IV in
hypothyroidismhypert children.
hyroidism. Skin: Slate-blue
Neuro: ataxia, pigmentation, photosen
involuntary sitivity, rash.
movement, Other: With chronic use,
paresthesia, angioedema.
peripheral
neuropathy, poor
coordination, tremor.
Responsibilities in the Nursing Process (ADPIE) Responsibilities in the Nursing Process (ADPIE)
A-● Monitor ECG continuously during IV therapy or initiation of oral therapy. Monitor heart rate and D - ● Decreased cardiac output (Indications) ● Impaired gas exchange (Side Effects)
rhythm throughout therapy; PR prolongation, slight QRS widening, T-wave amplitude reduction with P - ● Cease life-threatening ventricular arrhythmias. Adverse effects may take up to 4 mo to
Twave widening and bifurcation, and U waves may occur. QT prolongation may be associated with resolve. ● Teach patients to monitor pulse daily and report abnormalities.
worsening of arrhythmias and should be monitored closely during IV therapy. Report bradycardia or I - ● High Alert: IV vasoactive medications are inherently dangerous; fatalities have occurred from
increase in arrhythmias promptly; patients receiving IV therapy may require slowing rate, medication errors involving amiodarone. Before administering, have second practitioner check
discontinuing infusion, or inserting a temporary pacemaker●Assess for signs of pulmonary toxicity original order, dose calculations, and infusion pump settings. Patients should be hospitalized and
(rales/crackles, decreased breath sounds, pleuritic friction rub, fatigue, dyspnea, cough, wheezing, monitored closely during IV therapy and initiation of oral therapy. IV therapy should be
pleuritic pain, fever, hemoptysis, hypoxia). Chest x-ray and pulmonary function tests are administered only by physicians experienced in treating life-threatening arrhythmias. ● Do not
recommended before therapy. Monitor chest x-ray every 3–6 mo during therapy to detect diffuse confuse amiodarone with amantadine
interstitial changes or alveolar infiltrates. Bronchoscopy or gallium radionuclide scan may also be E - Cessation of life-threatening ventricular arrhythmias. Adverse effects may take up to 4 mo to
used for diagnosis. Usually reversible after withdrawal, but fatalities have occurred. ● IV: Assess for resolve.
signs and symptoms of ARDS throughout therapy. Report dyspnea, tachypnea, or rales/crackles
promptly. Bilateral, diffuse pulmonary infiltrates are seen on chest x-ray● Monitor liver and thyroid
functions before and every 6 mo during therapy
