Amiodarone

INTRODUCTION

Indications

Life-threatening ventricular arrhythmias unresponsive to less toxic agents. Unlabeled Use: PO: Management of supraventricular tachyarrhythmias. IV: As part of the Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) guidelines for the management of ventricular fibrillation/pulseless ventricular tachycardia after cardiopulmonary resuscitation and defibrillation have failed; also for other life-threatening tachyarrhythmias.

Action

Prolongs action potential and refractory period. Inhibits adrenergic stimulation. Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular resistance (vasodilation). Therapeutic Effects: Suppression of arrhythmias.

Adverse Reactions/Side Effects

CNS: confusional states, disorientation, hallucinations, dizziness, fatigue, malaise, headache, insomnia. EENT: corneal microdeposits, abnormal sense of smell, dry eyes, optic neuritis, optic neuropathy, photophobia. Resp: ADULT RESPIRATORY DISTRESS SYNDROME (ARDS), PULMONARY FIBROSIS, PULMONARY TOXICITY. CV: CHF, WORSENING OF ARRHYTHMIAS, bradycardia, hypotension. GI: LIVER FUNCTION ABNORMALITIES, anorexia, constipation, nausea, vomiting, abdominal pain, abnormal sense of taste. GU: decreased libido, epididymitis. Derm: TOXIC EPIDERMAL NECROLYSIS (RARE), photosensitivity, blue discoloration. Endo: hypothyroidism, hyperthyroidism. Neuro: ataxia, involuntary movement, paresthesia, peripheral neuropathy, poor coordination, tremor.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess heart rate, ECG, and heart sounds, especially during exercise (see Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

• Watch for signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician or nursing staff immediately.

• Watch for signs of pulmonary toxicity, pulmonary fibrosis, and ARDS. Signs include rales/crackles, decreased breath sounds, pleuritic friction rub, fatigue, dyspnea, tachypnea, cough, wheezing, pleuritic pain, fever, hemoptysis, and hypoxia. Monitor pulse oximetry and perform pulmonary function tests (See Appendices I, J, K) to quantify suspected changes in ventilation and respiratory function. Notify physician or nursing staff immediately of any pulmonary dysfunction.

• Be alert for signs of liver function abnormalities, as indicated by anorexia, abdominal pain, severe nausea and vomiting, yellow skin or eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, and unusual bleeding or bruising. Report these signs to the physician or nursing staff immediately.

• Monitor rashes or other skin reactions (hives, acne, abnormal sweating, exfoliation). Notify physician or nursing staff immediately because certain skin reactions may indicate rare but serious hypersensitivity reactions (toxic epidermal necrosis).

• Assess blood pressure periodically, and compare to normal values (see Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

• Monitor and report any increase or ...