A Heart To Heart Review of Amiodarone

In an emergency situation, physicians, nurses and paramedics are administering Amiodarone for heart arrhythmia.  The majority of the health care professionals are knowledgeable about the class of drug, the route of administration, and the ACLS arrhythmia that requires Amiodarone to be given.  It is important to look at Amiodarone a little bit closer as well as the patients that receive this medication.

Amiodarone is an anti-arrhythmia medication that is used for Ventricular Tachycardia, Ventricular Fibrillation and some physicians (cardiologists) order the medication for Atrial Fibrillation.  Amiodarone works like a beta-blocker and calcium channel blockers.   The medication is given via IV access, comes in tablets to be taken orally.  It is also prescribed orally for chronic atrial fibrillation.  Let’s focus on the intravenous route of Amiodarone.

During the ACLS course you will need to know the amount of drug that is used in the algorithm for ventricular arrhythmias.  The first dose to be given is 150 mg. of Amiodarone over 10 minutes, which is 15mg/minute.  And then start the drip at 360 mg to be given over 6 hours= 1mg/min., then 540 mg to be given over 18 hours=0.5 mg/min. In the ICU setting the patients are closely monitored while they are receiving Amiodarone.

Have you as a nurse ever had a patient on Amiodarone infusion?  There may be some things you may need to consider for the safety administration of the medication.  Inform the PALS class patient if applicable, or the family members about the medication they are receiving.  As a healthcare professional you will need to monitor ECG readings and watch for any changes in heart rate (bradycardia) or changes in the appearance of the ECG strip.  Any changes in the ECG readings, a physician should be notified and a decision is made about the continuing the administration of the medication.

If you are a healthcare professional and you have a patient on an Amiodarone infusion,
be aware that the half-life of Amiodarone is about 61 days according to drug guide references.  The reason for the long half-life is because Amiodarone accumulates in the fat, skin, liver, lung, heart and muscles.  It is metabolized by the liver.  It is eliminated in bile and breast milk.  If your patient is on dialysis it is NOT removed by dialysis.  In speaking to a number of nurses and paramedics they were amazed at how long Amiodarone stays in the body.  This is extremely important for the patients who may have had an allergic reaction or the ones that are experiencing severe Heart Bradycardia after their rhythm has converted.  So your patient may have these symptoms that will not go away quickly as you would like for them to.

Monitor the patient for coughing, chest pain, shortness of breath, mild fever.  Amiodarone can cause lung toxicity, lung fibrosis, and other lung problems.  Notify physician for possible order for CT scan or chest x-ray.  Monitor the patient also for any drug interactions while on Amiodarone, that includes over the counter medications and herbal medications.  Monitor the patients labs, including liver and thyroid functions.  Remember to safely administer all medications, monitor the patient and report any changes in the condition of the patient to the physician.

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