Pharm exam 3 - Antidysrhythmic Medication

Amiodarone MOA:

Potassium Channel Blocker
(delays repolarization)

Amiodarone uses:

Atrial & Ventricular dysrhythmias
• Life-threatening ventricular dysrhythmias (refractory)
• Atrial fibrillation (off label)

Amiodarone pharmacokinetics

Given IV & PO
LONG T 1/2
Highly protein bound
CYP enzyme metabolism
• Inhibitor to other drugs
• Grapefruit juice is inhibitor for this drug

Amiodarone short term adverse effects:

• Hypotension & Bradydysrhythmias
• GI effects (N/V anorexia)
• CNS effects (ataxia, tremors, mood changes, hallucinations)

Amiodarone long term - toxicity adverse effects:

• Pulmonary (fibrosis, pneumonitis)
• Cardiac (dysrhythmias)
• Thyroid (Hypo/Hyper thyroidism)
• Liver (cirrhosis, fibrosis)
• Eyes (optic neuropathy/neuritis - RARE)
• Skin (photosensitivity)
• Teratogenic

What should the nurse monitor while a patient is taking amiodarone?

• ECG

• BP & HR

• Liver function tests (LFTs)

• Thyroid function

• Chest X-ray/Pulmonary function tests (CXR/PFTs)

When should the nurse hold amiodarone?

• HR <60 bpm

• New or worsening dysrhythmias

Notify the provider.

What symptoms require immediate provider notification while taking amiodarone?

• Shortness of breath or cough (pulmonary toxicity)

• Jaundice/yellow skin (liver toxicity)

• Vision changes

What patient teaching is important for amiodarone?

• Avoid grapefruit juice

• Wear sunscreen/sun protection

• Report cough, SOB, jaundice, or vision changes

Which medications interact with amiodarone?

• Digoxin

• Warfarin

• Statins

• Phenytoin

Atropine MOA:

• Suppresses the action of the parasympathetic nervous system

Atropine Symptomatic Bradycardia:

• feeling lightheaded, tired, or dizzy or may experience syncope

Atropine administration:

IV bolus: Repeat every 3 to 5 minutes to avoid exceeding a total dose of 3 mg or 0.04 mg/kg;
may also be administered via IM, subcutaneous, and endotracheal tubes

Atropine contraindications:

Angle-closure glaucoma, Urinary Retention

Atropine Side Effects:

Dry mouth, constipation, headache

Atropine Adverse Effects:

• Blurred vision, urinary retention, decreased gastric motility, disorientation, hallucinations, dizziness, sedation, hypotension, hypertension, tachycardia

Atropine Medication Outcomes:

Increased heart rate, corrected bradycardia

When is atropine indicated?

Symptomatic bradycardia

• Dizziness

• Hypotension

• Syncope

• Altered mental status

• Chest pain

What should the nurse assess before administering atropine?

• HR

• BP

• ECG

• Signs of poor perfusion

What should the nurse do if atropine is ineffective?

Prepare for:

• Transcutaneous pacing

• Vasoactive medications per ACLS protocol

What patient teaching is important for atropine?

Temporary side effects may include:

• Dry mouth

• Blurred vision

• Palpitations