Intensive Care Paramedic Drugs - Amiodarone

Front 1

What are the indications for amiodarone?

Back 1

1. Cardiac arrest with persistent VF or VT

2. Persistent VT (out side of cardiac arrest)

3. Fast atrial fibrillation or flutter causing compromise

Front 2

What are the contraindications of amiodarone?

Back 2

None in the pre hospital setting

Front 3

What are the precautions of amiodarone use?

Back 3

1. no precautions if used in cardiac arrest

2. risk or negative intropic effect

3. life threatening bradycardia post reversion

Need caution in:
Hypotension, sick sinus syndrome with out pacemaker, & previous 2nd or 3rd HB

Front 4

When giving amiodarone to fast AF what is important to consider?

Back 4

AF is commonly associated with septic shock. If septic shock is a possibility attempts to cool and volume load the patient should occur first. If significant myocardial ischemia exists post treatment amiodoraone can be used with caution.

Front 5

What is the onset of effect of amiodarone?

Back 5

5 - 10 minutes

Front 6

What is the duration of effect of amiodarone?

Back 6

1 - 2 hours after a single dose

Front 7

Describe the mechanism of action of amiodarone?

Back 7

1. Amiodarone is class III antiarrhytmic but also exerts similar effects to class Ia, II, & IV
2. prolongs the action potential duration & the refractory period of atrial, nodal & ventricular tissue.
3. Effect on the atrium & AV node: reduced frequencies of stimuli reaching the ventricle. When there is desynchronisation of the refractory periods, amiodarone allows the ventricles time to re polarise.|
4. Effect of His-purkinje system: lengthening the refractory period prevents micro re entry
5. Also increases coronary blood flow, decreases cardiac oxygen requirements, surpresses ectopic pacemakers

Front 8

Describe the pharmacokinetics of amiodarone?

Back 8

1. metabolised in the liver

2. metabolite is DEA (N-desethylamiodarone) - this is an active antiarrhythmic

3. DEA crosses the placental barrier therefore present in breast milk.

4. The metabolites are excreted in bile

Front 9

What are the adverse effects of amiodarone?

Back 9

1. Nausea

2. Hypotension

3. Light headness

4. Bradydysrhytmia

Front 10

What is the goal of treatment with amiodarone?

Back 10

1. Control of the ventricular rate

2. Reversion may also occur

Front 11

Is amiodarone safe in a patient that has been in A-fib for several days?

Back 11

1. Yes

2. There is a small chance that emboli may exit the left atrium.

3. This why amiodarone should only be given if significant cardiac compromise is present

Front 12

Is amiodarone contraindicated in the presence of long QT?

Back 12

1. Yes, but only if being Rx for long term

Front 13

If rhythm reversion occurs

Back 13

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