CC July 2015 Amiodarone

echoecho's version from 2015-10-26 12:42


Question Answer
What is Amiodarone?it is an antiarrhythmic agent approved by the FDA for treating recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia
Amiodarone is frequently prescribed off-lable for what?to restore and maintain sinus rhythm in pts with hx of atrial fibrillation
Does Amiodarone appear to be the most effective medical therapy for maintenance of sinus rhythm in such patients?yes
*** Why does the AHA/ACC/HRS recommend the use of amiodarone only after consideration of risks an when other agents have either failed or are contraindicated?because the potential benefits of amiodarone rx must be balanced against several serious cardiovascular and noncardiovascular risks
Studies have compared rhythm control with rate control for management of atrial fibrillation. Which of the two controls has not been shown to reduce cardiovascular morbidity associated with atrial fibrillation and an increased risk of hospitalization with anti-arrhythmic use?rhythm control
List the conditions when rhythm control should be considered?1) pts who are markedly symptomatic (with palpitations or symptoms of heart failure) 2) pts w/ evidence of tachycardia-mediated cardiomyopathy
If a rhythm control strategy is appropriate, compare amiodarone to other antiarrhythmic agents (including sotalol (Betapace)?Amiodarone had the lowest odds ratio for recurrence of atrial fibriation.
While amiodarone, like most other antiarrhythmics prolongs the ____ interval, risk of ventricular arrhythmia is relatively low?QT
***Amiodarone is an appropriate first-line therapy in what 3 conditions?1) heart failure 2) left ventricular hypertrophy 3) hx of MI
Why, when using Amiodarone are additional medications for rate control not necessary?because of amiodarone's negative chronotropic effect
How is amiodarone metabolized and do dose adjustments based on renal function need to be done?hepatically; no
Advantages of amiodarone should be weighed against potential for toxicity. About 2-17% of patients can develop what serious toxicity?pulmonary toxicity shown by hypersensitivity or interstitial pneumonitis
***What tests should be obtained prior to initiating amiodarone therapy? What is the follow-up?1) base line CXR and pulmonary function testing 2) f/u lung exams and chest x-rays every 3-6 months, although some experts feel that annual CXRs are sufficient
What is the most common cardiovascular side effect of amiodarone use? In which patients should amiodarone not be used?1) bradycardia 2) C.I. in pts w/ sinus node dysfunction OR second OR third-degree AV block
25% of patients will have GI side effects, often when during treatment? What tests should be monitored?1) during loading phase of therapy 2) liver function tests
Typical doses of amiodarone introduce inorganic ________ at levels far above normal dietary consumption with the potential for what?1) iodide 2) hypo- or hyperthyroidism
Baseline testing and periodic monitoring because of what should be done given the above?thyroid function tests
List other commonly reported side effects with use of amiodarone?1) tremors 2) visual disturbances
*** Amiodarone has many drug-drug interactions notably with warfarin and digoxin. When initiating amiodarone therapy, the dose of warfarin should be reduced by ___ to ___%?30-50%
In the network meta-analysis cited above, the odds ratio for any serious adverse effect was what?2.41
Why does the effect of Amiodarone persist for weeks after discontinuation?1) high volume of distribution 2) long elimination half-life
Has meta-analysis demonstrated a statistically significant impact of amiodarone therapy on all-cause mortality?no
A recent retrospective analysis of the ARISTOTLE trial found a possible association between amiodarone use and what event? What was the hazard ratio? 1) stroke 2) 1.47
Amiodarone use was associated with a _____ (increase vs. decrease) in the time in the therapeutic range for warfarin treated patients?decrease
What was the objective of the ARISTOTLE trial? Did amiodarone use affect the relative efficacy of warfarin and apixaban?1) compare warfarin and apixaban 2)no
While amiodarone may be beneficial for carefully selected patients, what should providers be aware of?1) numerous toxicities 2) numerous contraindications
*** SUMMARY - Amiodarone is FDA approved for treating what 2 conditions and is used off-label for what condition?1) recurrent ventricular fibrillation and recurrent hemodynamic unstable ventricular tachycardia 2) atrial fibrillation
*** SUMMARY - The AHA/ACC/HRS recommendation is to use amiodarone how?only for atrial fibrillation after consideration of risks and when other agents have either failed or are contraindicated
*** SUMMARY - Serious pulmonary toxicity prompts the recommendation to obtain what 2 tests before initiating therapy w/ follow (optimal interval not defined)?CXR and pulmonary function testing
*** SUMMARY - When adminstered with warfarin, the dose of warfarin should be decreased by ___ to ___%?30-50 %