DRUG STUDY
Drug Features
Brand Name:
Cordarone
Generic Name:
Amiodarone
Classification:
Therapeutic:
Antiarrhythmics
Route/Dosage/Frequency
: amiodarone or iodine.
Ventricular Arrhythmias
PO (Adults): 800 – 1600
mg/day in 1 – 2 doses for 1
– 3 weeks, then 600 – 800
mg/day in 1 – 2 doses for 1
month, then 400 mg/day
maintenance dose
PO (Children): 10
mg/kg/day (800
mg/1.72m²/day) for 10
days or until response or
adverse reaction occurs,
then 5 mg/kg/day (400
mg/1.72m²/day) for several
weeks, then decreased to
Mechanism of Action Indication Contraindication Effects Nursing
Responsibilities
Prolongs action Life-threatening Contraindicated in: Side effects  Check for
potential and ventricular arrythmias Patients with doctor’s order
refractory period. unresponsive to less cardiogenic shock; CNS: Confusional  Carefully ready
Inhibits adrenergic toxic agents. severe sinus node states, the product
stimulation. Slows the dysfunction; 2nd – and disorientation, packaging to
sinus rate, increases 3rd degree AV block; hallucinations, note strength of
PR and QT intervals, Bradycardia (has dizziness, fatigue, solution,
and decreases caused syncope unless malaise, headache, dosage/route of
peripheral vascular a pacemaker is in insomnia. EENT: administration
resistance place); Corneal  Observe 10 R’s
(vasodilation). Hypersensitivity to microdeposits, in medicine
abnormal sense of administration
Therapeutics Effects: smell, dry eyes,  Instruct patient
Suppression of Use cautiously in: optic neuritis, optic to take
arrhythmias. History of CHF; neuropathy, medication
Thyroid disorders; photophobia. CV: around the clock
Corneal refractive laser Bradycardia, and to finish the
surgery; Severe hypotension. GI: drug completely
pulmonary or liver Nausea, vomiting, as directed even
disease. anorexia, if he/she already
constipation, feels better.
abdominal pain,
abnormal sense of Assessment:
taste, liver function  Monitor ECG
abnormalities. GU: continuously
Decreased libido, during IV
epididymitis. Endo: therapy or
Hyperthyroidism, initiation of oral
Hypothyroidism. therapy. Monitor
Neuro: Ataxia,
2.5 mg/kg/day (200 involuntary heart rate and
mg/1.7m²/day) or lowest movement, rhythm
effective maintenance paresthesia, throughout
dose. peripheral therapy; PR
neuropathy, poor prolongation,
IV (Adults): 150 mg over coordination, slight QRS
10 min, followed by 360 termor. widening, T
mg over the next 6 hrs and wave amplitude
then 540 mg over the next Adverse effect: reduction with T
18 hrs. Continue infusion wave widening
at 0.5 mg/min until oral Resp: Adult and bifurcation,
therapy is initiated. If respiratory distress and U waves
arrhythmias recurs, a small syndrome (ARDS), may occur. QT
loading infusion of 150 mg Pulmonary Fibrosis, prolongation
over 10 min should be Pulmonary toxicity. may be
given; in addition, the rate CV: Congestive associated with
of the maintenance Heart Failure, worsening of
infusion may be increased. Worsening of arrhythmias and
Conversion to initial oral Arrhythmias. should be
therapy – If duration of IV Derm: Toxic monitored
infusion was <1 wk, oral Epidermal closely during IV
dose should be 800 – 1600 Necrolysis therapy. Report
mg/day; if IV infusion was bradycardia or
1 – 3 wk, oral dose should increase in
be 600 – 800 mg/day; if IV arrhythmias
infusion was >3 oral dose promptly;
should be 400 mg/day. patients
ACLS guidelines for receiving IV
pulseless Vfib/Vtach – 300 therapy may
mg IV push, may repeat require slowing
once after 3 – 5 min with rate,
150 mg IV push discontinuing
(maximum cumulative infusion, or
dose 2.2 g/24 hrs; inserting a
unlabeled). temporary
pacemaker.
IV: Intraosseous  Assess pacing
(Children and infants): and
PALS guidelines for defibrillatioin
pulseless Vfib/Vtach – 5 threshold in
mg/kg as a bolus; patients with
perfusion tachychardia – 5 pacemakers and
mg/kg loading dose over implanted
20 -60 min (maximum of defibrillators at
15 mg/kg/day; unlabeled). beginning and
periodically
Supraventicular during therapy.
Tachycardia  Assess for signs
of pulmonary
PO (Adults): 600 – 800 toxicity (rales,
mg/day for 1 wk or until crackles,
desired response occurs or decreased breath
side effects develop, then sounds, pleuritic
decrease to 400 mg/day for friction rub,
3 wks, then maintenance fatigue, dyspnea,
dose of 200 – 400 mg/day. cough,
wheezing,
PO (Children): 10 pleuritic pain,
mg/kg/day (800 fever,
mg/1.72m²/day) for 10 hemoptysis,
days or until response or hypoxia). Chest
side effects occur, then 5 x-ray and
mg/kg/day (400 pulmonary
mg/1.72m²/day) for several function tests are
weeks, then decreased to recommended
2.5 mg/kg/day (200 before therapy.
mg/1.72m²/day) or lowest Monitor chest x-
effective maintenance ray every 3 – 6
dose. months during
therapy to detect
diffuse
interstitial
changes or
alveolar
infiltrates.
Bronchoscopy or
gallium
radionuclide
scan may also be
used for
diagnosis.
Usually
reversible after
withdrawal, but
fatalities have
occurred.
 IV: Assess for
signs and
symptoms of
ARDS
throughout the
therapy. Report
dyspnea,
tachypnea, or
rales/crackles
promptly.
Bilateral, diffuse
pulmonary
infiltrates are
 seen on chest x-
ray.
 Monitor blood
pressure
frequently.
Hypotension
usually occurs
during first
several hours of
therapy and is
related to rate of
infusion. If
hypotension
occurs, slow rate
 PO: Assess for
neurotoxicity
(ataxia, proximal
weakness,
tingling, or
numbnessin
fingers and toes,
uncontrolled
movements,
tremors);
common during
initial therapy,
but may occur
within 1 wk to
several months
of initiation of
therapy and may
persist for more
than 1 yr after
 withdrawal.
Dose reductioin
is recommended.
Assist patient
during
ambulation to
prevent falls.
 Opthalmic
exams should be
performed before
and regulary
during therapy
and whenever
visual changes
(photophobia,
halos around
lights, decreased
acuity) occur.
May cause
permanent loss
of vision.

Implementation:
 High Alert: IV
vasoactive
medicaitons are
inherently
dangerous;
fatalities have
occurred from
medication
errors involving
amiodarone.
 Before
administering,
have second
practitioner,
check original
order, dose
calculation, and
infusion pump
settings. Patients
should be
hospitalized and
monitored
closely during IV
therapy and
initiation of oral
therapy. IV
therapy should
be administered
only by
physicians
experienced in
treating life-
threatening
arrhythmias.
 Hypokalemia
and
hypomagnesemia
may decrease
effectiveness or
cause additional
arrhythmias;
correct before
therapy.
 Monitor closely
when converting
from IV to oral
therapy,
especially in
geriatric patients.
 PO: May be
administered
with meals and
in divided if GI
intolerance
occurs or if daily
dose exceeds
100mg.