September 26, 2007 · Leave a Comment
Cordarone, Amio-Aqueous, Pacerone
Classifications: cardiovascular agent; antiarrhythmic, class iii
Pregnancy Category: D
Assessment & Drug Effects
- Monitor BP carefully during infusion and slow the infusion if significant hypotension occurs; bradycardia should be treated by slowing the infusion or discontinuing if necessary. Monitor heart rate and rhythm and BP until drug response has stabilized; report promptly symptomatic bradycardia. Sustained monitoring is essential because drug has an unusually long half-life.
- Monitor for S&S of: Adverse effects, particularly conduction disturbances and exacerbation of arrhythmias, in patients receiving concomitant antiarrhythmic therapy (reduce dosage of previous agent by 30%–50% several days after amiodarone therapy is started); drug-induced hypothyroidism or hyperthyroidism (see Appendix F), especially during early treatment period; pulmonary toxicity (progressive dyspnea, fatigue, cough, pleuritic pain, fever) throughout therapy.
- Lab tests: Baseline and periodic assessments should be made of liver, lung, thyroid, neurologic, and GI function. Drug may cause thyroid function test abnormalities in the absence of thyroid function impairment.
- Monitor for elevations of AST and ALT. If elevations persist or if they are 2–3 times above normal baseline readings, reduce dosage or withdraw drug promptly to prevent hepatotoxicity and liver damage.
- Auscultate chest periodically or when patient complains of respiratory symptoms. Check for diminished breath sounds, rales, pleuritic friction rub; observe breathing pattern. Drug-induced pulmonary function problems must be distinguished from CHF or pneumonia. Keep physician informed.
- Anticipate possible CNS symptoms within a week after amiodarone therapy begins. Proximal muscle weakness, a common side effect, intensified by tremors presents a great hazard to the ambulating patient. Assess severity of symptoms. Supervision of ambulation may be indicated.
Patient & Family Education
- Check pulse daily once stabilized, or as prescribed. Report a pulse <60.
- Take oral drug consistently with respect to meals.
- Become familiar with potential adverse reactions and report those that are bothersome to the physician.
- Use dark glasses to ease photophobia; some patients may not be able to go outdoors in the daytime even with such protection.
- Follow recommendation for regular ophthalmic exams, including funduscopy and slit-lamp exam.
- Wear protective clothing and a barrier-type sunscreen that physically blocks penetration of skin by ultraviolet light (e.g., titanium oxide or zinc formulations) to prevent a photosensitivity reaction (erythema, pruritus); avoid exposure to sun and sunlamps.
- Do not breast feed while taking this drug without consulting physician