Amiodarone - Critical Care Medications

all right in this lesson we're going to discuss a medication that while it isn't specifically used only in critical care it is a medication that you will use frequently for many different reasons therefore it's an important medication for you to know with that said let's go and get started talking about amiodarone [Music] all right you guys my name is eddie watson and welcome back to another video lesson from icu advantage where my goal is to give you guys the confidence to succeed in the icu by making complex critical care topics easy to understand i truly hope that i'm able to do just that for you and if i am i do invite you to subscribe to the channel down below when you do make sure you hit that bell icon and select all notifications so you never miss out when i release a new lesson and to test your knowledge at the end of the lesson head over to icuadvantage.com or follow the link that i'll have down in the lesson description check your learning while also being entered into weekly gift card drawings also don't forget that the notes for this lesson as well as all the others are available to the youtube and patreon members along with some other great benefits you can find links to both of those down in the description below alright with that out of the way let's go ahead and get in and start talking about what is amiodarone and how it is that it works so amiodarone is a medication that's been around for many decades it actually was first discovered in 1961 and was initially used for chest pain before it was actually pulled from the market in 1967 due to some of its side effects in 1974 though there were uses found for it in the treatment of arrhythmias and it found its way back into the market now amiodarone commonly called amio also goes by the trade names pacerone or cordurone is actually classified as an antiarrhythmic and when it comes to our antiarrhythmics we can classify them into one of five different groups amio itself is actually classified as a class 3 antiarrhythmic and so really what does that mean for it to be a class 3 antiarrhythmic now this is actually going to be a quick flyover of the pharmacology here but if you do want to understand this more in depth then please do watch a previous lesson that i did where i broke all this down in much more detail i'll link to that up above here but to illustrate how these medications work let's actually take a look at the action potential of a cardiac muscle cell also known as a myocyte now for this example we're going to be looking at just the myocyte but amiodarone also impacts the action potential of our cardiac pacemaker cells in a similar fashion so here we have the action potential along with the flow of ions at different phases of that action potential the ions flow at different times and impact the action potential in different ways the ions that we're primarily looking at are sodium calcium and potassium now the action potential starts with the quick inflow of sodium then it drops off a little bit and is sustained with the inflow of calcium and then drops back to baseline by the outflow of potassium now our class iii antiarrhythmics work by blocking or slowing the flow of potassium out of the cell during this repolarization phase doing this increases the duration and the refractory phase of both the pacemaker cells and the myocytes and so this is going to have the effect of slowing the conduction of the sa and av nodes as well as prolonging the time in which the myocyte is not going to respond to new electrical impulses now amiodarone is unique in that it does also have effects on sodium calcium as well as some beta and alpha adrenergic antagonistic effects meaning it does also act as a beta blocker the result of all of this of having these multiple effects is that we can slow the rate of our patient's heart rhythm which can be useful in our tachyarrhythmias which we are going to discuss further in just a minute here now for amiodarone there are quite a few side effects that we do want to be aware of now fortunately most of them are dose dependent so the higher the dose and the longer the administration can actually increase these risks here but amio has been shown to have minimal side effects for short duration use which is great now there are many potential side effects but really i'm just going to cover the major ones here so the first of these are actually going to be pulmonary toxicity fibrosis and ards and here doses greater than 400 milligrams per day combined with longer durations of administration can lead to this interstitial lung disease and so what this means is if possible we want to try to avoid this medication in patients who do have decreased lung function another potential side effect is going to be related to our thyroid function now amyo itself is actually structurally similar to the thyroid hormone thyroxine so t4 as well as it does also contain iodine these can lead to either under or over activity of the thyroid and is somewhat common with prolonged use particularly in rpo dosage we can also see cardiac effects of this medication and so the use of amiodarone can lead to things like bradycardia hypotension possible ventricular arrhythmias as well as asystole and then the last major side effect that i want to talk about is going to be our hepatotoxicity so liver function is something that we do want to monitor as amio can be toxic to our patient's liver all right so now let's move on and talk about our uses for amiodarone in critical care and amiodarone can be given either po iv push or as a continuous iv infusion for this lesson though i'm not going to be discussing any of the po uses or dosing and speaking of dosing our dosing for amio can primarily be divided into two groups of uses the first one is going to be for cardiac arrest so the use of amiodarone during cardiac arrest is recommended by the american heart association during acls now important to note is that while amio is a recommendation of the aha the evidence for its benefit is really not very strong and questions have been raised about its effectiveness that said it is recommended for use in the algorithm for pulseless v-tac and v-fib i'll go ahead and link to a lesson that i previously did covering this acl algorithm up above but after defibrillation and after the first dose of epinephrine we can give 300 milligrams iv push and then follow that up with another 150 milligrams iv push if there's no conversion of the vtac or vfip and for this dose we're just going to be drawing it up from the vial into the syringe and then just pushing it quickly during the code all right now the next group of use for amiodarone is going to be for various arrhythmias the most common one that you'll encounter will be for atrial fibrillation or afib now most often it's going to be for new onset so less than 48 hours afib and particularly one with a rapid ventricular rate so an afib rvr and amio has actually been shown to convert about 60 to 70 of these patients back into a normal sinus rhythm that said though amios should not be used in patients who have afib resulting from wolf parkinson white or wpw syndrome unless they are unresponsive to all other medications and cardioversion now other arrhythmias that we can use amio for would be things like atrial flutter stable supraventricular tachycardias wide complex tachycardia as well as monomorphic v-tac with a pulse now polymorphic vtec may actually be worsened by amio as that one is actually often commonly caused by prolonged qt interval which the amio is potentially going to make even worse now for our dosing for our arrhythmias we actually use a combination of a loading iv dose which is typically going to be 150 milligrams in 100 ml given over 10 minutes followed by a continuous infusion don't rapid bolus the loading dose as you can see profound bradycardia and hypotension if you do so now we follow up that loading dose with our continuous infusion and the formulation for the bag that we use is going to be 900 milligrams in 500 mls of d5 water now a 0.22 micron inline filter must be used here because we want to prevent the possible precipitates from reaching the patient and then with our continuous infusion we're actually going to start this off at one milligram per minute for the first six hours then we're going to transition to 0.5 milligrams per minute for 18 hours now if your patient has no conversion after the 18 hours the provider may actually elect to keep the infusion going longer all right and that was our review of amiodarone what it is how it is that it works some of the effects that you guys want to keep an eye on as well as the different uses that you're commonly going to see for this medication in the icu i really hope that you guys enjoy this lesson if you did please go down below and leave me a like on this video it really goes a long way to help support this channel and it lets youtube know to show this video to other people if you haven't done so already make sure and subscribe to the channel down below and a special shout out for all the youtube and patreon members out there the support that you guys showed me for this channel is truly appreciated and i absolutely value you guys thank you so much for the rest of you guys if you'd be interested in showing support for this channel as well as getting some additional perks for doing just that you can find the links to both the youtube and the patreon memberships down in the lesson description below down there you also find links to some of my favorite books in nursing gear as well as a couple awesome shirt designs that i have down there as well make sure you guys stay tuned for the next lesson i release otherwise in the meantime check out a couple awesome lessons i'm going to link to right here as always thank you guys so much for watching you have a wonderful day

Channel: ICU Advantage

Views: 59,286

Keywords: Amiodarone, Pacerone, cordarone, amio, critical care medication, ICU meds, ICU medications, how does Amiodarone work, what is Amiodarone

Id: Fpe6WHq6X20

Length: 9min 45sec (585 seconds)

Published: Tue Sep 14 2021