Report new cough, dyspnea, or chest pain (pulmonary toxicity).
Before you read
Test yourself first: 5 questions
Question 1 of 5
A client is receiving an IV amiodarone infusion for a ventricular dysrhythmia. Which assessment finding requires immediate intervention?
Answer: B. Amiodarone can cause significant bradycardia and hypotension, and it prolongs the QT interval and risks torsades de pointes. A heart rate of 44 with a systolic pressure of 80 reflects symptomatic bradycardia and hypotension that requires immediate intervention, such as slowing or stopping the infusion and notifying the provider. A blue-gray skin tint, photosensitivity, or mild nausea are concerns but not immediately life-threatening.
Question 2 of 5
A client in stable wide-complex monomorphic ventricular tachycardia with a pulse and a blood pressure of 110/70 is to receive an antiarrhythmic. Which medication does the nurse anticipate?
Answer: A. Stable ventricular tachycardia with a pulse is treated with an antiarrhythmic such as amiodarone, procainamide, or sotalol. Amiodarone is commonly used. Adenosine is for narrow-complex SVT, and atropine treats bradycardia; neither is appropriate for stable VT.
Question 3 of 5
A client on amiodarone (an antiarrhythmic) needs monitoring for which serious toxicity?
Answer: B. Amiodarone can cause pulmonary toxicity/fibrosis, as well as thyroid and liver effects and corneal deposits — monitor lung/thyroid/liver function and report a new cough or dyspnea.
Question 4 of 5
A client in stable monomorphic ventricular tachycardia with a pulse is prescribed an antiarrhythmic. Which medication does the nurse anticipate administering?
Answer: B. Amiodarone is a first-line antiarrhythmic for stable ventricular tachycardia with a pulse. Atropine is used for symptomatic bradycardia, adenosine is for stable narrow-complex supraventricular tachycardia, and digoxin is not used to acutely terminate VT.
Question 5 of 5
A client has stable, narrow-complex supraventricular tachycardia (SVT) at a rate of 180 that did not respond to vagal maneuvers. Which medication does the nurse prepare to give as a rapid IV push?
Answer: B. Adenosine is the drug of choice for stable narrow-complex SVT after vagal maneuvers fail. It must be given as a rapid IV push followed by a rapid saline flush because of its very short half-life. The client should be warned about a brief period of asystole or flushing. Amiodarone and digoxin are not the first-line acute push agents here, and atropine treats bradycardia.
Keep the streak going with more questions like these, each with a full rationale.
What is amiodarone?
It prolongs the action potential and slows conduction. Key principle: it has serious long-term toxicities, most importantly pulmonary fibrosis, and affects the thyroid, liver, and eyes.
Key points to remember
- It can cause pulmonary toxicity and fibrosis, the most serious long-term adverse effect.
- It affects the thyroid and can cause either hypothyroidism or hyperthyroidism (it contains iodine).
- It can cause blue-gray skin discoloration, corneal deposits, photosensitivity, and liver toxicity.
- It prolongs the QT interval and can cause bradycardia and hypotension.
- It has a very long half-life, so effects and toxicities persist for weeks after stopping.
Nursing priorities
- Monitor cardiac rhythm, heart rate, blood pressure, and QT interval.
- Assess respiratory status, including a baseline chest x-ray and lung sounds, for pulmonary toxicity.
- Monitor thyroid function and liver enzymes during therapy.
- Use an in-line filter and infusion pump for IV administration.
- Assess for visual changes and report new dyspnea or cough.
Labs & values
Patient teaching
- Wear sunscreen and protective clothing because of photosensitivity.
- Report shortness of breath, cough, vision changes, or unusual fatigue.
- Keep all lab and pulmonary follow-up appointments.
Red flags: report now
- Report new cough, dyspnea, or chest pain (pulmonary toxicity).
- Report severe bradycardia, hypotension, or prolonged QT.
- Report vision changes and signs of thyroid or liver dysfunction.
References
Clinical references for this topic
