I am enrolled in NS426 a critical care class and am looking for a little help. I think I might have bitten off a lot, but I am willing to chew. I graduated from an ASN program five years ago, took my NCLEX this summer and passed, but have no real life experiences yet. I am hoping some one might be willing to be my interviewed colleague. I have attached the question the professor has asked us to research below:
"The newest ACLS guidelines include amiodarone as a first line drug for ventricular tachycardia and fibrillation. Think of a patient who received amiodarone.
What dose did you administer, and what effect did you observe?
If you have not administered amiodarone, interview a colleague who has used this drug."
And, I am not laughing at you at all. I just found your analogy about the cartoon very funny. I would never belittle someone for their fears. And, ACLS can be most fearful.:balloons:
And I didn't feel that you were. More laughing or commiserating with me. I took absolutely no offense. In the end, it's way better to laugh at the entire thing than continue on being depressed. Choices. That's what it's all about. I choose to learn from my own mistakes and negative experiences.
I applaud your practice of querying newbies as to where they are coming from. It would have made a huge help to me and others. Our class was also a mix of ER/ICU/PCU/docs/paramedics. None of those people were there for the first time. Review for them and I'm sure they really didn't want to start at the beginning just because the rest of us needed to.
Specializes in Education, FP, LNC, Forensics, ED, OB.
I heard that amiodarone can stay in the bloodstream for about six months. And that it can cause fibrosis for patients who have certain underlying pulmonary conditions.
Of course, I'm talking stable V-Tach patients here, not pulseless ones....
Is my info correct?
Hi, Angie,:balloons:
Chemistry/Pharm lesson here and a good question, I might add.
Amiodarone when used for longer than 6 months can cause some severe adverse events such as pulmonary fibrosis. Many other events as well. I think that is where you saw '6 months' in literature.
As for half life and tissue depletion, each individual is different. Much depends on if loading doses were given, food interference (when given orally), age, presence of renal and/or liver dz, etc. It (tissue depletion) varies with numerous factors, but, generally you can say anywhere between 10-200 days for the drug to be completely depleted. When a loading dose is used, the time for complete tissue depletion is shorter. Average is at or around 50 days.
Chemistry/Pharm lesson here and a good question, I might add.
Amiodarone when used for longer than 6 months can cause some severe adverse events such as pulmonary fibrosis. Many other events as well. I think that is where you saw '6 months' in literature.
As for half life and tissue depletion, each individual is different. Much depends on if loading doses were given, food interference (when given orally), age, presence of renal and/or liver dz, etc. It (tissue depletion) varies with numerous factors, but, generally you can say anywhere between 10-200 days for the drug to be completely depleted. When a loading dose is used, the time for complete tissue depletion is shorter. Average is at or around 50 days.
It also can cause discoloration of skin, sclera of the eyes, and organs. Have you ever washed betadine off a postop surgical patient, and the washcloth turns the sheets purple? That is the color the patients can turn. Kinda weird to see the first time. These are usually only for patients on high doses for long periods of time.
On a related topic, does anyone know why long-term amio use often causes thyroid problems? Does it have to do with the iodine atoms in the amiodarone molecule (yes, I went and looked up the molecular formula)? This is starting to bug me, not being able to find this out...
Specializes in Education, FP, LNC, Forensics, ED, OB.
rone
On a related topic does anyone know why long-term amio use often causes thyroid problems? Does it have to do with the iodine atoms in the amiodarone molecule (yes, I went and looked up the molecular formula)? This is starting to bug me, not being able to find this out...[/quote']
Hi, Angie,
Try this link, Angie. (good questions......you are taxing my brain:chuckle )
Thanks for the info! Looks like it is the iodine that is the culprit. I wonder what would happen if it were replaced with Cl or Br...would that make it better? I know there was a drug called dronedarone that was similar to amio but didn't have the iodine (I think it just had hydrogens at those spots) that they were testing but it wasn't very effective, unfortunately. Maybe if the iodine were replaced with another halogen it would be better--anyone have any idea?
300mg IV Push for pulseless VT and VFib, of course shock first....then 1mg/min gtt per hospital protocol.....150mg IV over 10 minutes for VT with a pulse if you have enough time then gtt, some MDS will go for another 150mg if it doesnt work then gtt....Our protocol says to use a filtered tubing set, I guess there must be particals within the mixture that may be harmful for the patients.
some smarter person will come along to straighten both of us out. it's one of the great things about nursing--we're surrounded by really brilliant people.
let me tell you how i think about amio. (back years ago we used a lidocaine. it's like 'novacaine' that dentists use--slowed nerve conduction. just like the dentist slowed the pain receptors in your jaw, lido slowed conduction in the heart. it wasn't hard to think about "novaine in the cardiac muscle" stoping vf or vt.)
now there's this amio. does everything. how's it do all that? well, it just does. in my simple way--i imagine the heart in crisis as being on fire. the fire dept arrives. they pull out this fire hose. you were using the garden hose, right. you were trying to save the kitchen or the living room. now the fire dep't is here. they are going to pump thousands of gallons per minute into your house. that is amio.
since it's going into the whole house--instead of just the kitchen where you know the fire is--a huge flood in necessary to start off with. ok?
so you start off with an iv bolus of amio; (if memory serves--150mg iv over 10min) (repeat in 10--30min prn). so you've filled the whole body and it's tissues with amio. (ie. you've soaked the whole house.)
then you give enough amio to put out the stove that's still hot--whoops--to de-energize the source of cardiac ectopics. (1 mg/min for 10hrs--most ways of reconstituting the drug make this about 34cc/hr.)
the way we use amio, since day one after the trial time, was amio bolus, for vt w/pulse, or vea, is 150 over 10 mins, then a drip of 1mgm-33 gtts, for 6 hrs, then decreased to .5 mgm for the next 18 hrs=17 gtts. usually they try and start po by then, but for the icu they usually keep it on, or wean it off if peri infarct. for pulseless vt, or vf, it's 300mgm ivp, then shock, again. hope i explained. the repeat boluses are as amio recomemends. also, a question................ does anyone only use amio in a central line?, or do you run peripherally?
also, a question................ does anyone only use amio in a central line?, or do you run peripherally?
yes, i give amio all the time through a central line. i work on ct surgery stepdown so everyone comes to me with an ij. eventually, the ij is d/c'd so there are other patients who get it peripherally.
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tntrn, ASN, RN
1,340 Posts
And I didn't feel that you were. More laughing or commiserating with me. I took absolutely no offense. In the end, it's way better to laugh at the entire thing than continue on being depressed. Choices. That's what it's all about. I choose to learn from my own mistakes and negative experiences.
I applaud your practice of querying newbies as to where they are coming from. It would have made a huge help to me and others. Our class was also a mix of ER/ICU/PCU/docs/paramedics. None of those people were there for the first time. Review for them and I'm sure they really didn't want to start at the beginning just because the rest of us needed to.
Thanks for your posts.