Amiodarone

offlabel · May 19, 2018

It would be unusual for someone to be on oral amiodarone for a fib. Not saying it isn't done, but it isn't that common. More likely for some issue with ventricular tachydysrhythmias, maybe bridging for an ICD or something like that.

Yes, HR and rhythm is intimately connected to blood pressure (and cardiac output). That's why tachydysrhythmias are bad.

Where does the BP and HR run normally for the patient? What was the BP and HR when the last dose was given? What happens to the HR and BP when the patient gets the dose of amiodarone? These are all questions you ask to determine if you'll give the drug or not. There isn't a binary approach to taking care of sick people. If the patient has a pacemaker, does it matter what the HR is?

And why would you be concerned that the patient will develop v fib with amiodarone? It's an antiarrhythmic agent.

As an aside to the moderators, an RN can receive anonymous advice on critical patient care issues that will probably be brought to bear at the bedside but someone can't ask a nurse for their opinion on their medical condition without having the thread closed? Even an RN from another specialty asking for a specialist RN's opinion?

neuron · May 20, 2018

It would be unusual for someone to be on oral amiodarone for a fib. Not saying it isn't done, but it isn't that common. More likely for some issue with ventricular tachydysrhythmias, maybe bridging for an ICD or something like that.
Yes, HR and rhythm is intimately connected to blood pressure (and cardiac output). That's why tachydysrhythmias are bad.
Where does the BP and HR run normally for the patient? What was the BP and HR when the last dose was given? What happens to the HR and BP when the patient gets the dose of amiodarone? These are all questions you ask to determine if you'll give the drug or not. There isn't a binary approach to taking care of sick people. If the patient has a pacemaker, does it matter what the HR is?
And why would you be concerned that the patient will develop v fib with amiodarone? It's an antiarrhythmic agent.
As an aside to the moderators, an RN can receive anonymous advice on critical patient care issues that will probably be brought to bear at the bedside but someone can't ask a nurse for their opinion on their medical condition without having the thread closed? Even an RN from another specialty asking for a specialist RN's opinion?

Not sure I understand you, but I am referring to patients on this medication. I am inquiring whether to give it to patients when b/p is low. The two pts that I know are on it have hx of A-fib. They both have pacemakers. Last I heard rhythm starts in the atria, where the natural pacemaker is (SA node). A-fib starts in the atria.

I wanted to be confident giving it without worrying whether their rhythm will be disturbed when they have 15 meds to take, and their b/p is low.

chare · May 20, 2018

[...]
When I ask other more experienced nurses, some don't know. Some say 'hold if heart rate is below 60, b/p low, etc'. Any input? please include when to give with all antiarrhythmics, I guess I'm worried that the pts will go completely v-fib on me
[...]

I realize that you've told us you don't want to hear this, however, parameters on when to hold cardiovascular medications is a question best directed to the treating physician, particularly if the ordering physician is also the patient's physician, as he or she should be in the best position to determine parameters. The questions that you posted in the first paragraph of this post are all pertinent, and can help guide your discussion with the ordering physician.

[...]
I wanted to be confident giving it without worrying whether their rhythm will be disturbed when they have 15 meds to take, and their b/p is low.

Again, what is the patient's baseline blood pressure and heart rate. If he or she has a cardiac history, or is on multiple medications, it might trend low at baseline. As for heart rate, if the patient has an implanted pacemaker, then this isn't as much of a concern. Potential rhythm disturbances are also a valid concern. and considering that most antiarrhythmics are also proarrhythmic, this possibility can increase if the patient is on multiple antiarrhythmics. However, if the patient is on multiple antiarrhythmics, rate and/or rhythm control might have been difficult to; all the more reason to discuss these concerns with the ordering physician.

psu_213, BSN, RN · May 20, 2018

Not sure I understand you, but I am referring to patients on this medication. I am inquiring whether to give it to patients when b/p is low. The two pts that I know are on it have hx of A-fib. They both have pacemakers. Last I heard rhythm starts in the atria, where the natural pacemaker is (SA node). A-fib starts in the atria.
I wanted to be confident giving it without worrying whether their rhythm will be disturbed when they have 15 meds to take, and their b/p is low.

What type of unit are we talking here?

I generally have not seen BP/HR parameters for giving amio.

I have seen amio used for A fib (particularly S/P cardiac surgery as it has less of an impact on BP), and then changed to an antiarrhythmic with fewer side effects--such as dilt--when the pt is more stable.

Why are you so opposed to hearing about doctors orders. For meds that do have a HR parameter--such as beta blockers--I have seen hold for HR

Guest856929 · May 24, 2018

Given the data you provided, I would give it. I also have the luxury of monitoring the pt in the ICU. Nonetheless, I would give it.

zoidberg, BSN, RN · Jun 3, 2018

Just because they have a-fib and they are on amio doesn't mean they are on amio for a-fib. talk to the cardiologist following the patient to try to gain an understanding of what his/her main worries are for the patient. I would be wary of not giving a medication someone has been stable on.

the electrical impulse starts in the atria. But, the atria are not as important as the ventricles, which actually pump blood out to the body. If, as in a-fib, the atria are not doing their job... the ventricles will contract anyway.

in my experience, if someone has a pacer, it is more likely to be due to ventricular issues.

afib is easily managed with rate control (beta blocker) and anticoagulation (Coumadin).

I often have new nurses ask me if they should hold the (insert antihypertensive here) since BP is "low" (110/70 or something like that). No, that means its working!

MilliePieRN · Jun 3, 2018

I would never hold amiodarone without a specific "this time, this patient" order. I would be very surprised to hear any cardiologist wanting a single dose held for a one time low hr/bp. I wouldn't even call a dr over it.