New cough, dyspnea, or chest pain — notify the provider (possible 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 cardiac action potential and slows conduction. This steadies the rhythm but can also cause QT prolongation, bradycardia, and hypotension. Its half-life is very long, so its effects and toxicities last for weeks after it is stopped. It contains iodine and can injure the lungs, thyroid, liver, eyes, and skin. Pulmonary fibrosis is the most serious long-term risk, so the nurse tracks breathing, thyroid and liver labs, and vision.
Key points to remember
- Pulmonary toxicity and fibrosis is the most serious long-term adverse effect.
- It contains iodine and can cause either hypothyroidism or hyperthyroidism.
- It can cause blue-gray skin discoloration, corneal deposits, photosensitivity, and liver toxicity.
- It prolongs the QT interval and can cause bradycardia and hypotension.
- Its very long half-life means effects and toxicities persist for weeks after stopping.
- IV amiodarone is given by infusion pump through an in-line filter.
Nursing priorities
- Monitor rhythm, heart rate, blood pressure, and QT interval on telemetry, because bradycardia, hypotension, and QT prolongation can develop.
- Get a baseline chest x-ray and pulmonary function tests and assess lung sounds and breathing at every visit, because pulmonary fibrosis is the most serious toxicity.
- Monitor TSH and liver enzymes during therapy, because the drug affects the thyroid and liver.
- Give IV doses by pump through an in-line filter.
- Ask about vision changes and teach sun protection, because of corneal deposits and photosensitivity.
Labs & values
Worked example
- Cue: A client on long-term amiodarone reports a dry cough and increasing shortness of breath over several weeks.
- Meaning: Possible pulmonary toxicity, the most serious long-term effect.
- Action: Assess lung sounds and oxygen saturation, notify the provider, and anticipate a chest x-ray and pulmonary function tests.
- Evaluation: The provider evaluates for fibrosis and adjusts therapy, and the client can name the symptoms to report.
Patient teaching
- Wear sunscreen and protective clothing because your skin will burn more easily.
- Report shortness of breath, a new cough, vision changes, unusual tiredness, or a blue-gray skin color.
- The drug stays in your body for weeks, so side effects can continue after it is stopped.
- Keep all lab, lung, and eye follow-up appointments.
Common mistakes
- Blaming a new cough or dyspnea on a cold or heart failure without considering pulmonary toxicity.
- Assuming toxicity ends soon after the drug is stopped. The long half-life keeps it going for weeks.
- Expecting only hypothyroidism. Amiodarone can cause either low or high thyroid function.
- Giving the IV form without an in-line filter or pump.
Red flags: report now
- New cough, dyspnea, or chest pain — notify the provider (possible pulmonary toxicity).
- Severe bradycardia, hypotension, or a prolonged QT — hold the dose and notify the provider.
- Vision changes — report for eye evaluation.
- Signs of thyroid or liver dysfunction — report and expect labs.
References
Clinical references for this topic
