/strong>(Da Long) is definitely a “godfather”, a good medicine, and its usage is very simple:
Quickly: 150mg (15mg/min) for the first 10 minutes;
slow after: then 6 360 mg per hour (1 mg/min);
maintenance< /span>: Administer 540 mg (0.5 mg/min) for the remaining 18 hours.
The total amount of oral and intravenous doses per day should not exceed 1200mg. Everyone said it was good.
Is that so? Let’s see an example strong>How amiodarone got involved in a lawsuit
Case
60-year-old female patient with a history of rheumatic heart disease 5 years, repeated palpitations for 3 days, fatigue and poor appetite, lower extremity edema and admission to hospital, electrocardiogram and atrial fibrillation, 150mg of amiodarone was added to 20ml of normal saline for slow intravenous push, and then 300mg of normal saline was added to 50ml of micro-pump 5ml/h to maintain 6 Change to 2.5ml/h after one hour.
The patient died after taking amiodarone and got a lawsuit. What was wrong? Let’s find fault together.
▎Lethal Use 1:
Amiodarone is both a cardioversion and maintenance Heart rate drugs, then atrial fibrillation more than 48h, can direct cardioversion? The patient was cardioverted, but suffered a cerebral embolism and died.
●Atrial fibrillation is a common heart rhythm disorder, most of which occurs in patients with heart disease, such as rheumatic heart disease, coronary heart disease and hypertension. In chronic atrial fibrillation, a mural thrombus often forms in the atrium, and the thrombus shedding can cause arterial embolism. Atrial fibrillation is one of the main causes of thromboembolic events, and 75% of such cases are complicated by cerebrovascular accidents.
▎Fatal Usage 2:
Can amiodarone be added to normal saline? ? Can’t! Dalong (Amiodarone Hydrochloride Injection) is required to be prepared with 5% glucose solution (isotonic), and it is forbidden to prepare with normal saline.
●First, amiodarone is a diiodine substitute on the benzene ring. Generally speaking, the iodine substitute is unstable and prone to spontaneous deiodine degradation. The acidic environment can inhibit the degradation of amiodarone.
●Secondly, the precipitation occurred because the chloride ion in the NaCl solution replaced the iodine on the benzene ring. If it is prepared with normal saline, the formation of precipitates can be seen, which will have serious consequences when intravenously injected. Therefore, 5% glucose should be used for clinical use of amiodarone injection.
▎Lethal usage 3:
After the patient took the medicine, the electrolyte test results came out, Hypokalemia, induced ventricular fibrillation.
Amiodarone must be used to prevent (and correct) hypokalemia: the QT interval should be monitored, and if “torsade de pointes” tachycardia”, antiarrhythmic drugs should not be used (ventricular pacing should be given, magnesium can be given intravenously).
▎Fatal usage 4:
The QTC of the original electrocardiogram was significantly prolonged, and ventricular fibrillation was induced .
Amiodarone is proarrhythmic and sometimes fatal. Distinguishing between proarrhythmic effects and cardiac conditions that may manifest as exacerbations of drug ineffectiveness is important but difficult. Amiodarone plasma concentrations should be monitored when possible. The effective blood concentration of amiodarone is 1-2.5 μg/ml, and the poisoning blood concentration is above 1.8-3.7 μg/ml.
●Arrhythmogenic effects of amiodarone have been reported more rarely than other antiarrhythmic drugs, and usually occur in the context of drug interactions and/or electrolyte disturbances.
▎Fatal Usage 5:
Look at the original ECG pre-excitation syndrome with atrial fibrillation , pre-excitation and atrial fibrillation should not be used at least, the guide recommends procainamide.
●If the diagnosis of fast ventricular rate atrial fibrillation and pre-excitation syndrome is accurate, radiofrequency ablation is recommended. This is a minimally invasive surgery without surgery, and the success rate is 95% about. Medications are ineffective and carry risks.
▎Fatal Usage 6:
Heart failure is aggravated after use .
●Intravenous administration is contraindicated in hypotension, severe respiratory failure, cardiomyopathy, or heart failure (which may worsen the condition).
▎Fatal Usage 7:
The blood pressure is already low, use upShocked.
▎Fatal Usage 8:
The patient was advised to do radiofrequency, but the patient failed Now, the reason is that amiodarone is used, and the drug has not been metabolized completely, so radiofrequency should not be performed, the operation will not go well, and the patient may die.
fatal Usage 9:
Patients with hyperthyroidism, if the person is hyperthyroid and complicated with atrial fibrillation, pay attention that amiodarone may cause hyperthyroid crisis.
●Hyperthyroidism can occur after drug discontinuation. In addition to exophthalmos, typical signs of hyperthyroidism may appear, and new arrhythmias may also appear. The incidence is about 2%, and it can be completely disappeared after a few weeks to several months of drug withdrawal, and a few need to be treated with antithyroid drugs, propranolol or adrenal corticosteroids.
▎Fatal Usage 10:
Patients with abnormal liver function, died of liver failure.
●It is recommended that liver function (transaminases) be closely monitored at the start of treatment and periodically during treatment. Acute liver damage (including severe hepatocellular damage or liver failure, sometimes fatal) and chronic liver damage can occur within the first 24 hours of starting intravenous amiodarone. Therefore, the dose of amiodarone should be reduced or discontinued when transaminase elevations exceed 3 times normal.
▎Fatal Usage 11:
Oral digoxin is being taken, the dose has not been reduced, It is easy to cause digoxin poisoning.
Amiodarone can increase serum digoxin concentration and may also increase the concentration of other digitalis preparations to toxic levels. Stop the drug or reduce it by 50%. If it is used in combination, the serum concentration of traditional Chinese medicine should be carefully monitored. This product can strengthen the inhibitory effect of digitalis drugs on the sinoatrial node and atrioventricular node.
▎Fatal Usage 12:
Simvastatin is being used, dose not reduced, May cause myolysis.
●Increased risk of muscle toxicity when statins metabolized by CYP3A4 such as simvastatin, atorvastatin and lovastatin are combined with amiodarone< span>.
▎Fatal Usage 13:
Warfarin is being used, the dose has not been reduced, May cause cerebral hemorrhage.
●Amiodarone increases the concentration of anticoagulants in the blood, causing anticoagulation and increased bleeding risk. Frequent control of prothrombin levels and monitoring of international normalized ratios (INRs). The dose of oral anticoagulants should be adjusted during and after treatment with amiodarone.
▎FATAL USAGE 14:
Bradycardia, Sinus Arrest, Cardiac Sudden stop.
Amiodarone is contraindicated in: sinus bradycardia and sinoatrial block, sinus node disease or high-grade atrioventricular conduction disorder, without artificial pacemaker patient.
▎Lethal Use 15:
Adult acute respiratory distress syndrome.
● Very rare cases of interstitial pneumonia have been reported with intravenous amiodarone. Clinical manifestations include shortness of breath, dry cough and chest pain, restrictive pulmonary function changes, increased erythrocyte sedimentation rate and increased blood white blood cells, and severe cases can lead to death. Need to stop and treat with adrenal corticosteroids.
▎Fatal Usage 16:
Severe peripheral phlebitis.
●Plebitis caused by local irritation during intravenous administration. Amiodarone should be administered via the central venous route whenever possible.
There is no safe medicine in this world. Medications are often risky. Our responsibility is to maximize the effect of treatment. As low as possible!
Disclaimer: This article comes from the Center for Drug Evaluation, authorGcplive, reprinted in the Pre-hospital Emergency Alliance, is only for learning and communication, if there are pictures and texts Copyright or other issues, please contact us and we will delete it immediately.
Related Reading
Early Reading | Anti-AF Drug Amiodine Comparison of ketones and dronedarone and precautions for use
Early reading | Ventricular tachycardia, how to choose 6 antiarrhythmic drugs?
Morning reading | Amiodarone will not be used yet? Please keep this user guide!
Click the business card below to quickly follow us
span>Click“read original span>”, start your learning journey!< /p>