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Slow and wide distribution of amiodarone to tissue (fat, muscle, highly perfused organs) results in a requirement of long loading periods in an effort to accelerate the onset of drug activity.

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Something to consider : do we need to think about the patient's underlying condition such as renal function/ liver function when giving a loading dose? Or body weight? If so why??

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Potassium/Magnesium

MOA:

Indications for use:

Nursing considerations:

Drug-drug interactions:

Signs and Symptoms:

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A loading does is a higher dose/quicker administration of a drug that may be given at the start of a course of treatment before dropping down to a lower maintenance dose. a loading dose is mainly used for drugs that are eliminated from the body slowly. drugs only need a lower or regular dose to maintain the therapeutic level.

We would give a loading dose of amiodarone so we can control and lower his heart rate back to sinus rhythm as quick as possible and then continue with the infusion to help sustain regularity in heart rhythm

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Amlodipine

MOA: act on coronary arteriolar smooth muscle to reduce vascular resistance and myocardial oxygen requirements, relieving angina symptoms. The blockage of calcium channels inhibits the influx of calcium ions in, the cell reducing depolarization of myocardial cells and reduction of myocardial contraction, due to its association with actin and myosin stimulation.

Indications: hypertension, angina

Nursing considerations: ECG, vitals - BP, HR, due to vasodilation of blood vessels can cause headaches, pain levels of patient

Signs and Symptoms: respiratory depression, vasodilatory effects, hypotension, nausea/vomiting, peripheral oedema

Drug-drug interaction:
magnesium - increases the effects of IV magnesium sulphate and the risk of adverse effects
enoxaparin - increases the toxicity of amlodipine

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Due to the drugs nature of a long half life, initiating a loading dose in the beginning helps to achieve the therapeutic levels on the first dose, then maintenance to achieve these therapeutic levels can be achieved following.

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Metoprolol

MOA:
Metoprolol is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors at oral doses of less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects.

Indications for use:
- High blood pressure
- Chest pain due to reduced blood flow to the heart (Angina)
- Tachyaahythmias
- Prevention of migraine
- Chronic heart failure

Nursing considerations:
- Monitoring blood pressure
- Assess hypersensitivity
- Monitor for side effects

Signs and Symptoms:
- Bradycardia
- Hypotension
- Worsening of heart failure
- Nausea
- Diarrhoea
- Bronchospasm
- Dyspnoea
- Cold extremitites
- Fatigue
- Dizziness
- Abnormal vision
- Alteration of glucose
- Hallucinations
- Insomnia
- Nightmares
- Heart block
- Rash
- Muscle cramp
- Nasal congestion
- Hypersensitivity reaction

Drug-Drug interactions
Lidocaine and Metoprolol= Metoprolol may reduce metabolism and increase risk of toxicity of lidocaine when it is used IV
Amiodarone and Metoprolol= Amiodarone may increase metoprolos concentration, increasing the risk of severe bradycardia

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Amiodarone

MOA:
Decreases sinus node and junctional automaticity, slows atrioventricular (AV) and bypass tract conduction and prolongs refractory period of myocardial tissues (atria, ventricles, AV node and bypass tract); also has weak beta-blocker activity.

Indications:
Treatment and prophylaxis of serious tachyarrhythmias refractory to other treatment, including ventricular tachycardia, AF and SVT

Nursing considerations:
- Check patient allergies
- Understand their baseline vital sign readings
- You'll want to monitor the EKG continuously during IV amiodarone infusion and initiation of PO therapy. Amiodarone can cause pulmonary toxicity and ARDS, so monitor your patient's respiratory status carefully. Patients taking amiodarone long-term should get regular chest x-rays and pulmonary function tests.

Drug-drug interactions:

- Amiodarone has a very long half-life and it may take weeks to months before an interaction fully develops; when it is stopped interactions may continue for weeks to months.

- Amiodarone may increase metoprolol’s concentration, increasing the risk of severe bradycardia; consider using a low dose to start metoprolol treatment, and monitor carefully.

Signs and symptoms:
- nausea & vomiting
- constipation
- anorexia
-

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the benefits of a loading dose is that is gets the drug to a therapeutic range quicker then what normal dosing of a drug does.
as amiodarone medication can take longer time periods to reach therapeutic levels a loading dose gets the drug to work quickly and effectively (orally).
IV amiodarone
Loading, IV 5 mg/kg over 20 minutes – 2 hours.
Maintenance, IV 15–20 mg/kg over 24 hours (maximum 1.2 g in 24 hours); begin oral treatment as soon as possible, overlapping oral and IV treatment by up to 2 days.

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Temazepam

MOA:
Benzodiazepines potentiate the inhibitory effects of GABA throughout the CNS, resulting in anxiolytic, sedative, hypnotic, muscle relaxant and antiepileptic effects.

Indications for use: Short-term treatment for Insomnia

Nursing considerations: Consideration of the pts. vital signs (RR) since it causes respiratory depression.
- Increased risk of oversedation, falls, memory, confusion, ataxia due to the pat being on the elderly side.

Drug/Drug interaction: Metabolism of temazepam can be decreased when combined with Amiodarone

Signs and Symptoms: Drowsiness, over-sedation, headache, hypotension, respiratory depression, confusion.

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Note: Always consider:
Is there anything in the patient's condition/ past history that may increase the risks?

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This will be added once we get to it :)

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Compare and contrast the significant risks for each of the drug classes

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Compare and contrast the significant risks for each of the drug classes

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What were your significant risks? Why are they significant?
Do you understand the MoA of how the patient might develop the risk?
Did you need to go and look them up again?

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What would they be for this medication chart?

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How / why does it occur?
What are they and what signs and symptoms would we see?
What do we as nurses do;
- prevent and/ or manage these?