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Old 05-01-2012
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Drug Amiodarone toxicity

A physician is called into the emergency dept to see a 75 yr old white man with tachy-brady syndrome who is complaining of shortness of breath. He has been diligently taking his prescribed amiodarone for the past 3 years. Which of the following additional toxicities would most likely be seen in patients amiodarone?

1) Cinchonism
2) Hypokalemia
3) Hypothyroidism
4) New arrhythmia
5) Torsades de pointes
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hypothyroidism? its like lithium in this respect
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hmmm, amiodarone can cause both thyroid irregularities and Torsades.

So im stuck between C and E.

Dude already has a heart problem though so i'll go with C. hypothryoidism.
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Default my answer

after few years of taking that drug by the patient I would actually expect amiodarone to start being pro-arrhythmogenic (paradoxical reaction), so either 4) or 5).
I guess I'm leaning more to 4) new arrhythmia...
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Quote:
Originally Posted by Dr.NickRiviera View Post
hmmm, amiodarone can cause both thyroid irregularities and Torsades.

So im stuck between C and E.

Dude already has a heart problem though so i'll go with C. hypothryoidism.
i guess it was mentioned in one of the uworld qs tht all the drugs that prolong QT interval can cause Torsades, but Amiodarone is the least likely to cause!

I go with hypothyroidism, amiodarone can cause either hypo/hyperthyroidism.
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Hypothyrodism and Pulmonary fibrosis are probably the most common side effects of amiodarone, altough it elongets the QT interval you are told that the patient has been taking the drug for 3 years so probably the acute torsde wont be the side effect, on the other hand hypothyroidsm is something that is very commonly seen after years of taking the drug, sometimes subclinical hypothyroidsm.
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Quote:
Originally Posted by vna.rao22 View Post
i guess it was mentioned in one of the uworld qs tht all the drugs that prolong QT interval can cause Torsades, but Amiodarone is the least likely to cause!

I go with hypothyroidism, amiodarone can cause either hypo/hyperthyroidism.
What I remember all class 1b and all class 3 drug cause torsade 😓
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Quote:
Originally Posted by Kabutar111 View Post
What I remember all class 1b and all class 3 drug cause torsade ��
yeah except amiodarone! and its class 1A that cause torsades.

Last edited by steps_8186; 05-01-2012 at 09:04 AM.
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Quote:
Originally Posted by vna.rao22 View Post
yeah except amiodarone! and its class 1A that cause torsades.
yea actually i had a UW question a few months back that was "which of the following is least likely to cause Torsades" and to my amazement, the answer was amiodarone! So i guess although it can cause it, it seldom does.
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hypothyroidism
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The correct answer is HYPOTHYROIDISM...

but i answered it torsades since i remem class 1a and class 3 drugs can prolong the effective refractory period, prolong QT interval and predispose to torsades...hence i choose torsades

i agree with modesty...for 3 years so the probability of torsades may be low with higher changes of thyroid dysfunction...i was looking for this one...thanks everyone....
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Btw its a Usmlerx question....

QID is 1346
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