Monitoring Requirements Consultant responsibility GP responsibility Every Sample Clauses

Monitoring Requirements Consultant responsibility GP responsibility Every. 6 months • Assess compliance, ask patient about adverse effects (breathlessness, non-productive cough) and review possible interactions • TFTs (and for up to 12 months after discontinuation), U&Es, LFTs Annually • History & examination, Heart rate & ECG Other monitoring if applicable • Digoxin level- assess serum digoxin levels if dose increased or toxicity is suspected • INR- more frequent monitoring of INR both during and after amiodarone treatment (initially weekly for first 7 weeks) • Chest X-ray or CT scan if clinically indicated (suspected pulmonary toxicity) • Eye exam- Assess if new or worsening visual symptoms occur. • Check for drug interactions if new agents added to patient’s usual prescription Baseline *Loading History & examination ♦ adverse effects ♦ ♦ Heart rate & 12 lead ECG ♦ ♦ TFTs ♦ U&Es ♦ LFTs ♦ ♦ Digoxin level (if applicable) ♦ ♦ INR (if applicable) ♦ ♦ CXR ♦ PFTs inc DLCO ♦ Actions to be taken Parameter Action Symptoms of pulmonary toxicity (new/worsened cough or shortness of breath) Perform prompt ECG and CXR to exclude alternative diagnoses. If pulmonary toxicity remains a possibility, contact cardiologist/specialist or a respiratory physician urgently for confirmation of diagnosis and consideration of alternative anti-arrhythmics. Acute admission may be required. Early investigation with HRCT chest scan is important. ECG If there are signs of the following discuss with the oncall cardiology specialist: • QTc interval ≥ 500 milliseconds • QRS duration>120 milliseconds • prolonged PR interval (>240 milliseconds) if previously normal • Morbitz Type II or complete heart block GPs can also contact cardiologist for advice on • Interpretation of ECG • Consideration for stopping treatment e.g. if patient develop permanent AF/ ventricular tachycardia. Thyroid function tests (see appendix 1) An increase of up to 40% above the baseline T4 is a normal effect of amiodarone. This occurs approximately 2 months after initiation and does not require discontinuation if there is no clinical or further biological evidence (TSH) of thyroid disease. If TFTs are borderline repeat test in 6 weeks. In the event of thyrotoxosis seek the urgent advice of an endocrinologist. Liver function tests (See appendix 2) Normal results - continue treatment and reassess in 6 months If ALT increase within three times the normal range and patient is not jaundiced, continue amiodarone and repeat LFTs in 2 weeks. If still raised, refer to initiating hospital specialist ur...
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Related to Monitoring Requirements Consultant responsibility GP responsibility Every

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