What monitoring is essential for a patient on amiodarone for atrial fibrillation?

• A. BP measurement only; monitor HbA1c.
• B. Only monitor potassium; ignore hepatic.
• C. EKG for QT interval and rhythm; LFTs; thyroid function; pulmonary status; monitor for drug interactions and toxicity.
• D. Monitor calcium and magnesium only.

Answer: (C)

Amiodarone requires broad, ongoing monitoring because it affects the heart rhythm and multiple organ systems. Regular EKG assessment is essential to watch the actual rhythm and the QT interval, since amiodarone can prolong the QT and influence conduction, even though it’s less proarrhythmic than some other drugs. Liver function tests are important due to the risk of hepatotoxicity, and thyroid function tests are needed because the iodine in amiodarone can cause both hypothyroidism and hyperthyroidism. Pulmonary status must be monitored because amiodarone can cause interstitial pneumonitis and fibrosis. Because this medication has many drug interactions and a very long half-life, ongoing vigilance for interactions and signs of toxicity is also key. The other choices miss several of these critical areas of monitoring.