With amiodarone, which monitoring is essential for potential pulmonary toxicity?

• A. Regular chest X-ray every week.
• B. No monitoring for pulmonary effects.
• C. Pulmonary function tests only in special cases.
• D. Regular assessment of pulmonary status; chest imaging or PFTs as indicated.

Answer: (D)

Monitoring for amiodarone-related lung toxicity relies on ongoing, regular assessment of the patient’s pulmonary status, with imaging or pulmonary function testing used as indicated by symptoms or risk factors. Amiodarone can cause a delayed and insidious form of lung injury (pneumonitis that can progress to fibrosis), so early detection is key. Start with a baseline pulmonary evaluation before therapy, then periodically reassess clinically for cough, dyspnea, fever, or other respiratory changes. If new symptoms or abnormal findings arise, follow up with chest imaging and/or pulmonary function tests to evaluate for toxicity. This approach balances vigilance with practicality, avoiding unnecessary routine weekly imaging while ensuring that pulmonary toxicity is not missed.