A 68-year-old man with symptomatic atrial fibrillation is started on oral amiodarone for rhythm control. Due to the medication's well-established toxicity profile, specific organ systems must be evaluated prior to initiation and periodically during long-term therapy. Which of the following tests are required for routine baseline and ongoing monitoring in this patient? (Select all that apply)
- Thyroid-stimulating hormone (TSH) levelsAnswer
- Hepatic transaminase levelsAnswer
- Pulmonary function testing and chest radiographyAnswer
- DRoutine serum creatine kinase (CK) levels
- ESerial echocardiograms every 3 months
Answer
The correct evaluations are thyroid-stimulating hormone (TSH) levels, hepatic transaminase levels, and pulmonary function testing with chest radiography.
Amiodarone is a highly effective antiarrhythmic but is associated with significant end-organ toxicity. It has a high iodine content and can cause both hyperthyroidism and hypothyroidism, requiring baseline and periodic thyroid-stimulating hormone (TSH) monitoring. It can also cause hepatotoxicity, necessitating regular evaluation of hepatic transaminase levels. Furthermore, amiodarone-induced pulmonary toxicity (e.g., interstitial pneumonitis) is a potentially fatal complication, making baseline chest radiography and pulmonary function testing essential.
Step-by-Step Solution
Key Concept
Patients starting amiodarone require baseline and periodic monitoring of thyroid function (TSH), liver function (LFTs), and pulmonary function (PFTs/CXR) due to the drug's multiorgan toxicity profile.