QuestionSBA
QuestionChoice
Amiodarone is a potassium channel blocker and as such imbalances in potassium should be corrected prior to starting this drug, rather than magnesium.
50197
b
Serum magnesium
QuestionChoice
An elevation in cardiac enzymes may suggest some ongoing myocardial ischaemia and can be useful in the general clinical setting on a background of acute chest pain, but is of limited utility with respect to starting this drug.
50198
c
Troponin
QuestionChoice
While pancreatitis as a result of amiodarone use has been reported, this is a very rare side effect of amiodarone use. HPL also isn't a useful test as it can be raised for many reasons, it is also used for the **diagnosis** of acute pancreatitis, not for screening for acute pancreatitis.
50199
d
Human pancreatic lipase
QuestionChoice
Amiodarone contains iodine which in turn can commonly cause thyroid disorders. Both hypothyroidism and hyperthyroidism have been linked to amiodarone use. Amiodarone doesn't need to be withdrawn if it is essential and causes hypothyroidism, this can be treated with replacement therapy.
50196
a
Thyroid function tests
QuestionChoice
While blood dyscrasias have been reported with use of amiodarone, these are very rare and as such a full blood count would be useful as a baseline but is not routinely done.
50200
e
Full blood count
Concept
Chapter
Osteoporosis, otherwise known as thin bones, is a condition associated with high risk of low trauma fractures due to reduced bone mineral density. Osteoclast activity exceeds osteoblast activity, meaning that bone resorption is occurring at a greater rate than bone formation.

**Symptoms and Signs**

- Generally asymptomatic until a fragility fracture occurs
- Back pain
- Kyphosis (stooped posture)
- Fragility fractures

**Risk factors**

- Female sex
- Increasing age
- Smoking
- Corticosteroid use
- Low BMI (< 20-25kg/m<sup>2</sup>)
- Low body weight (<58kg)
- Vitamin D deficiency

**Protective factors**

- Higher BMI
- Exercise - mechanical loading stimulates bone formation

**Diagnosis**
Osteoporosis can be detected on dual-energy x-ray absorptiometry (DEXA) scan.
A T score of < -2.5 indicates osteoporosis

**Management**

- Fall prevention
- Vitamin D and calcium supplementation
- Hormone replacement therapy (postmenopausal women)
- Oral bisphosphonates
2657
3617
TFTs should be measured before initiating treatment with amiodarone due to the increased risk of thyroid disorders
Topic
9
Internal Medicine
10087
Case Presentation:  A 64 year old man is sent to the rapid access chest pain clinic by his GP following the reported results of a 24 hour ECG Holter monitor. 


**PMH** myocardial infarction with 100% LAD occlusion, hypertension, hypercholesterolaemia, COPD

**DH** aspirin 75mg PO OD, bisoprolol fumarate 2.5mg PO OD, ramipril 10mg PO OD, amlodipine 5mg PO OD, salmeterol 50micrograms INH BD, tiotropium 5micrograms INH OD, atorvastatin 80mg PO OD.  NKDA

**Investigations**

24 hour ECG holter monitor: infrequent runs of ventricular tachycardia lasting 30-40 seconds

It is recommended to start amiodarone hydrochloride 200mg PO TDS whilst awaiting implantation of an Implantable Cardioverter Defibrillator (ICD).

Question: Select the most appropriate monitoring option required before initiating amiodarone hydrochloride.
a