The Influence of Various Time Points After Standing up on Orthostatic Blood Pressure and Pulse Rate

Abstract

Background: Clinical guidelines warrant a comprehensive assessment prior to maintenance treatment with amiodarone and repeated monitoring for the appearance of adverse reactions. The aim of the study was to evaluate the adherence to these guidelines. Methods: A retrospective chart review of adult patients treated with oral amiodarone for at least 3 months. Data were collected from computerized medical records and subjected to descriptive statistical analysis. Results: 100 patients were included in the final analysis. Average age was 76.6 years (range 28 to 93 years). 61% were males. All were treated with amiodarone for atrial fibrillation with maintenance daily dose of 200mg. Average duration of treatment in the study was 35.9 months (range 3 to 83 months). Almost all patients (97%) were evaluated for thyroid and liver functions prior to treatment. While liver functions were properly monitored every 6 months during treatment (in 96% of patients), TSH was repeatedly monitored every 6 months in only 59% of patients. In another 32% of patients, the adherence to TSH monitoring was partial. Most patients (84%) completed a chest XR before treatment but only 2% completed respiratory function test as recommended. None of the patients completed chest XR annually as recommended; it was carried out only partially. Approximately two-thirds of the patients (64%) were examined by an ophthalmologist prior to treatment; regular surveillance ophthalmic checkups were not consistent. Directed neurological evaluation was not recorded for any of the patients prior to treatment, nor was periodical neurological examination during treatment, unless symptoms appeared. Conclusions: In this study the adherence to recommended clinical guidelines for monitoring adverse reactions of amiodarone was found to be poor. Interventions to improve compliance with these guidelines are needed. Background: Aripiprazole is mainly metabolized in the liver by CYP2D6 and CYP3A4 and it is also a substrate of P-glycoprotein.