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Amiodarone Pharmacology — FRCA Primary MCQ

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HardPharmacology - CardiovascularAmiodarone PharmacologyFRCA Primary

A patient taking digoxin is started on amiodarone. Several days later nausea, bradycardia and new atrioventricular block develop. Which mechanism and preventative adjustment best fit this event?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Amiodarone raises digoxin exposure; halve digoxin with ECG monitoring

The best answer is “Amiodarone raises digoxin exposure; halve digoxin with ECG monitoring”. Amiodarone inhibits P-glycoprotein and can substantially increase digoxin exposure; both drugs also slow rate and atrioventricular conduction. The UK SmPC advises clinical, ECG and biological monitoring and commonly halving digoxin when the combination is initiated. The interaction is not prevented by spacing doses and is not caused by chelation, thyroid uptake or renal induction.

Reference: Amiodarone hydrochloride 200 mg tablets, UK SmPC: https://www.medicines.org.uk/emc/product/101141/smpc; Royal College of Anaesthetists, Primary FRCA syllabus v2.2: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf