Procainamide

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Procainamide Trade Name

Back 1

-Pronestyl

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Procainamide Classification

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-Class Ia Antiarrhythmic

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Procainamide Mechanism of Action

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-decreases conduction velocity in atria, ventricles and His Purkinjie system
-Prolongs effective refractory period of atria
-shortens effective refractory period of AV Node
-decreases automaticity in His Purkinje system and ectopic pacers
-pronlongs PR and QT intervals
-Exerts a peripheral vasodilatory effect
-therapeutic doses, myocardial contractility of undamaged heart is usually not affected

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Procainamide Indications

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-Stable monomorphic VT with no signs of heart failure
-control rapid ventricular rate in A-fib or atrial flutter and no signs of failure
-Control rapid rate vent rate in Afib or flutter with known WPW and no signs of heart failure
-AV reentrant narrow-complex tachy such as reentry SVT if no response to vagal maneuvers and adenosine and if no signs of heart failure

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Procainamide Dosing

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-20mg/min infusion until one of following:
1. dsysrhythmia resolves
2. Hypotension
3. QRS widens by >50%
4. Total dose 17mg/kg
-Maintenance infusion 1 to 4 mg/min

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Procainamide Precautions

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-use caution with other meds that prolong QT interval (eg: phenothiazines, tricyclic antidepressants, thiazide diuretics, sotalol)
-During admin, watch ECG and BP. If bp falls(>15) temporarily D/C
-watch ECG for lengtening PR or QT interval or widening QRS, complete Heart block and torasades.
-reduce rate if liver dsyfunction

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Procainamide Contraindications

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-Complete AV block in absence of pacer
-sensitivity to
-Lupus
-prolonged QRS or QT b/c of potential for heart block
-preexisting QT prolongation/ Torsades
-Digitalsis toxicity (may further depress conduction)

Front 8

Procainamide Special Considerations

Back 8

-Pharmalogical effects of procainamide may be increased if amiodarone is also given