Procainamide

Question 1

Indications for Procainamide (4 points)

Answer 1

❑ stable monomorphic VT with normal QT interval and preserved LV function
❑ stable reentry SVT uncontrolled by adenosine and vagal maneuvers
❑ Stable wide complex tachycardia of unknown origin
❑ A-fib with rapid rate in WPW

Question 2

Dosages for Procainamide

Answer 2

Adult: Loading dose 20 to 50 mg/min IV until:
-arrhythmia suppressed
-hypotension
-QRS prolonged by 50%
-total cumulative dose of 17 mg/kg
If conversion is successful, may use maintenance infusion (avoid if prolonged QT or CHF);
-Mix: 1 gm/250 ml NS (4mg/mL); Infuse at 1-4 mg/min

Pediatric: 15mg/kg IV/IO load over 30 to 60 minutes

Question 3

Contraindications for Procainamide (9)

Answer 3

❑ Hypersensitivity to: 
-procainamide
-ester type local anesthetics
-benzyl alcohol
-sulphites
❑ Digoxin toxicity or TCA induced dysrhythmia 
❑ Atypical V-Tach (Torsades de Pointes)
❑ 2nd or 3rd degree AV block
❑ Preexisting QT prolongation
❑ Myasthenia gravis
❑ SLE - Lupus
❑ Pre-excitation with preexisting QT prolongation