Procainamide

Question 1

Procainamide:class

Answer 1

antiarrhythmic (class 1A)

Question 2

Procainamide:drug actions

Answer 2

suppresses depolarization in normal ventricular muscle and purkinje fibers, thus reducing the automaticity of ectopic pacemakers, like ventricular;suppresses reentry dysrhythmias by slowing intraventricular conduction, like PSVT

Question 3

Procainamide:route

Answer 3

IVPB after Lidocaine and not if Amiodarone is given

Question 4

Procainamide:indications

Answer 4

reentry SVT (PSVT) uncontrolled by Adenosine and vagal maneuvers if normotensive;AFib with rapid rate in WPW syndrome;stable wide-complex regular tachycardia with a pulse - usually after Lidocaine

Question 5

Procainamide:contraindications

Answer 5

second and third degree blocks (complete heart block), without a pacemaker;Digitalis toxicity;Torsades de pointes;tricylic antidepressant toxicity;preexisting hypotension

Question 6

Procainamide:side effects

Answer 6

hypotension in patients with impaired LV function;bradycardia;reflex tachycardia;heart blocks;VT/VF/asystole;QRS widening, and less frequently PR and QT prolongation;CNS: (rare)confusion;hallucinations;mental depression - usually in overdose

Question 7

Procainamide:drug interactions

Answer 7

increases effecs of skeletal muscle relaxants;other antiarrhythmics (Amiodarone)

Question 8

Procainamide:adult dose

Answer 8

20 - 50 mg/min IV for urgent ventricular rhythms, max of 17 mg/kg;if effective must be followed by a maintenance IVPB drip of 1 - 4 mg/min

Question 9

Procainamide:pedi dose

Answer 9

loading dose 15 mg/kg IVPB over 30-60 min

Question 10

Procainamide:precautions

Answer 10

be aware of the potent vasodilating and negative inotropic effects;monitor BP and spO2;monitor ECG;have IV access;use with caution with other drugs that prolong QT interval;stop medication if:arrhythmia is suppressed;hypotension occurs;QRS widens by greater than 50%;maximum dose is achieved