Procainamide (Pronestyl)

Question 1

Drug Classification

Answer 1

Antidysrhythmic

Question 2

Mechanism of Action

Answer 2

Class IA antiarrhythmic /moderate Na+ channel blocker -> decreases slope and amplitude of phase 0 depolarization for non-pacemaker action potential

Question 3

Pharmacokinetics

Answer 3

• Onset of Action- 10-30 minutes
• Peak Effects- 15-20 minutes
• Duration of Effects- 3-6 hours
• Half-Life- 3 hours

Question 4

Indications-/Field Use

Answer 4

Persistent cardiac arrest secondary to VF/VT refractory to lidocaine

Question 5

Contraindications

Answer 5

• Severe conduction disturbances, especially 2/3 degree heart blocks
• PVC’s with bradycardia

Question 6

Side effects/Adverse reactions

Answer 6

Confusion, drowsiness, bradycardia, hypotension, heart blocks, cardiac and respiratory arrest, N&V, Seizures

Question 7

Dose

Answer 7

Adult
100mg infusion over 5 minutes; maintenance 1-4mg/min

Pedi
15mg/kg IV/IO over 30-60 minutes

Question 8

Precautions

Answer 8

D/c if: dysrhythmia is suppressed, hypotension occurs, QRS complex widens by 50%, or 17mg/kg has been administered

Question 9

Drug-drug interactions

Answer 9

Chance of neurotoxicity increases if given with Lidocaine