Procainamide (Pronestyl, Procan)

Question 1

Classification

Answer 1

Antidysrythmic

Question 2

Mechanism of Action

Answer 2

• Decreases myocardial excitability
• Slows atrial and intraventricular conduction
• Prolongs ventricular repolarization
• May depress myocardial contractility

Question 3

Indications

Answer 3

• Atrial and ventricular dysrythmia
• PVC’s and recurrent V-Tach not controlled by lidocaine

Question 4

Contraindications

Answer 4

• Hypersensitivity
• Myasthenia gravis

Question 5

Adverse Effects

Answer 5

• Cardiovascular: hypotension, ventricular dysrhythmias, heart blocks, widening QRS complex, lengthened QT interval
• Neurological: confusion, seizures

Question 6

Administration

Answer 6

• Adult:
  
  • SIVP: 20 mg/min to a max of 17 mg/kg, until dysrythmia is supressed followed by IVPB infusion.
  • IVPB: 1 gm in 500-1000 cc D5W or NSS run at 104 mg/min to a total maximum dose of 17 mg/kg.
• Pediatrics: 15 mg/kg IVPB or IO infusion over 30-60 minutes.

Question 7

Special Considerations

Answer 7

• Discontinue immediately if patient becomes hypotensive, if BP drops more than 15 mm/hg, PRI prolongs, or QRS widens by 50% of its original width.
• Administer with patient in a supine position with continuous monitoring and reassessment
• In emergent situations up to 30 mg/min may be administered
• Use with caution in patients with acute MI, heart or kidney disease