Procainamide

Aka: Procainamide, Pronestyl

1. Mechanism
   1. Suppresses ventricular ectopy
      1. Suppresses Phase 4 diastolic depolarization
      2. Reduces automaticity of all Pacemakers
   2. Slows intraventricular conduction
      1. May terminate reentrant arrhythmias
2. Indications
   1. Ventricular Tachycardia (refractory to Lidocaine)
   2. Ventricular Fibrillation
   3. Atrial Fibrillation Rate Control and cardioversion
      1. Time to Cardioversion: 1 hour
      2. Conversion Rate: 20%
      3. Chronic Efficacy: 50%
3. Relative Contraindications
   1. Acute Myocardial Infarction
   2. Hypokalemia
   3. Hypomagnesemia
4. Preparation
   1. Blood Pressure monitoring
   2. Electrocardiogram Monitoring
5. Endpoints to Dosing
   1. Arrhythmia is suppressed
   2. Hypotension
   3. QRS Complex widening over 50% of original width
   4. PR interval or QT Interval lengthening over 50%
   5. Max total dose reached: 17 mg/kg administered
6. Dose: Child
   1. Load: 15 mg/kg in D5W IV over 30 minutes
   2. Maintenance: 20 to 80 ug/kg/minute
7. Dose: Adult
   1. Load: 20-30 mg/min until any above endpoint reached
      1. Max Total Dose: 17 mg/kg
   2. Maintenance: 1-4 mg/min
      1. Start after effect is achieved with loading dose
8. Adverse Effects
   1. Hypotension
   2. Electrocardiogram changes
      1. QRS Complex widening
      2. PR interval lengthening
      3. QT Interval lengthening
   3. Atrioventricular conduction disturbance
      1. AV Block
      2. Cardiac Arrest
   4. Malignant Ventricular arrhythmia