Procainamide

Aka: Procainamide, Pronestyl

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II. 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

III. 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%

IV. Relative Contraindications

  1. Acute Myocardial Infarction
  2. Hypokalemia
  3. Hypomagnesemia

V. Preparation

  1. Blood Pressure monitoring
  2. Electrocardiogram Monitoring

VI. 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

VII. Dose: Child

  1. Load: 15 mg/kg in D5W IV over 30 minutes
  2. Maintenance: 20 to 80 ug/kg/minute

VIII. 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

IX. 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

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Ontology: Procainamide (C0033216)

Definition (MSH) A class Ia antiarrhythmic drug that is structurally-related to PROCAINE.
Definition (CSP) derivative of procaine, cardiac depressant used in treatment of cardiac arrhythmias.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011342
SnomedCT 11959009, 372589008
LNC LP32138-7, LP16261-7, MTHU005035
English Procainamide, Amide, Procaine, Procaine Amide, procainamide, Benzamide, 4-amino-N-(2-(diethylamino)ethyl)-, Procainamide [Chemical/Ingredient], procaine amide, Benzamide, p-amino-N-(2-(diethylamino)ethyl)-, p-Aminobenzoic Diethylaminoethylamide, PROCAINAMIDE, Procainamide (product), Procainamide (substance)
Swedish Prokainamid
Czech prokainamid
Finnish Prokaiiniamidi
Russian NOVOKAINAMID, PROKAINAMID, НОВОКАИНАМИД, ПРОКАИНАМИД
Japanese プロカインアミド, プロカインアミド塩酸塩
Italian Procainammide, Procanaimide
Polish Prokainamid
Spanish procainamida (producto), procainamida (sustancia), procainamida, Procainamida, Procaína Amida
French Procaïnamide
German Procain-Amid, Procainamid
Portuguese Amida Procaínica, Procainamida
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Pronestyl (C0392424)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D011342
English pronestyl, Pronestyl, Apothecon Brand of Procainamide Hydrochloride, Bristol-Myers Squibb Brand of Procainamide Hydrochloride
Derived from the NIH UMLS (Unified Medical Language System)

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