Procainamide*

• Procainamide

• Pronestyl

Classification:

• Antidysrhythmic (Class 1 A)

Mechanism of Action:

• Suppresses PVC’s by decreasing automaticity
• Suppresses reentry arrhythmias by prolonging the refractory period
• Increases threshold of VF
• Negative chronotropic, dromotropic and inotropic effects
• Potent peripheral vasodilation
  

Indications:

• VFib/Pulseless VT
• Wide-complex tachycardia
• PSVT (AFib/A-flutter)

Contraindications:

• 3^rd degree heart block
• Hypotension
• Digitalis toxicity
• Tricyclic induced arrhythmias
• Torsades de pointes
• Preexisting QT prolongation
  

Precautions:

• Torsades de pointes
• QT prolonged
• Reduce maintenance dose with renal failure

Adverse Effects:

• Dizziness
• Hypotension
• VFib
• Reflex tachycardia
• CNS depression
• Seizures
• Systole
• Hallucinations
• Confusion
• Bradycardia
• AV blocks
• Nausea and vomiting
• Fever

Dose:

• VFib/VTach: 30 - 50 mg/min slow IVP
• VTach with a pulse: 20 mg/min slow IVP
• Maintain infusion: 1 - 4 mg/min
• End points
  • Max dose 17 mg/kg
  • QRS widens 50%
  • Arrhythmia is suppressed

• IV

• Compendium of Pharmaceuticals and Specialties (CPS)
• Pharmacology for the Prehospital Provider 2nd Edition