PROCAINAMIDE HCI (Pronestyl)

Name:	PROCAINAMIDE HCI (Pronestyl^R)
Classification:	antiarrhythmic useful in supraventricular and ventricular tachycardias may be useful when lidocaine is ineffective undergoes hepatic metabolism to active metabolite, N-acetyl-procainamide (NAPA)
Dose:	Bolus: 100mg IV direct q5 minutes to a maximum of 1 g then maintenance infusion 2 - 6mg/min or 17mg/kg IV direct as loading dose followed by maintenance infusion 2.8mg/kg/hour dose must be reduced in renal failure to maintenance infusion 1.4mg/kg/hour
Administration:	IV Direct: administration rate should not exceed 25-50 mg/min IV Infusion: 1g/250 mL of sodium chloride 0.9% NURSE TO MIX ALL BAGS DUE TO STABILITY. yellow discoloration is acceptable; dark amber solutions should be discarded
Adverse Effects:	Cardiac: arrhythmias: ventricular tachycardia or fibrillation, Torsades de Pointes (associated with high levels of procainamide and/or NAPA; secondary to prolonged QT interval) heart block prolongation of PR, QRS, QT intervals (up to 50%) bradycardia, asystole decreased BP, decreased CO Immunologic: lupus erythematosus like syndrome fever neutropenia, agranulocytosis, thrombocytopenia Others: peripheral neuropathy
Contraindications:	myasthenia gravis in complete heart block or type II second degree heart block unless functional pacemaker in place (can suppress a ventricular escape rhythm) following electrical conversion
Drug Interactions:	procainamide + amiodarone = increased plasma procainamide concentration procainamide + cimetidine = increased plasma procainamide concentration procainamide + lidocaine = increased CNS toxicity procainamide + neuromuscular blockers = increased neuromuscular blockade
Monitoring Therapy:	continuous heart rate and rhythm PR, QRS, QT widening by 50% blood pressure urine output CBC, platelets procainamide serum level: therapeutic: 17-68 umol/L (pre-dose) procainamide + NAPA serum level: therapeutic: 43-128 umol/L (pre-dose)
CCTC Protocol:	May be administered IV direct or by IV infusion by a nurse in Adult Critical Care Continuous infusions must be administered by infusion device and the pump library must be enabled May be titrated to ECG rhythm by a nurse in Adult Critical Care