Paramedic Program PDF

Paramedic Program Box 417 Lac La Biche, AB T0A 2C0 Generic Name: procainamide HCL Trade Name: Pronestyl Classification: ventricular and supraventricular antiarrhythmic (Class Ia) Supplied: 1 gm/10 mL (100 mg/mL) Actions (Pharmacodynamics):  Antiarrrhythmic: Blocks open sodium channels and prolongs...

Paramedic Program Box 417 Lac La Biche, AB T0A 2C0 Generic Name: procainamide HCL Trade Name: Pronestyl Classification: ventricular and supraventricular antiarrhythmic (Class Ia) Supplied: 1 gm/10 mL (100 mg/mL) Actions (Pharmacodynamics):  Antiarrrhythmic: Blocks open sodium channels and prolongs the cardiac action potential (outward potassium (K+) currents maybe blocked.) Decreases myocardial excitability, conduction velocity and may depress contractility.  Prolongs PR and QT intervals.  Has peripheral vasodilatory properties which may result in hypotension. Indications:  Useful for treatment of a wide variety of arrhythmias, including stable monomorphic VT with normal QT interval and preserved LV function  May use for treatment of reentry SVT uncontrolled by adenosine and vagal maneuvers if BP is stable  Stable Wide complex tachycardia of unknown origin  Atrial fibrillation with rapid rate in WPW  Re-entry SVT if uncontrolled with adenosine Dosage: Adult Administer IV loading dose: 20 to 50 mg/min until arrhythmia suppressed or hypotension ensues or QRS prolonged by 50% or total cumulative dose of 17 mg/kg; If conversion is successful, may use maintenance infusion (avoid if prolonged QT or CHF); Mix: 1 gm/250 ml NS (4mg/mL); Infuse at 1-4 mg/min Pediatric 10- 15mg/kg slow IV/IO over 30 to 60 minutes Contraindications:  Hypersensitivity to procainamide, ester type local anesthetics, benzyl alcohol or sulphites  QT prolongation  Torsade de Pointe  Any dysrhythmia induced by digoxin toxicity  Atypical V-Tach (Torsades de Pointes)  TCA antidepressant induced dysrhythmia  2nd or 3rd degree AV block  Patients with preexisting QT prolongation  Pre-excitation with preexisting QT prolongation Precautions:  If cardiac or renal dysfunction is present reduce max total dose to 12 mg/kg  Hypotension  Heart failure  Lupus  Hepatic impairment  Myasthenia gravis © Portage College Paramedic Program, 2004 Page 1 of 2    Note:   Pro-arrhythmic, especially in setting of AMI, hypokalemia or hypomagnesemia May induce hypotension is pts with impaired LV function Use with caution with other drugs that prolong QT interval (amiodarone), expert consultation is needed. Obtain a baseline vitals and ECG strip If given too rapidly or if increased plasma concentration induced hypotension References: 5 (433), 6, 7, 8 (198, 380), 9 (135), 10 (89) Revised: May 2023 © Portage College Paramedic Program, 2004 Page 2 of 2