Procainamide
1. Used when Lidocaine is ineffective. (suppresses ventricular ectopy and slows intraventricular conduction)
2. Persistent cardiac arrest due to VF.
3. PVCs or recurrent VT

Mix 2 Gms in 500 ml NS or LR.

1 mg/min=15ml/hr
2 mg/min=30ml/hr
3 mg/min=45ml/hr

Bolus 20-50 mg/min

- Dosing: 20-30mg/min until:
1) arrhythmia suppressed
2) hypotension occurs
3) PR or QRS widens by 50% of its original width or MAX dose of 17mg/kg has been given

- if effective, start drip @ 1-4mg/min
* Monitor BP closely during
administration; may cause precipitous hypotension; infuse cautiously in acute MI
* Contraindicated in patients with preexisting long QT intervals or torsades de points.

* Hypokalemia and hypomagnesemia may exacerbate arrhythmias
Procainamide
Give bolus slowly with patient in supine position.
Bolus 100 mg every 5 minutes at a rate of 20-30mg per minute until:
-Arrhythmia is suppressed.
-Hypotension develops.
-QRS is widened by 50%.
-17mg/kg Gm has been given.
Maintenance infusion - 1-4mg per minute.

Mix 2 Gm in 500ml D5W at 15-60cc/Hr.

May be given orally 1 Gm initially, followed by 250-500mg every 3-4 hours.

Countraindications:
a. Complete, second, or third degree heart block.
b. CHF,BBB, hepatic or renal impairment.
c. Myasthenia gravis.

Uses:
a. Treatment of ventricular arrhythmias, especially when lidocaine has been unsuccessful.
b. May be used to treat atrial arrhythmias.

Actions:
a. Decreases excitability and slows conduction.
b. Depresses automaticity.

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