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procainamide (proe-kane-ah-mide)
Pronestyl
Classification
Therapeutic: antiarrhythmics (class IA)
Pregnancy Category C
Interactions
Drug-Drug: May have additive or antagonistic effects with other antiarrhythmics.
Indications
Treatment of a wide variety of ventricular and atrial arrhythmias, including: Atrial
premature contractions, Premature ventricular contractions, Ventricular tachycardia, Paroxysmal atrial tachycardia. Maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.
Action
Decreases myocardial excitability. Slows conduction velocity. May depress myocardial contractility. Therapeutic Effects: Suppression of arrhythmias.
Pharmacokinetics
Absorption: Well absorbed (75– 90%) following IM administration.
Distribution: Rapidly and widely distributed.
Metabolism and Excretion: Converted by the liver to N-acetylprocainamide
(NAPA), an active antiarrhythmic compound. Remainder (40– 70%) excreted unchanged by the kidneys.
Half-life: 2.5– 4.7 hr (NAPA— 7 hr);qin renal impairment.
TIME/ACTION PROFILE (antiarrhythmic effects)
ROUTE
ONSET
PEAK
DURATION
IV
IM
immediate
10–30 min
25–60 min
15–60 min
3–4 hr
3–4 hr
Contraindications/Precautions
Contraindicated in: Hypersensitivity; AV block; Myasthenia gravis.
Use Cautiously in: MI or digoxin toxicity; HF, renal dysfunction, or hepatic dysfunction (doseprecommended); Geri: Doseprecommended); OB, Lactation,
Pedi: Safety not established.
⫽ Genetic Implication.
pg 1 # 1
Adverse Reactions/Side Effects
CNS: SEIZURES, confusion, dizziness. CV: ASYSTOLE, HEART BLOCK, VENTRICULAR ARRHYTHMIAS, hypotension. GI: diarrhea, anorexia, bitter taste, nausea, vomiting.
Derm: rash. Hemat: AGRANULOCYTOSIS, eosinophilia, leukopenia, thrombocytopenia. Misc: chills, drug-induced systemic lupus syndrome, fever.
1
⫽ Canadian drug name.
Plate # 0-Composite
Additive neurologic toxicity (confusion, seizures) with lidocaine. Antihypertensives and nitrates may potentiate hypotensive effect. Potentiates neuromuscular
blocking agents. May partially antagonize the therapeutic effects of anticholinesterase agents in myasthenia gravis.qrisk of arrhythmias with pimozide. Additive
anticholinergic effects with other drugs possessing anticholinergic properties,
including antihistamines, antidepressants, atropine, haloperidol, and phenothiazines. Effects of procainamide may beqby cimetidine, quinidine, or trimethoprim.
Route/Dosage
IM (Adults): 50 mg/kg/day in divided doses q 3– 6 hr.
IV (Adults): 100 mg q 5 min until arrhythmia is abolished or 1000 mg have been
given; wait at least 10 min until further dosing or loading infusion of 500– 600 mg
over 30– 60 min followed by maintenance infusion of 1– 4 mg/min.
NURSING IMPLICATIONS
Assessment
● Monitor ECG, pulse, and BP continuously throughout IV administration.
Parameters should be monitored periodically during oral administration. IV administration is usually discontinued if any of the following occur: arrhythmia is resolved, QRS complex widens by 50%, PR interval is
prolonged, BP drops ⬎15 mm Hg, or toxic side effects develop. Patient
should remain supine throughout IV administration to minimize hypotension.
● Lab Test Considerations: Monitor CBC every 2 wk during the first 3 mo
of therapy. May causepleukocyte, neutrophil, and platelet counts. Therapy may be discontinued if leukopenia occurs. Blood counts usually return to normal within 1 mo of discontinuation of therapy.
● Monitor ANA periodically during prolonged therapy or if symptoms of lupus-like
reaction occur. Therapy is discontinued if a steady increase in ANA titer occurs.
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Name /bks_53161_deglins_md_disk/procainamide
02/17/2014 09:27AM
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● May cause q AST, ALT, alkaline phosphatase, LDH, bilirubin, and a positive
Coombs’ test result.
● Toxicity and Overdose: Serum procainamide and N-acetylprocainamide levels
may be monitored periodically during dosage adjustment. Therapeutic blood level
of procainamide is 4– 8 mcg/mL.
● Toxicity may occur with procainamide blood levels of 8– 16 mcg/mL or greater.
● Signs of toxicity include confusion, dizziness, drowsiness, decreased urination,
nausea, vomiting, and tachyarrhythmias.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)
Implementation
● IM: Used only when IV route is not feasible.
IV Administration
● pH: 4.0– 6.0.
● Direct IV: (only to be used for life-threatening arrhythmias).Diluent: Dilute
each 100 mg of procainamide with 10 mL of 0.9% NaCl. Rate: Not to exceed 25
mg/min. Rapid administration may cause ventricular fibrillation or asystole.
● Intermittent Infusion(preferred route of administration): Diluent: Add 2 g of
procainamide to 250 mL of 0.9% NaCl. Concentration: 8 mg/mL. Rate: Administer initial infusion over 30– 60 min. Administer maintenance infusion at rate
of 1– 4 mg/min to maintain control of arrhythmia.
● Y-Site Compatibility: alemtuzumab, alfentanil, amikacin, aminocaproic acid,
aminophylline, amiodarone, amphotericin B lipid complex, amphotericin B liposome, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, aztreonam, benztropine, bivalirudin, bleomycin, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium gluconate, caspofungin, cefazolin,
cefotaxime, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chlorpromazine, cisatracurium, cisplatin, clindamycin, cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, digoxin, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium,
doxorubicin, doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, epoetin alfa, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide
phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluoro-
Plate # 0-Composite
pg 2 # 2
uracil, folic acid, furosemide, gemcitabine, gentamicin, glycopyrrolate, granisetron, heparin, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, indomethacin, insulin, irinotecan, isoproterenol, ketorolac, labetalol,
lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine,
meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, midazolam, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin,
oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, papaverine, pemetrexed, penicillin G, pentamidine, pentazocine, pentobarbital, phenobarbital, phentolamine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium acetate, potassium chloride, prochlorperazine,
promethazine, propranolol, protamine, pyridoxime, quinupristin/dalfopristin,
ranitidine, remifentanil, rocuronium, sodium bicarbonate, streptokinase, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trimetaphan,
vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, vitamin B complex with C, voriconazole, zoledronic acid.
● Y-Site Incompatibility: acyclovir, azathioprine, carboplatin, carmustine, chloramphenicol, dantrolene, diazepam, diazoxide, ganciclovir, hydralazine, metronidazole, milrinone, phenytointrimethoprim/sulfamethoxazole.
Patient/Family Teaching
● May cause dizziness. Caution patient to request assistance with ambulation until
response to medication is known.
● Advise patient to notify health care professional immediately if signs of
drug-induced lupus syndrome (fever, chills, joint pain or swelling, pain
with breathing, skin rash), leukopenia (sore throat, mouth, or gums),
or thrombocytopenia (unusual bleeding or bruising) occur. Medication
may be discontinued if these occur.
● Advise patient to carry identification at all times describing disease process and
medication regimen.
● Emphasize the importance of routine follow-up exams to monitor progress.
Evaluation/Desired Outcomes
● Resolution of cardiac arrhythmias without detrimental side effects.
Why was this drug prescribed for your patient?
䉷 2015 F.A. Davis Company
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