Anticoagulation, endocrine and GI
Procainamide (Pronestyl) drip
Pronestyl
Dosing
| Start | Load 20–50 mg/min until the arrhythmia stops, hypotension, QRS widens by over 50%, or 17 mg/kg is given |
|---|---|
| Titrate | Then 1–4 mg/min |
| Maximum | Load 17 mg/kg; maintenance 4 mg/min |
| Common bags | 1,000 mg in 250 mL (4 mg/mL); 2,000 mg in 500 mL (4 mg/mL) |
| Dose units | mg/min |
Line and administration
- Peripheral or central
Watch for
- Hypotension during the load
- QRS and QT prolongation; avoid with a long QT or severe heart failure
- NAPA metabolite builds up in kidney failure
Procainamide: full drug monographIndications, mechanism, pharmacokinetics, cautions and every dose the app lists.
In the one-pagers
- Rhythm GallerySinus, atrial and junctional: AF with WPW (fast, irregular, wide): no AV-nodal blockers (adenosine, diltiazem, beta-blockers, digoxin, amiodarone). Unstable: cardiovert. Stable: procainamide or ibutilide.
- ACLS Algorithms in BriefTachycardia with a pulse: Or procainamide 20–50 mg/min; stop at 17 mg/kg, hypotension or QRS widening over 50%; avoid in long QT or heart failure
- Medical Emergencies: Neuro, Endocrine, Blood and InfectionNeuromuscular respiratory failure and spine emergencies: Myasthenic crisis affects about 15-20% of patients at least once, often after infection, and respiratory failure may come rapidly once it starts. Aminoglycosides, quinine, magnesium sulfate, procainamide and calcium channel blockers can precipitate weakness. Too much pyridostigmine causes cholinergic crisis (fasciculations, tears, salivation
Practice Rhythm Gallery questions free17 exam-style questions with rationales on the topic where procainamide comes up most. No account or download needed.
Other anticoagulation, endocrine and gi
- Heparin
- Insulin (regular)
- Amiodarone
- Diltiazem
- Octreotide
- Pantoprazole
- Furosemide
- Argatroban
- Bivalirudin
- Lidocaine
- Magnesium sulfate
- Naloxone
- Eptifibatide
- Bumetanide
Practice free in your browser2,450+ exam-style questions with rationales. No account, no ads. Also free on the App Store and Google Play.
For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against your local protocols and medical direction, the bag label and your pump.