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.
- Myasthenic Crisis and Guillain-Barré SyndromeMyasthenic crisis: Worsen MG: fluoroquinolones (boxed warning), aminoglycosides, macrolides, IV magnesium, β-blockers, procainamide, neuromuscular blockers, volatile anesthetics, checkpoint inhibitors
- 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
- CEN Mental Health: Crisis, Suicide Risk, Eating Disorders and AbuseHyperventilation and caffeine: Caffeine (Willson 2018): a Red Bull can holds about 80 mg and a Monster about 160 mg, and one 473 mL product held 357 mg. Roughly 1 g may cause toxic symptoms, 2 g may need hospital care and 5 g or more is typically lethal; tachycardia is near universal above 10 mg/kg. Mild toxicity is irritability, palpitations, nausea, tremor and sweating; severe toxicity brings ve
Practice Rhythm Gallery questions free86 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
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For education and exam preparation only. Follow your institution’s protocols. Study aid: check every dose against the order, the bag label, your pump library and your institution's protocol.