Pronestyl

procainamide

Pronestyl

Indications

Action

Pharmacokinetics

Time/action profile (antiarrhythmic effects)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• seizures (life-threatening)
• confusion
• dizziness

Cardiovascular

• asystole (life-threatening)
• heart block (life-threatening)
• ventricular arrhythmias (life-threatening)
• hypotension

Gastrointestinal

• diarrhea (most frequent)
• anorexia
• bitter taste
• nausea
• vomiting

Dermatologic

• rash

Hematologic

• agranulocytosis (life-threatening)
• eosinophilia
• leukopenia
• thrombocytopenia

Miscellaneous

• chills
• drug-induced systemic lupus syndrome
• fever

Interactions

Drug-Drug interaction

Route/Dosage

Availability (generic available)

Nursing implications

Nursing 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 cause ↓ leukocyte, 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.
  • May cause ↑ AST, ALT, alkaline phosphatase, LDH, bilirubin, and a positive Coombs’ test result.
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

Implementation

• Intramuscular: Used only when IV route is not feasible.

• Intravenous Administration

• pH: 4.0–6.0.
• (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, fluorouracil, 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.