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Procainamide


Presentation

  • CONCLUSION: In the present study, procainamide was more effective than propafenone for the treatment of AF of short duration.[ncbi.nlm.nih.gov]
  • In the present study, the relationship between electrophysiological parameters and the noninducibility of VT was assessed during procainamide therapy with a special reference to the change of an excitable gap.[ncbi.nlm.nih.gov]
  • The objective of the present study was to characterize major cytochrome P450 isozyme(s) involved in the N-hydroxylation of procainamide.[ncbi.nlm.nih.gov]
  • Clinical hallmarks of hypersensitivity include fever, eosinophilia, rash, and lymphadenopathy; nausea and vomiting also may be present. Of the five reported cases, all experienced fever and only one experienced pruritus.[ncbi.nlm.nih.gov]
  • The earliest reported case of fetal supraventricular tachycardia at 17 weeks' gestation causing hydrops fetalis is presented. Maternal treatment with digoxin and procainamide successfully cardioverted the fetus with resolution of the hydrops.[ncbi.nlm.nih.gov]
Fever
  • Clinical hallmarks of hypersensitivity include fever, eosinophilia, rash, and lymphadenopathy; nausea and vomiting also may be present. Of the five reported cases, all experienced fever and only one experienced pruritus.[ncbi.nlm.nih.gov]
  • If agranulocytosis occurs, procainamide should be discontinued promptly and the fever should be treated aggressively with combination broad spectrum antibiotics.[ncbi.nlm.nih.gov]
  • We describe a patient who developed liver dysfunction after procainamide administration, manifested by fever, jaundice, elevated bilirubin concentration, and alkaline phosphatase concentration.[ncbi.nlm.nih.gov]
  • Any patient who has an unexplained fever or a toxic reaction while taking one of these preparations should have a complete blood count done.[ncbi.nlm.nih.gov]
  • We here describe the case of a patient who had a hypersensitivity reaction to procainamide with fever, chills, arthralgia, abdominal pain and acute elevations of serum aminotransferase activities and bilirubin concentration.[ncbi.nlm.nih.gov]
Pain
  • Clinicians should be aware of this potential problem when prescribing these medications, and have a high index of suspicion when painful or refractory constipation occurs.[ncbi.nlm.nih.gov]
  • We here describe the case of a patient who had a hypersensitivity reaction to procainamide with fever, chills, arthralgia, abdominal pain and acute elevations of serum aminotransferase activities and bilirubin concentration.[ncbi.nlm.nih.gov]
  • […] urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or joint pain or swelling with fever, swollen glands, muscle pain or weakness, unusual thoughts or behavior, patchy skin color, red spots.[rxlist.com]
  • . • General : Joint pain, abdominal pain, lung infection, fever, chills and muscle pain. • Blood : Anemia, decrease in white blood cells and platelets. • Skin : Swelling under the skin, hives, itching, flushing and rash. • Gastrointestinal : Loss of appetite[medindia.net]
  • Signs of lupus like a rash on the cheeks or other body parts, sunburn easy, muscle or joint pain, chest pain or shortness of breath, or swelling in the arms or legs. Low mood ( depression ).[drugs.com]
Congestive Heart Failure
  • NAPA concentrations can become quite high in patients with renal or congestive heart failure. For these reasons, it is important to consider both procainamide and NAPA levels when evaluating the status of a patient.[clinlabnavigator.com]
  • If possible, before you receive procainamide, tell your doctor if you have congestive heart failure , circulation problems, a history of heart attack or stroke (including " mini-stroke "), a weak immune system, kidney or liver disease , myasthenia gravis[emedicinehealth.com]
  • Congestive Heart Failure For patients in congestive heart failure, and those with acute ischemic heart disease or cardiomyopathy, caution should be used in PA therapy, since even slight depression of myocardial contractility may further reduce cardiac[rxlist.com]
Intravenous Administration
  • The same protocol was repeated in another 15 patients after intravenous administration of verapamil (0.15 mg/kg) and in another 15 patients after intravenous administration of procainamide (15 mg/kg).[ncbi.nlm.nih.gov]
  • Intravenous administration of procainamide is more likely to cause hypotensive effects.[pdr.net]
  • Intravenous administration of Procainamide should be done cautiously to avoid a possible hypotensive response.[wikidoc.org]
  • Intravenous administration of Procainamide Hydrochloride Injection can produce therapeutic Procainamide levels within minutes after infusion is started.[drugs.com]
Nausea
  • Symptoms may include nausea, vomiting, rash, and fever. Liver enzyme concentrations are abnormal.[ncbi.nlm.nih.gov]
  • No serious cardiac or noncardiac adverse events were noted during procainamide therapy, although there was a significant increase in the incidence of nausea.[ncbi.nlm.nih.gov]
  • Gastrointestinal Anorexia , nausea , vomiting, abdominal pain, bitter taste, or diarrhea may occur in 3 to 4 percent of patients taking oral procainamide.[rxlist.com]
  • They are also liable to cause side effects such as nausea… Read More lupus erythematosus role In lupus erythematosus …counteract high blood pressure, and procainamide, which is a medication for irregular heart rhythms.[britannica.com]
  • Contact your doctor at once if you develop signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, mouth sores, or unusual weakness.[emedicinehealth.com]
Scleral Icterus
  • In addition to disorientation, scleral icterus, and diffuse maculopapular rash, her physical examination was generally normal. There was no evidence of fever, nausea, vomiting, lymphadenopathy, or eosinophilia.[ncbi.nlm.nih.gov]
Hypotension
  • Intravenous propafenone was superior to procainamide in achieving rapid cardioversion and a better rate control with a lower incidence of symptomatic hypotension.[ncbi.nlm.nih.gov]
  • We report a case of lone paroxysmal atrial fibrillation in a patient with a structurally normal heart who suffered paradoxical accelerated atrioventricular nodal conduction and secondary hypotension in response to procainamide administration.[ncbi.nlm.nih.gov]
  • Procainamide may precipitate hypotension in left ventricular failure or impaired function. May cause dysrhythmias in the presence of acute MI, hypokalemia, or hypomagnesemia.[shadwige.sites.truman.edu]
  • -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.[micunursing.com]
  • Adverse Reactions PR, QRS, and QT widening, AV Block, cardiac arrest, hypotension, seizures. Nausea, vomiting, reflex tachycardia, PVCs, VT, VF. CNS depression, confusion. Drug Interaction None with other emergency drugs.[cram.com]
Blepharospasm
  • With a serum level of 3.8 mg l-1 procainamide a reduction of the resting metabolic rate of 22% was observed, and times needed to climb stairs and to re-open eyes after forceful contraction (blepharospasm) were significantly reduced.[ncbi.nlm.nih.gov]
Petechiae
  • The patient exhibited gross hematuria and lower extremity petechiae. There were no signs of splenic sequestration and other hematologic indices were normal. Procainamide was discontinued on hospital day 32.[ncbi.nlm.nih.gov]
Seizure
  • Vol. 37, Pg. 551, 1985. mouse LD50 intravenous 49mg/kg (49mg/kg) BEHAVIORAL: CONVULSIONS OR EFFECT ON SEIZURE THRESHOLD BEHAVIORAL: ATAXIA Polish Journal of Pharmacology and Pharmacy.[chem.nlm.nih.gov]
  • Lupus-like reaction, seizures. May potentiate some other medications. Administration and Dosage Loading dose is 20-30mg/min until rhythm suppressed or : Hypotension, widening of QRS by 50%, 17 mg/kg maximum is reached. Lupus-like reaction, seizures.[ems.grmc.org]
  • Adverse Reactions PR, QRS, and QT widening, AV Block, cardiac arrest, hypotension, seizures. Nausea, vomiting, reflex tachycardia, PVCs, VT, VF. CNS depression, confusion. Drug Interaction None with other emergency drugs.[cram.com]
  • […] toxicity Torsades de pointes PROCAINAMIDE (PRONESTYL) Adverse Reactions Hypotension Bradycardia Reflex tachycardia AV block Widened QRS Prolonged PR or QT interval PVCs Ventricular tachycardia, ventricular fibrillation, asystole CNS depression Confusion Seizure[eilat.sci.brooklyn.cuny.edu]

Workup

  • CONCLUSION: Irrespective of the baseline ECG, procainamide testing provoked a Brugada pattern in a significant proportion of subjects with UCA or a FHSD, thereby facilitating a diagnosis of Brugada syndrome, and is recommended in the workup of UCA.[ncbi.nlm.nih.gov]
Pericardial Effusion
  • effusion, pericardial tamponade, acute hepatomegaly, splenomegaly, lymphadenopathy, acute pancreatitis, and the presence of LE cells in the blood. b Patients with procainamide-induced SLE may have a positive direct antiglobulin (Coombs’) test. b 152[drugs.com]
Wide QRS Complex
  • We performed a multicentre randomized open-labelled study to determine the safety and efficacy of intravenous procainamide and amiodarone for the acute treatment of tolerated wide QRS complex (probably ventricular) tachycardia.[ncbi.nlm.nih.gov]
  • However, the majority of wide QRS complex tachycardias presenting at Emergency Departments are in fact VTs, even if the haemodynamic tolerance is acceptable. 15 As such, the present trial refers to ‘wide QRS complex tachycardia (probably of ventricular[eurheartj.oxfordjournals.org]
  • Population Patients 18 years of age presenting with a regular, wide QRS complex ( / 120 ms) tachycardia / 120 bpm and with good hemodynamic tolerance (SBP / 90 mm Hg, absence of dyspnea at rest, absence of peripheral hypoperfusion and no severe anginal[coreem.net]
Prolonged QT Interval
  • Class: Class IA antidysrhythmic agent Actions: Blocks cardiac sodium channels Decreases conduction velocity in the ventricles Delays myocardial repolarization Widening of QRS and prolonged QT interval Indications: Antidysrhythmic medication for: Stable[shadwige.sites.truman.edu]
  • People with an abnormal heart rhythm seen on a heart monitoring trace ( ECG ) as a 'prolonged QT interval'. People taking medicines that can cause a 'prolonged QT interval' (your doctor will know, but see end of this factsheet for some examples).[netdoctor.co.uk]
  • Henbane: increased anticholinergic activity Jimsonweed: adverse cardiovascular effects Licorice: prolonged QT interval Drug-behaviors.[medical-dictionary.thefreedictionary.com]
  • QT interval ) heart block prolongation of PR, QRS, QT intervals (up to 50%) bradycardia, asystole decreased BP, decreased CO Immunologic: lupus erythematosus like syndrome fever neutropenia, agranulocytosis, thrombocytopenia Others: peripheral neuropathy[lhsc.on.ca]
Third Degree Atrioventricular Block
  • Before using this medication , tell your doctor or pharmacist your medical history, especially of: certain irregular heartbeat problems (second- or third-degree atrioventricular block or bundle branch block, unless you have a heart pacemaker ), new or[webmd.com]
Torsades De Pointes
  • Class IA antiarrhythmics are associated with QT prolongation and torsades de pointes (TdP). Quinolones have been associated with a risk of QT prolongation and torsade de pointes (TdP).[pdr.net]
  • Cardiotoxicity associated with these levels included progressive widening of the QRS and corrected Q-T intervals, induction of polymorphic non-sustained ventricular tachycardia (torsades de pointes), and severe depression of left ventricular function[ncbi.nlm.nih.gov]
  • Side Effects Hypotension Myocardial depression Heart block, tachyarrhythmias, Torsades de pointes. Lupus-like reaction, seizures. May potentiate some other medications.[ems.grmc.org]
  • Torsades de Pointes In the unusual ventricular arrhythmia called "les torsades de pointes" (twistings of the points) characterized by alternation of one or more ventricular premature beats in the directions of the QRS complexes on ECG in persons with[druglib.com]

Treatment

  • BACKGROUND AND HYPOTHESIS: Antiarrhythmic drugs are widely used for treatment of atrial fibrillation (AF) and restoration of sinus rhythm.[ncbi.nlm.nih.gov]
  • Of those, 15 (22%) had side effects considered treatment related. Most of the adverse events occurred during the first 6 weeks of treatment. Only a few patients (8%) withdrew as a consequence of treatment with the bid formulation.[ncbi.nlm.nih.gov]
  • Procainamide, given orally may also be used in breast cancer patients who developed resistance during the tamoxifen treatment.[ncbi.nlm.nih.gov]
  • In contrast, the mode duration of treatment with PA before lupus-like symptoms develop is 10-12 months.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: These cardiovascular drugs have a promising tumor suppressor-reactivating action and could potentially be used in clinic as an anticancer treatment, most likely to increase the efficacy of current biological or chemotherapeutic treatments[ncbi.nlm.nih.gov]

Etiology

  • Associated clinical, laboratory, and pathologic findings suggest the diagnosis of drug-induced lupus and exclude other vasculitic or inflammatory etiologies.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Provocative testing with adrenaline and procainamide infusions is useful in unmasking the etiology of apparent unexplained cardiac arrest.[ncbi.nlm.nih.gov]

Pathophysiology

  • Reorganized to mirror your changing practice, each cardiovascular-problem-based section offers a chapter on pharmacologic treatment (with a minimum of pathophysiology)...a chapter on catheter-based or minimally invasive interventions...and a discussion[books.google.it]
  • Useful For Suggests clinical disorders or settings where the test may be helpful Monitoring therapy with procainamide Assessing compliance Evaluating toxicity Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as[mayocliniclabs.com]

Prevention

  • Beta blockers prevent atrial fibrillation postoperatively, but there are few data regarding the prophylactic use of type 1 antiarrhythmic agents or the prevention of ventricular arrhythmias.[ncbi.nlm.nih.gov]
  • The preventive effect of bafilomycin A1 suggests that the vacuoles originate from the osmotic swelling of acidic organelles in which the charged basic drugs are trapped at low pH.[ncbi.nlm.nih.gov]
  • Three-hour dosage intervals are required to prevent fluctuations of plasma level exceeding 50%. In urgent situations, a parenteral priming dose should be given.[doi.org]
  • These results further suggest that procaine and procainamide may have a potential use for preventing the development of lung cancer.[ncbi.nlm.nih.gov]
  • We finally demonstrated that the co-administration of PdHCl prevents DNA digestion accounting for a restriction enzyme inhibition that in some cases was greater than that obtained by DDP alone.[ncbi.nlm.nih.gov]

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