Page 366 - Cardiac Nursing

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Monitor QT interval, QRS width, PR. Monitor NAPA level (active metabolite) Watch for hypotension with IV use Amiodarone, cimeti- dine, ranitidine increase procainamide procainamide levels Additive effects on conduction system dis- ease when given with other class IA, class IC, tricyclic antidepressants, or Was not included in CAST but is same class as drugs shown to cause higher digoxin levels. c blocker -blocker and Ca 2
Quinidine and cimetidine increase Additive effects
Comments Drug Interactions: levels Alcohol T blockers Ca 2
mortality post-MI Watch for proarrhythmia Drug interactions: Potentiates coumadin Has mild effects Cyclosporin levels c propafenone levels Drug interactions: digoxin
GI: nausea, vomiting, anorexia CV: bradycardia, heart block, proarrhythmia (less than that with quinidine). Prolongs QT Hypotension. With IV use CNS: headache, insomnia, dizziness, psy- chosis, hallucinations, depression Lupus-like syndrome with long-term use (15%–25% of patients who take drug Other: rash, fever, swollen joints, agranu- locytosis, pancytopenia GI: nausea, anorexia, constipation, CNS: dizziness, headache, blurred vision CV: HF, bradycardia, AV block, bundle- br
Side Effects interval 1 year) metallic taste depression
(continued) PO dose (regular release form): loading dose of 1,000–1,200 mg; maintenance dose 50 mg/kg/day in divided doses three to four times a day (never more SR forms: 750–1,500 mg q 6 hours IV loading dose: 17 mg/kg at 20 mg/min. If rapid loading is needed, give 100-mg doses over 5 minutes to total of 1g 4–10 mcg/mL (may be as high as 5–32 mg/L to prevent about 3.5 hours Active metabolite is NAPA: therapeutic 0.2–3 mcg/mL 2–10 hours in normal metab- olizers, up to 32 hours in slow
Dose/Administration Therapeutic Level/Half-Life than 6 hour between doses) IV drip 2–4 mg/min Therapeutic level sustained VT) Half-life 9–12 mg/L level 150–300 mg t.i.d. Therapeutic level Half-life lizers IV: 1–3 mg at rate of 1 mg/min 50–100 ng/mL Half-life
DRUGS USED FOR HEART RATE AND RHYTHM CONTROL
Conversion of atrial fib to sinus and maintenance of NSR Treatment of AT, atrial flutter and fib Slows conduction through accessory path- Treatment of monomorphic VT Conversion of atrial fib to sinus and maintenance of NSR Slow conduction through accessory path- Life-threatening ventricular arrhythmias Ventricular rate control in atrial fib/ Treatment of SVT (slow AV node conduction): AVNRT, CMT Effective in some types of VT: exercise in- duced, digitalis induced Effective in re

Indication ways in WPW ways (sustained VT) flutter

■ Procainamide (Pronestyl) (Class IA antiarrhythmic) Propafenone (Rythmol) (Class IC antiarrhythmic, also has -blocker effects) Propranolol (Inderal) (Noncardioselective -
Table 16-2 Drug (Class) blocker)

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