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INTRODUCTION

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procainamide (proe-kane-ah-mide)

Pronestyl

Classification

Therapeutic: antiarrhythmics (class IA)

Pharmacologic: membrane stabilizers

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Indications
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Treatment of a variety of ventricular and atrial arrhythmias, including Atrial premature contractions, Premature ventricular contractions, Ventricular tachycardia, Paroxysmal atrial tachycardia. Maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.

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Action
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Decreases myocardial excitability. Slows conduction velocity. May depress myocardial contractility. Therapeutic Effects: Suppression of arrhythmias.

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Adverse Reactions/Side Effects
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CNS: SEIZURES, confusion, dizziness. CV: ASYSTOLE, HEART BLOCK, VENTRICULAR ARRHYTHMIAS, hypotension. GI: diarrhea, anorexia, bitter taste, nausea, vomiting. Derm: rashes. Hemat: AGRANULOCYTOSIS, eosinophilia, leukopenia, thrombocytopenia. Misc: chills, drug-induced systemic lupus syndrome, fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • Monitor cardiac symptoms at rest and during exercise. Seek immediate medical assistance if symptoms of asystole or heart block develop, including sudden chest pain, pain radiating into the arm or jaw, shortness of breath, dizziness, sweating, anxiety, nausea, and loss of consciousness.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

  • Monitor signs of blood dyscrasias including agranulocytosis and leukopenia (fever, sore throat, mucosal lesions, signs of infection), eosinophilia (fatigue, weakness, myalgia), or thrombocytopenia (bruising, nose bleeds, bleeding gums). Report these signs to the physician immediately.

  • Be alert for early signs of myasthenia gravis syndrome, such as drooping eyelids, facial muscle weakness, and difficulty swallowing and speaking. Report these signs to the physician immediately, and monitor other muscle groups for signs of unusual weakness and fatigue, especially after repeated contraction.

  • Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Because of the risk of serious cardiac arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

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Patient/Client-Related Instruction
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  • Advise patient and family or caregivers about the signs of cardiac arrest and arrhythmias (see above under Examination and Evaluation) and to seek immediate medical assistance if these signs develop

  • Instruct patient and ...

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