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41. Comparative evaluation of intravenous phenytoin, procainamide and practolol in the acute treatment of ventricular arrhythmias. (Abstract)

Comparative evaluation of intravenous phenytoin, procainamide and practolol in the acute treatment of ventricular arrhythmias. Ten patients with a persistent ventricular arrhythmia, but no other sign of heart disease, were studied by means of an exercise test performed 4 times with a fixed work load, over 30--40 min. No drug was given in the first exercise test and in the others phenytoin, procainamide or practolol were chosen at random for i.v. administration. Blood samples for determination (...) of plasma concentration were frequently collected. The ECG was recorded continuously during the exercise test and was analysed minute by minute. Despite plasma levels within the suggested therapeutic range, only procainamide showed a statistically significant antiarrhythmic effect in this group of patients.

1977 European journal of clinical pharmacology Controlled trial quality: uncertain

44. Management of Poisoning

with dysrhythmia, serum pH should be maintained at 7.45 to 7.55. Other causes of widened QRS should be considered if the patient fails to respond to suf? cient doses of sodium bicarbonate therapy (pg 149). Grade C, Level 2- GPP Use of physostigmine as an antiarrhythmic is not recommended. In the setting of TCA overdose, it has been associated with the development of seizures and fatal dysrhythmias (pg 149). GPP GPP Avoid antiarrhythmic drugs from class Ia (quinidine, procainamide, disopyramide), class Ic

2020 Ministry of Health, Singapore

45. Mexiletine hydrochloride (Namuscla) - symptomatic treatment of myotonia in adult patients with non-dystrophic myotonic disorders

as an unlicensed medicine for the treatment of non-dystrophic myotonia in the UK for decades. Several medicines are also used off-label, including flecainide, phenytoin, procainamide, and tocainide. The EMA notes that these medicines cannot be recommended as treatment for myotonia, because of associated severe side effects. 1, 2 The key study (MYOMEX) in patients with myotonia congenita and paramyotonia congenita used a randomised, double-blind, short, crossover design and reported statistically significant

2020 Scottish Medicines Consortium

47. Cardiac arrhythmias in coronary heart disease

procainamide was more effective than IV amiodarone in terminating wide complex tachycardia (22 of 33 participants, (67%) v 11 of 29 participants (38%), respectively; p=0.026). Intravenous procainamide was associated with fewer major cardiac adverse events (9% v 41%, odds ratio (OR) 0.1, 95% CI 0.03 to 0.6), the main one being severe hypotension, and total adverse events (24% v 48%, OR 0.34, 95% CI 0.12 to 1.00) in the acute study period (40 minutes from infusion initiation). 156 There were a number (...) of uncertainties in the sample size calculation for this trial as the anticipated adverse event rates were 20% and 5% in the procainamide and amiodarone groups, respectively, requiring a sample of 302 patients to detect a difference of 15% in major adverse events between groups. After six years, only 74 patients had been recruited with a decline in inclusion rates noted over time. At this point, recruitment was stopped and consequently the study is underpowered. The 2010 CoSTR guidance on advanced life support

2018 SIGN

49. Amiodarone: Wonder Drug or Wonder Why?

was recommended as a "first line anti arrhythmic agent" in refractory VF/pulseless VT, based on limited evidence for improved rates of ROSC and hospital admission. In addition, amiodarone been recommended for use in recent-onset AF for over twenty years ( ). Given the rise in prominence of procainamide use in AF (see ), and an increased focus on , we decided to review evidence for a variety of amiodarone indications frequently seen in the ED. Stable Ventricular Tachycardia , a small, multicenter randomized (...) controlled trial conducted at several hospitals in Spain enrolled 74 patients with hemodynamically stable, wide-complex tachycardia and randomized them to receive either IV amiodarone or IV procainamide over twenty minutes. Major cardiac events (clinical signs of hypoperfusion, dyspnea, hypotension, or acceleration of heart rate) occurred less frequently among patients receiving procainamide (OR 0.1' 95% CI 0.03 to 0.6). These patients also had a much higher rate of cardioversion (OR 3.3, 95% CI 1.2

2018 Washington University Emergency Medicine Journal Club

50. Steroids in Sepsis and Septic Shock

-onset AF for over twenty years ( ). Given the rise in prominence of procainamide use in AF (see ), and an increased focus on , we decided to review evidence for a variety of amiodarone indications frequently seen in the ED. Intranet Locations Contact Us Follow Us: F: (314) 362-0478 EM Statistics Adult ED Visits: 95,600 Pediatric ED Visits: 55,000 Trauma Center: Level 1 Residency Type: 1-4 Fellowship Programs: 5 FT Faculty: 46 Residents: 53 | | | | © 2019 by Washington University in St. Louis One

2018 Washington University Emergency Medicine Journal Club

52. Chiefs’ inquiry corner

of pseudo right bundle branch block features. Type 1, and not Type 2, Brugada pattern is considered the diagnostic pattern. Brugada patterns or resulting ventricular arrhythmias can be unmasked by several provoking factors, including fever, electrolyte abnormalities, and medications with sodium channel blocking properties. Provocative testing of candidates for Brugada Syndrome can be performed with sodium channel blocking ant arrythmics, such as flecanide and procainamide. Candidates for provocative

2019 Clinical Correlations

53. Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association

, any drug that prolongs the QT interval should generally be avoided in any patient suspected of having long-QT syndrome. Examples include amiodarone, procainamide, and sotalol. Many of the vasoactive agents used to support myocardial function can increase myocardial irritability and risk of arrhythmias. Premature atrial or ventricular depolarizations are frequently observed and can be controlled by optimizing the dose of the vasoactive drugs. Arrhythmias are frequently reported during TTM

2019 American Heart Association

55. Practicing emergency medicine in New Zealand: A Canadian’s perspective

and avoided opioids in a tremendous number of patients. They did not have a few drugs, most notably Procainamide, so I had to cardiovert my Atrial Fibrillation patients electrically. I was considered ‘aggressive’ in my management of these patients, and it was one of the few conditions where there was a significant practice difference between Canada and New Zealand. I saw some interesting infectious disease cases. Varicella vaccinations are relatively new in NZ, so I would regularly see cases of chicken

2018 CandiEM

56. CRACKCast E140 – Accidental Hypothermia

there is a rapid ventricular response. No clear consensus on administering antiarrhythmics – probably safer not to. The ideal approach to ventricular dysrhythmias in the hypothermic patient has not been well studied. Lidocaine and propranolol have minimal hemodynamic effects during hypothermia. Their efficacy in the treatment of ventricular dysrhythmias appears limited. The efficacy of amiodarone is not supported either In hypothermia, at least one Group 1 antidysrhythmic agent, procainamide, increases

2018 CandiEM

57. CRACKCast E179 – Drug Therapy in Pregnancy

Doxycycline Tetracyclines Fluoroquinolones Trimethoprim Sulfonamides Nitrofurantoin [5] List 2 safe anti-dysrhythmics in pregnancy Adenosine Digoxin Verapamil Procainamide Some beta blockers The top four are definitely the most widely supported. Electrical cardioversion is very safe! Emergent or elective electrical cardioversion can be performed at all stages of pregnancy, and should be used for any sustained arrhythmia with hemodynamic compromise and can be considered for drug-refractory arrhythmias

2018 CandiEM

58. Tiny Tips: “TREADMILLS” Peripheral Neuropathy mnemonic

, glucose, urea, creatinine), and thyroid stimulating hormone (TSH) 2 . There are many causes for peripheral neuropathy, so when considering the etiology, think “TREADMILLS.” T oxins Ethanol, Heavy metals, Tetanus, Organophosphates, Diphtheria R enal Failure E ndocrine Diabetes, Hypothyroidism A cquired Immunodeficiency Syndrome (AIDS) D rugs/ D eficiency Amiodarone, Procainamide, Digoxin, Hydralazine, Statins, Isoniazid, Chloroquine, Misoprostol, Metronidazole, Nitrofurantoin Vitamin B6 deficiency

2018 CandiEM

59. CRACKCast E171 – Pediatric Cardiac Disorders

, blowing on an occluded straw, or blowing on the tip of a syringe) – don’t attempt carotid massage in children (it doesn’t work). Adenosine (0.1-0.2 mg/kg) – max 12 mg 3rd line drugs for stable SVT: Amiodarone Amiodarone may be given at a loading dose of 5 mg/kg over 60 minutes, then continued at 5 mcg/kg/min Procainamide Look for signs on ECG for WPW! *****If the pt is known to have an underlying Wolff-Parkinson-White syndrome, the four medications that should be avoided are the A-B-C-D medications (...) (adenosine, beta-blockers, calcium channel blockers, and digoxin); All of these medications preferentially block conduction down the atrioventricular node, leaving the accessory pathway open to conduct the atrial tachycardia to the ventricles at a potentially lethal rate. Under these circumstances, physicians should use amiodarone, procainamide, or cardioversion as safer alternatives [11] Describe procedures and conditions for which prophylaxis for bacterial endocarditis is recommended Predisposing

2018 CandiEM

60. CRACKCast E151 – Antidepressants

channel blockade ***Basically, all of the ANTI- anything drugs*** Rosen’s list / As per / WikiEM: Tricyclic antidepressants (= most common) class IA antidysrhythmics (eg, procainamide, disopyramide, quinidine) class II antiarrhythmics (eg sotalol or metoprolol) & propranolol class IC antidysrhythmics (eg, flecainide, encainide, and propafenone) local anaesthetics (bupivacaine, ropivacaine) Antimalarials (chloroquine, hydroxychloroquine) Antispasmodics (eg cyclobenzaprine) Antipsychotics (1st (...) meds to avoid in TCA overdoses Avoid anything with Na+ channel blocking effects! Physostigmine Class IA IC drugs Ia – Quinidine, procainamide, disopyramide (depress phase 0, prolonging repolarization) Ic – Flecainide, propafenone, moricizine (markedly depress phase 0, minimal effect on repolarization) Dilantin (phenytoin) [3] List the 2 common situations for NMS High Potency antipsychotics Abrupt cessation of Parkinson’s meds [4] Expand on the hot & bothered ddx MAOI toxicity sympathomimetic drugs

2018 CandiEM

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