프로카인아미드

항부정맥제 (Class 1A)

프로카인아미드는 국소 마취제인 프로카인과 구조적으로 관련된 **Class 1A 항부정맥제**입니다. 수의학에서는 주로 **심실성 빈맥성 부정맥**(심실조기수축[VPC] 및 심실빈맥 등)과 특정 **상심실성 빈맥**(SVT)을 관리하는 데 사용됩니다. 심방 및 심실 부정맥 모두에 대한 광범위한 활성 스펙트럼 때문에, 넓은 QRS군을 동반한 빈맥이 상심실성인지 심실성인지 명확히 식별할 수 없을 때 이상적인 1차 정맥 주사 치료제로 간주되는 경우가 많습니다. > **임상 요점:** 사람과 달리 개는 아세틸화 능력이 떨어져 활성 대사산물인 N-아세틸프로카인아미드(NAPA)를 충분히 생성하지 못합니다. 따라서 개의 치료 약물 모니터링은 프로카인아미드 농도에만 초점을 맞춰야 합니다.

작용 기전: Procainamide acts primarily as a **fast sodium channel blocker** (Class 1A), similar to quinidine. * **Phase 0 Blockade:** Slows the influx of sodium during Phase 0 depolarization of the cardiac action potential. * **→** Prolongs the refractory period in both the atria and ventricles. * **→** Decreases myocardial excitability and depresses automaticity and conduction velocity. * **Anticholinergic Effects:** Exhibits mild vagolytic properties which may cause slight increases in heart rate or unpredictable rate changes. * **ECG Effects:** Commonly causes widening of the QRS complex and prolongation of the PR and QT intervals.

동물 종별 용량

Cats

Chronic management of SVTs · 3-8 mg/kg PO q6-8h · PO · q6-8h
Chronic management of SVTs · 1-2 mg/kg slowly IV; 10-20 micrograms/kg/minute constant rate IV infusion · IV · Bolus then CRI
Chronic management of SVTs · 7.5-20 mg/kg q 6-8h · PO · q6-8h

Horses

Atrial fibrillation / Ventricular tachycardia · 1 mg/kg/min IV, not too exceed 20 mg/kg (20 minutes) total dose · IV · Once · 20 minutes max · Not as effective as quinidine for atrial fibrillation
Atrial fibrillation / Ventricular tachycardia · 25-35 mg/kg PO q8h · PO · q8h
V-Tach · 1 mg/kg/minute IV up to a total dose of 20 mg/kg; or 25-35 mg/kg PO q8h · IV/PO · Once or q8h

Dogs

Ventricular tachyarrhythmias · 2-4 mg/kg IV slowly (over two minutes) up to a total dose of 12-20 mg/kg until arrhythmia controlled and then a CRI may be started at 10-40 micrograms/kg/minute · IV · Intermittent boluses then CRI
Ventricular tachyarrhythmias · 20-30 mg/kg PO q6-8h · PO · q6-8h · Previous recommendations of 8-20 mg/kg PO q6-8h are almost certainly too low
Acute management of SVTs · 6-8 mg/kg IV over 3 minutes or 6-20 mg/kg IM · IV/IM · Once · After drugs have been used to slow AV nodal conduction (i.e., diltiazem)

투여 경로

IVIMPO

금기

Myasthenia gravis
Hypersensitivity to procainamide, procaine, or chemically related drugs
Systemic lupus erythematosus (SLE) in humans (unknown in dogs)
Torsade de pointes
2nd or 3rd degree heart block (unless artificially paced)
Doberman pinschers and boxers with dilated cardiomyopathy (relative - proarrhythmic risk)
Dogs with subaortic stenosis (relative - proarrhythmic risk)

이상반응

Anorexia
Vomiting
Diarrhea
Weakness
Hypotension (especially with rapid IV injection)
Negative inotropism
Widened QRS complex
Prolonged QT interval
AV block
Multiform ventricular tachycardias
Fevers
Leukopenias

약물 상호작용

Amiodarone · May increase procainamide levels; procainamide dose may need to be reduced
Anticholinesterase agents (e.g., pyridostigmine, neostigmine) · Procainamide may antagonize effects in patients with myasthenia gravis
Cimetidine · May increase procainamide levels
Hypotensive drugs · Procainamide may enhance hypotensive effects
Lidocaine · Toxic effects may be additive, and cardiac effects unpredictable
Neuromuscular blocking agents · Procainamide may potentiate or prolong the neuromuscular blocking activity
Quinidine · Toxic effects may be additive, and cardiac effects unpredictable
Phenytoin · Toxic effects may be additive, and cardiac effects unpredictable
Propranolol · Toxic effects may be additive, and cardiac effects unpredictable
Ranitidine · May increase procainamide levels
Trimethoprim · May increase procainamide levels

모니터링

ECG (continuously with IV dosing)
Blood pressure (during IV administration)
Clinical signs of toxicity (GI signs, weakness)
Serum drug levels (Trough levels for oral therapy. Note: Request lab to not run NAPA for dogs. Target range: 3-8 to 8-20 mcg/mL in dogs; 4-10 mcg/mL in horses)

과용량

Clinical signs of overdosage can include **hypotension, lethargy, confusion, nausea, vomiting, and oliguria**. Cardiac signs may include widening of the QRS complex, junctional tachycardia, ventricular fibrillation, or intraventricular conduction delays. * **Oral Ingestion:** Emptying of the gut and charcoal administration may be beneficial to remove unabsorbed drug. * **Hypotension:** IV fluids, plus dopamine, phenylephrine, or norepinephrine could be considered. * **Cardiotoxicity:** A 1/6 molar intravenous infusion of sodium lactate may be used in an attempt to reduce cardiotoxic effects. * **Elimination:** Forced diuresis using fluids and diuretics along with reduction of urinary pH can enhance renal excretion. * **AV Block:** Temporary cardiac pacing may be necessary should severe AV block occur.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.