Procainamide Hydrochloride and Rucaparib Camsylate

• Generic Name: procainamide
• Dosage Forms: n.a.
• Other Brand Names: Pronestyl, Procan SR, Pronestyl-SR, Procanbid

Comparably effective to quinidine for atrial or ventricular arrhythmias; choice based on pharmacokinetics and adverse effect profile.

Treatment of ventricular arrhythmias (e.g., sustained VT) that in the judgment of the clinician are life-threatening, but usually not the antiarrhythmic of first choice.

Not a first-line drug of choice during cardiac arrest, but may be used for treatment of wide-complex tachycardias in the periarrest period; included in current ACLS treatment guidelines for adult and pediatric tachycardia.

May be used in the treatment of sustained, stable monomorphic VT not associated with angina, pulmonary edema, or hypotension (BP <90 mm Hg) in patients with preserved ventricular function.

Some experts recommend revascularization and β-blockade followed by IV antiarrhythmic drugs, such as procainamide or amiodarone, for patients with recurrent or incessant polymorphic VT due to acute myocardial ischemia.

Because of procainamide's arrhythmogenic potential, lack of evidence for improved survival for class I antiarrhythmic agents, and risk of serious, potentially fatal adverse hematologic effects (see Boxed Warning), particularly leukopenia or agranulocytosis, use for less severe arrhythmias not recommended.

Reserve for suppression and prevention of documented life-threatening ventricular arrhythmias in carefully selected patients in whom the benefits of procainamide therapy outweigh the possible risks.

Avoid treatment of asymptomatic VPCs.

Initiate procainamide therapy only in a hospital setting.

Has been used for treatment of various supraventricular tachycardias (SVTs); because of higher risk of toxicity and proarrhythmic effects, antiarrhythmic agents generally reserved for patients who do not respond to or cannot be treated with AV nodal blocking agents (β-adrenergic blocking agents, verapamil, diltiazem).

May be useful in patients with preexcited atrial fibrillation and rapid ventricular response associated with Wolff-Parkinson-White syndrome; however, direct-current cardioversion is treatment of choice when patient is hemodynamically compromised.

Also has been used for treatment of junctional tachycardia; however, more limited role and generally considered only when IV β-adrenergic blocking agents are ineffective.

Used parenterally (preferably IM) in the treatment of arrhythmias that occur during surgery and anesthesia.

IV procainamide has been used effectively in the treatment of malignant hyperthermia.

• Generic Name: rucaparib
• Dosage Forms: n.a.
• Other Brand Names: Rubraca

Single-agent therapy for the treatment of deleterious germline and/or somatic BRCA-mutated (as detected by an FDA-approved companion diagnostic test [FoundationFocus CDx BRCA]) advanced ovarian cancer previously treated with ≥2 chemotherapy regimens (designated an orphan drug by FDA for this use). Subgroup analysis suggests overall response rate is higher in patients with platinum-sensitive disease than in those with platinum-resistant disease (66 versus 25%); no responses observed in a limited number of patients with platinum-refractory disease.

Accelerated approval based on overall response rate and duration of response. Continued approval may be contingent on verification and description of clinical benefit in confirmatory studies.

Women with mutations that result in defective BRCA genes are more likely to develop ovarian cancer. Approximately 10–15% of all cases of ovarian cancer appear to be associated with these hereditary BRCA mutations.