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When a patient receiving a procainamide drip becomes hypotensive, the most appropriate action is to discontinue the drip and reassess the patient's condition. Procainamide is an antiarrhythmic medication that can lead to hypotension as a side effect, particularly when given as an intravenous infusion.

Discontinuing the drip allows for the immediate alleviation of any potential exacerbating factors contributing to the hypotension. It is important to reassess the patient to determine the severity of the hypotension, evaluate the patient's overall condition, and identify any underlying causes that may need to be addressed.

Continuing the drip or increasing the rate could worsen the hypotension and pose a significant risk to the patient. Administering fluids might be helpful in some cases, but without first discontinuing the source of the hypotension, it may not effectively address the underlying problem. Starting an alternate medication would likewise not be appropriate without first understanding the patient's status and resolving the current issue.