Based on the article:  The Pediatric Cardiology Pharmacpoeia

By: Ra-id Abdulla, Sharon Young and Steve Barnes

Published in Pediatric Cardiology (1997) Volume: 18, Issue:  3

This page include many of the medications used in pediatric cardiology.  The drugs are grouped in categories of use, for example drugs used to control blood pressure, for heart rhythm and so on.  Within each category the medications are listed alphabetically by their generic name.  It is VERY IMPORTANT that you DO NOT change your medications type or dose without your cardiologists instructions, most of these medications have serious ill consequences if not used properly.  The purpose of this page is to provide you with knowledge about the medications you or your child is receiving.  Discuss any questions you have with your cardiologist prior to making any changes.

BP Drugs

 

Heart rhythm

 

Vasodilators

 

Diuretics

 

Amrinone

Calcium Chloride

Calcium gluconate

Digoxin

Dobutamine

Dopamine

Epinephrine HCl

Milrinone

Phenylephrine HCl

Norepinephrine

 

 

 

 

 

 

Adenosine

Amiodarone

Atenolol

Bretylium Tosylate

Disopyramide

Esmolol

Flecainide

Lidocaine

Phenytoin

Procainamide

Propafenone

Propranolol

Quinidine

Tocainide

Verapamil

 

Captopril

Diazoxide

Enalapril

Hydralazine

Metoprolol

Nifedipine

Nitroglycerine

Nitroprusside

Prazosin HCl

Bumetanide

Chlorothiazide

Ethacrynic Acid

Furosemide

Hydrochlorothiazide

Metolazone

Spironolactone

 

Emergency Drugs Sedatives

 

Miscellaneous

 

Atropine

Diphenhydramine

Bretylium Tosylate

Calcium Chloride

Epinephrine Hydrochloride

Lidocaine

Sodium Bicarbonate

Pancuronium

Vecuronium bromide

Chloral Hydrate

Chlorpromazine

Diazepam

Fentanyl

Ketamine

Meperidine

Midazolam

Morphine sulfate

Naloxone

Promethazine

Acetylsalicylic Acid

Ammonium Chloride

Argeninine HCl (10%)

Dexamethasone

Heparin

Ibuprofen

Indomethacin

Isoproterenol

Prostaglandin E1

Protamine sulfate

Streptokinase

Tolazoline HCl

Urokinase

Vitamin K (phytonadione)

Warfarin

 

Inotropic and Vasopressor Agents

 

Amrinone
Inocor
Indications for use:  to improve the ability of the heart muscles to contract and to reduce the blood pressure making it easier for the hear to function.
Onset of action: 2-5 minutes
Mode of action: Myocardial cAMP phosphodiesterase inhibitor, increase intracellular cAMP resulting in better myocardial function, pulmonary and systemic vasodilation
Side effects: Arrhythmia, thrombocytopenia
Caution: Bleeding disorder, hypertrophic cardiomyopathy, hypotension
Calcium Chloride
Indications for use:  calcium is used by the heart muscles to contract, therefore this medication may improve heart function.
Onset of action: rapid
Mode of action: Enhances contractility through regulation of action potential
Side effects: Bradycardia, hypotension, peripheral vasodilation, hypercalcemia, hypermagnesemia, hyperchloremic acidosis
Caution: Central venous line administration ONLY. Max. conc. is 20 mg/ml infusion Extravasation may lead to tissue necrosis, use local hyaluronidase if occur, may precipitate arrhythmia in digitalised patient
Contraindication: Hypercalcemia, ventricular fibrillation
Calcium Gluconate
Indications for use:  calcium is used by the heart muscles to contract, therefore this medication may improve heart function.
Onset of action: Rapid
Mode of action: Enhances contractility through regulation of action potential
Side effects: Bradycardia, hypotension, peripheral vasodilation, hypercalcemia, hypermagnesemia
Caution: Central venous line administration ONLY. Max. conc. is 20 mg/ml infusion Extravasation may lead to tissue necrosis, use local hyaluronidase if occur, may precipitate arrhythmia in digitalised patient
Contraindication: Hypercalcemia, ventricular fibrillation
Digoxin
Lanoxin, Lanoxicaps
Indications for use:  improves heart function by enabling the heart muscle to contract more efficiently.   It also is capable of eliminating certain abnormal rapid heart rhythms.
Onset of action: PO: 1-2 hr, IV: 5-30 min
Mode of action: Inhibition of Na+-K+ pump resulting in increase Ca++ intracellular influx
Side effects: Sinus bradycardia, AV block, fatigue, headache, nausea, anorexia, neuralgia, blurred vision, photophobia
Caution: Renal failure. Cardioversion or calcium infusion may cause VF in patients receiving digoxin (pretreatment with Lidocaine may be helpful).
Therapeutic level: 0.8-2 ng/ml, not reliable in neonates, since they may have falsely elevated levels (due to maternal digoxin like substances in serum)
Contraindication: Ventricular arrhythmia, AV block, IHSS, constrictive pericarditis
Dobutamine
Dobutrex
Indications for use:  improves heart muscle function.
Onset of action: Rapid
Mode of action: stimulates beta adrenergic receptors, resulting in increase myocardial contractility and heart rate
Side effects: Ventricular arrhythmias, hypertrophic cardiomyopathy, tachycardia, hypertension, angina, palpitation, headache
Caution: Patient should be euvolemic.
Contraindication: IHSS, tachycardia, arrhythmias, hypertension
Dopamine
Intropin
Indications for use:  causes blood vessels of the body to constrict, therefore, causing the blood pressure to improve.
Onset of action: Rapid
Mode of action: Through norepinephrine by stimulating adrenergic and dopaminergic receptors, selective renal vasodilation
Side effects: Tachyarrhythmias, premature beats, hypertension, headache, nausea
Caution: Correct hypovolemia. Extravasation will cause tissue necrosis, phentolamine should be infiltrated around the extravasation to minimize necrosis. Do NOT use discolored solution, high doses (>15 mcg/k/min causes decrease renal perfusion.)
Contraindication: Infusion through UAC, pheochromocytoma, ventricular fibrillation.
Epinephrine HCl
Adrenaline
Indications for use:  causes significant constriction of blood vessels leading to elevation of blood pressure.   It also causes the heart muscles to contract better.
Onset of action: 1-5 minute
Mode of action:
Inotropy: beta adrenergic receptor stimulation
Vasoconstriction: alpha adrenergic receptor stimulation
Side effects: Tachy-arrhythmias, hypertension, headache, nervousness, nausea, vomiting, decrease renal flow
Caution: Hyperthyroidisim, hypertension, arrhythmias. Do Not use discolored solution. Extravasation will cause tissue necrosis, phentolamine should be infiltrated around the extravasation to minimize necrosis
Contraindication: Acute coronary artery disease, angle closure glaucoma
Milrinone
Primacor
Indications for use:  improves contraction of heart muscles and reduce blood pressure, therefore, making it easy for the heart to work.
Onset of action: Rapid
Mode of action: Myocardial cAMP phosphodiesterase inhibitor, increase intracellular cAMP resulting in better myocardial function, pulmonary and systemic vasodilation
Side effects: Arrhythmia, headache, hypotension, thrombocytopenia rarely reported.
Caution: Renal dysfunction
Contraindication: Severe pulmonary or aortic obstructive disease
Phenylephrine HCl
Neo-synephrine
Indications for use:  causes constriction of blood vessels causing increase in blood pressure.
Onset of action: Rapid
Mode of action: Alpha adrenergic receptors stimulant
Side effects: Tremor, insomnia, palpitation, hypertension, angina, excitability, headache, tremors, bradycardia
Caution: Hypertension, hyperthyroidism, arrhythmia, hyperglycemia. Extravasation will cause tissue necrosis, Phentolamine should be infiltrated around the extravasation to minimize necrosis.
Contraindication: Pheochromocytoma, severe hypertension, ventricular tachyarrhythmias, severe coronary artery disease
Norepinephrine
Levophed
Indications for use:  causes constriction of blood vessels resulting in increase in blood pressure.
Onset of action: Rapid
Mode of action: Stimulates alpha and beta adrenergic receptors (predominantly alpha effect)
Side effects: Arrhythmias, palpitation, hypertension, angina, headache, anxiety, vomiting, uterine contractions, respiratory distress, diaphoresis.
Caution: Hypertension, arrhythmia, occlusive vascular disease. Extravasation will cause tissue necrosis, Phentolamine should be infiltrated around the extravasation to minimize necrosis.
Contraindication: Pheochromocytoma, severe hypertension, ventricular tachyarrhythmias, severe coronary artery disease

Antiarrhythmic Agents

Adenosine
Adenocard
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Very rapid
Mode of action: Slows AV node conduction.
Side effects: Palpitations, flushing, headache, dyspnea, nausea, chest pain, lightheadedness, bradycardia.
Caution: Bronchospasm in asthmatics
Contraindication: AV block or sick sinus syndrome, unless pace maker placed
Drug interactions: Potentates effects of dipyridamole. Carbamazepine may increase heart block. Theophylline antagonizes effect of adenosine.
Amiodarone
Cordarone
Indications for use:  to controle abnormal heart rhythm.
Onset of action: 3 d - 3 wk
Mode of action: Class III, inhibits alpha and beta adrenergic receptors, prolongs action potential and refractoriness
Side effects: Long half life. Pulmonary fibrosis, alters thyroid (hypothyroidism) and liver dysfunction. Worsening AV block and bradycardias. Anorexia, nausea, vomiting, dizziness, paresthesia, ataxia and tremor, corneal deposits, blue discoloration of skin, photosensitivity.
Caution: Increases digoxin (reduce dose by 1/2), warfarin, flecanide, procainamide, quinidine and phenytoin serum levels, thyroid disease
Therapeutic level: 0.5-2.5 mg/L
Contraindications: AV block, sinus node dysfunction, sinus bradycardia
Atenolol
Tenormin
Indications for use:  to controle abnormal heart rhythm.  Also used to treat hypertension.
Onset of action: 60-120 min
Mode of action: Class II antiarrhythmic agent, long acting selective b Blocker.
Side effects: Hypoglycemia, hypotension, nausea, vomiting, depression, weakness, less bronchospam than propranolol, heart block, bradycardia, negative inotropic effect
Caution: CHF, adjust dose in renal failure.
Contraindication: Cardiogenic shock, pulmonary edema
Bretylium Tosylate
Bretylol
Indications for use:  to controle abnormal heart rhythm.
Onset of action: IV: 6-20 min, IM: < 2 hr
Mode of action: Class III antiarrhythmic agent, sodium channel blocker, inhibits norepinephrine release
Side effects: Hypertension followed by hypotension, PVC, arrhythmias, increased sensitivity to digitalis and catecholamines, nausea, vomiting, vertigo, confusion, lethargy.
Caution: Pulmonary hypertension, aortic stenosis, renal dysfunction
Contraindication: Digitalis induced arrhythmias
Disopyramide
Norpace
Indications for use:  to controle abnormal heart rhythm.  Also used to decrease the force of heart muscle contraction when deemed excessive.
Onset of action: Minutes
Mode of action: Class Ia antiarrhythmic agent , sodium channel blockers depresses myocardial excitability
Side effects: Negative inotropic effect, prolong QRS and QT durations, ventricular arrhythmias, anticholinergic effect (dry mouth, urinary retention, constipation), nausea, vomiting, hypoglycemia, cholestasis, syncope.
Caution: Already prolonged QRS or QT durations, CHF, renal dysfunction
Contraindication: Already reduced myocardial contractility, AV block
Drug interactions: Increase Disopyramide effect: erythromycin due to decrease in metabolism. Decrease Disoparymide effect: Hepatic inducing agents, phenobarbital, phenytoin, rifampin.
Esmolol
Brevibloc
Indications for use:  to controle abnormal heart rhythm.  Also reduces forceful contraction of heart muscles.
Onset of action: Rapid
Mode of action: Class II. Selective b1 blocker.
Side effects: Hypoglycemia, hypotension, nausea, vomiting, depression, phlebitis, bronchospam at higher doses, heart block, bradycardia, negative inotropic effect
Caution: Skin necrosis may occur with extravasation, max. conc. : 10 mg/ml due to hyperosmolarity. May increase digoxin or theophylline serum levels
Contraindication: Cardiogenic shock, heart block, severe asthma
Flecainide
Tambocor
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Rapid
Mode of action: Class Ic antiarrhythmic agent, sodium channel blocker, cell membrane depression
Side effects: Negative inotropic effect, arrhythmias, rash
Caution: Heart failure, heart block, Hepatic impairment, reduce dose by 25-50% in renal failure
Contraindication: 2nd or 3rd degree AV block
Therapeutic level: 0.2-1 mcg/ml
Lidocaine
Xylocaine
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Rapid
Mode of action: Class Ib antiarrhythmic agent, sodium channel blocker , local anesthetic depressing myocardial irritability
Side effects: Hypotension, shock, nausea, seizures, respiratory depression, anxiety, euphoria, drowsiness, agitation
Caution: Hepatic disease, heart failure
Contraindication: AV block
Therapeutic level: 2-5 mcg/ml
Phenytoin
Dilantin
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Minutes
Mode of action: Not well defined
Side effects: Gingival hyperplasia, hirsutisim, exfoliative dermatitis, osteomalacia, ataxia, drowsiness, blood dyscrasias, SLE like syndrome, Stevens-Johnson syndrome, peripheral neuropathy, lymphadenopathy, hepatitis, nystagmus, hypotension, bradycardia, folic acid deficiency.
Caution: Oral absorption reduced in neonates, serum levels are increased by cimetidine, chloramphenicol, INH, sulfonamide, trimethoprim. Rapid injection may cause hypotension and bradycardia
Contraindication: Heart block or sinus bradycardia
Procainamide
Pronestyl, Procan SR
Indications for use:  to controle abnormal heart rhythm.
Onset of action: IV: Rapid PO: 2-4 hr, IM: 10-30 min
Mode of action: Class Ia antiarrhythmic agent, Sodium channel blocker depressing myocardial excitability and conduction
Side effects: Hypotension, Prolongs QRS and QT durations, SLE like symptoms, fever, positive coomb's test, thrombocytopenia, rash, myalgia, arrhythmias, GI symptoms, confusion.
Caution: Toxicity when QRS > 0.2 sec.
Therapeutic level: 4-10 mg/L of procainamide, or 10-30 mg/L of procainamide and NAPA levels combined.
Drug interactions: PA and NAPA levels are increased with: cimetidine, ranitidine, amiodarone, Beta Blockers, trimethoprin. Anticholinergic agents enhance effect.
Contraindication: Myasthenia gravis, complete heart block.
Propafenone
Rhythmol
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Rapid
Mode of action: Class Ic antiarrhythmic agent, also blocks sodium channels and b Blocker effect
Side effects: AV block, palpitations, bradycardia, CHF, conduction disturbances, dizziness, drowsiness, dry mouth, altered taste, dyspnea, flatulence, blurred vision, dyspepsia
Caution:  Recent MI, CHF, hepatic or renal dysfunction
Contraindication: cardiogenic shock, bronchospastic disorder, conduction disorder
Propranolol
Inderal
Indications for use:  to controle abnormal heart rhythm.  Also used to reduce blood pressure and excessive contraction of heart muscles.
Onset of action: PO: 40-120 min., IV: Rapid
Mode of action: b blocker, class II anti-dysrhythmic agent
Side effects: Hypo or hyperglycemia, hypotension, nausea, vomiting, depression, weakness, bronchospam, heart block, bradycardia, negative inotropic effect
Caution: In lung disease, heart, hepatic or renal failure. Barbiturates, rifampin or indomethacin will increase clearance, cimetidine, hydralazine, chlorpromazine, or verapamil cause decrease in clearance and enhanced effect.
Contraindication: Asthma. cardiogenic shock and heart block
Quinidine
Indications for use:  to controle abnormal heart rhythm.
Onset of action: Gluconate: IV 30-60 min., PO 4-8 hr. Sulfate: 1 hr
Mode of action: Class Ia anti-dysrhythmic agent, sodium channel blocker, depressing atrial and ventricular excitability. Vagolytic.
Side effects: GI symptoms, hypotension, tinnitus, thrombotic thrombocytpenic purpura, rash, heart block, blood changes, widen QRS complex, prolongs QT, ventricular arrhythmia, thrombocytopenia, anemia
Caution: Toxicity is indicated by QRS interval >0.02 sec. Causes increase of Digoxin serum level (reduce digoxin by 1/2). Quinidine's effect is enhanced by amiodarone or Cimetidine. Quinidine's effect is reduced by rifampin, phenytoin or barbiturates. Atrial flutter may conduct 1:1 when quinidine is used alone, due to enhancement of AV conduction.
Therapeutic level: 2-7 mg/L
Contraindication: AV Block
Tocainide
Tonocard
Indications for use:  to controle abnormal heart rhythm.
Onset of action: 10-20 min.
Mode of action: Sodium channel blocker , local anesthetic depressing myocardial irritability
Side effects: Rash, nausea, arrhythmias, dizziness, vertigo, blood changes
Therapeutic level: 4-10 mcg/ml
Verapamil
Isoptin, Calan, Verelan
Indications for use:  to controle abnormal heart rhythm.  Also used to decrease forceful contraction of heart muscles.
Onset of action: PO: 60-120 min., IV: Rapid
Mode of action: Class IV Calcium channel blocker
Side effects: Negative inotropic effect, constipation, hypotension, dizziness, fatigue
Caution: Extreme caution in infants and in WPW, may cause apnea, bradycardia, or hypotension. Do not use with other negative inotropes (e.g. beta-blockers). To reverse hypotension use calcium, isopreternol and IV volume. Reduce digoxin by 1/3 to 1/2.
Contraindication: CHF, hypotension, shock, AV block, right to left shunt lesions, atrial fibrillation, sinus bradycardia
Drug interactions: May increase serum level of digoxin, quinidine, carbamazepine, cyclosporin. Phenobarbital and rifampin may increase metabolism of verapamil.

Vasodilators 

Captopril
Capoten
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: 15-30 min
Mode of action: Angiotensin converting enzyme inhibitor
Side effects: Hypotension, rash, proteinurea, neutropenia, tachycardia, cough, diminution of taste, reduce aldosterone production causing increase potassium renal absorption causing hyperkalemia
Caution: Adjust with renal dysfunction, administer 1 hr. prior to meals.
Drug interactions: NSAIDs, e.g. indomethacin, may decrease the antihypertensive effect of captopril. Potassium sparing agents will potentate hyperkalemic effect
Diazoxide
Hyperstat
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: Rapid
Mode of action: vasodilator
Side effects: Hyponatremia, salt and water retention, arrhythmia, hypotension, GI disturbances, ketoacidosis, rash, hyperuricemia, hyperglycemia, flushing, tachycardia, dizziness, phlebitis
Caution: Diabetes mellitus, renal or hepatic disease
Contraindication: Coarctation of the aorta, AV shunts, dissecting aortic aneurysm
Enalapril
Vasotec
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: PO: 30-60 min, IV: 10-15 min
Mode of action: Angiotensin converting enzyme inhibitor
Side effects: Nausea, diarrhea, headache, dizziness, hypotension rash, diminishing of taste, neutropenia, hyperkalemia, hypoglycemia, chronic cough
Caution: Reduce dose in renal failure
Drug interactions: NSAIDs, e.g. indomethacin, may decrease the antihypertensive effect. Potassium sparing agents will potentate hyperkalemic effect.
Hydralazine
Apresoline
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: PO: 10-30 min, IV: 5-20 min
Mode of action: peripheral vasodilator
Side effects: SLE like syndrome(reversible), palpitation, flushing, rash hematological changes. Hypotension, tachycardia, headache, anorexia, nausea
Caution: Severe renal failure and cardiac disease, CVA
Contraindication: Coronary artery disease, dissecting aortic aneurysm, mitral valve rheumatic heart disease
Metoprolol
Lopressor
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: 15-30 min.
Mode of action: b adrenergic receptor blockade
Side effects: Hypoglycemia, hypotension, nausea, vomiting, abdominal pain, CNS symptoms (depression, weakness, dizziness) bronchospam, heart block, bradycardia, negative inotropic effect
Caution: In lung disease, heart, hepatic or renal failure.
Drug interactions: Barbiturates, rifampin will increase clearance of metoprolol. Metoprolol metabolism decreases with cimetidine, amiodarone, diltiazem, propafenone, quinidine, hydralazine, chlorpromazine, or verapamil.
Contraindication: Asthma, heart block with concurrent use of verapamil
Nifedipine
Adalat, Procardia
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: PO 20-30 min, Sublingual 1-5 min
Mode of action: Calcium channel blocker
Side effects: Hypotension, flushing, tachycardia, headaches, dizziness, nausea, palpitation, bone marrow suppression, arthralgia, shortness of breath
Caution: Heart failure, aortic stenosis.
For sublingual administration: puncture capsule and express fluid sublingually.
(conc = 10 mg per 0.34 ml)
Nitroglycerine
Tridil, Nitro-Bid
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: Rapid
Mode of action: Vasodilation, venous more than arterial
Side effects: Flushing, headache, hypotension, tachycardia, nausea, perspiration, tolerance
Caution: Increase ICP, hypovolemia
Contraindication: Glaucoma, severe anemia
Nitroprusside
Niprid, Nitropress
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action:: Rapid
Mode of action: peripheral vasodilator
Side effects: Profound hypotension, metabolic acidosis, weakness, psychosis, headache, increased ICP, thyroid suppression, nausea, sweating, cyanide and thiocyanate toxicity
Caution: Monitor thiocyanate level, if used >48 hr. Keep level < 35 mg/L.
Contraindication: Reduced cerebral perfusion, coarctation of the aorta, AV shunts
Prazosin HCl
Minipress
Indications for use:  causes blood vessels to relax, therefore reducing blood pressure and workload against which the heart has to pump.
Onset of action: 1-3 hr
Mode of action: vasodilator, a adrenergic receptor blocker
Side effects: Orthostatic hypotension, syncope, tachycardia, dizziness, headache, fluid retention, nausea, dry mouth, nasal congestion, urinary frequency
Caution: "First dose phenomenon": orthostasis, syncope, usually within 90 min of first dose

Diuretic Agents 

Bumetanide
Bumex
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action: PO: 30-60 min, IV: 5-10 min
Mode of action: Loop diuretic, prevent re-absorption of chloride at ascending loop of Henle
Side effects: Hypotension, dizziness, weakness, vertigo, nausea, muscle cramps, hypoglycemia, increase serum creatinine, hyperurecemia, hypokalemia, hypocalcemia, hyponatremia, hypochloremia, hypercalciurea. Metabolic alkalosis.
Caution: Sulfonamide hypersensitivity due to cross reaction.
Chlorothiazide
Diuril
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action: 1-2 hours
Mode of action: Inhibits renal tubular re-absorption
Side effects: Hypokalemia, hypochloremia, alkalosis, hypotension, dizziness, vertigo, hyperlipidemia, cholestasis, muscle weakness, parasthesia, pre-renal azotemia,
hyperurecemia, hyperglycemia, blood dyscrasias, allergic reaction
Caution: Sulfonamide hypersensitivity
Ethacrynic Acid
Edecrin
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action: PO: 10-30 min, IV: rapid
Mode of action: Potent loop diuretic, prevent re-absorption of chloride at ascending loop of Henle
Side effects: Hypovolemia, hypokalemia, hypochloremic alkalosis, pre-renal azotemia, hyperurecemia, 8th cranial nerve damage (deafness), abnormal LFTs, agranulocytosis or thrombocytopenia, anorexia, dysphagia, GI bleeding, GI irritation, rash, hypotension, vertigo, hyponatremia, hyperglycemia, hepatotoxicity, ototoxic, tinnitus, hematuria, hypomagnesemia
Drug interactions: Potentate potassium wasting with other loop diuretics. Increase risk for ototoxicity when used with aminoglycosides. Increase effect of Warfarin because it displaces warfarin from protein binding
Caution: Renal dysfunction
Furosemide
Lasix
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action: 5-15 min
Mode of action: Loop diuretic, prevent re-absorption of chloride at ascending loop of Henle
Side effects: Hypovolemia, hypokalemia, hypochloremia,
hypocalcemia, hypochloremic metabolic alkalosis. Hyperuricemia. Dermatitis,
hyperglycemia, azotemia, anemia, ototoxicity especially when used with aminoglycocides, hypotension, dizziness, vertigo, headache, photosensitivity, agranulocytosis, ototoxicity, hepatitis, anorexia, pancreatitis, interstitial nephritis, hypercalciurea
Drug interactions: Increase risk of ototoxicity when used with other ototoxic drugs, e.g. aminoglycoside
Caution: Prolonged use in neonates causes nephrocalcinosis.
Renal or hepatic failure
Hydrochlorothiazide
Hydrodiuril
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action:: 1-2 hr
Mode of action: Inhibits sodium re-absorption in the distal renal tubule
Side effects: Drowsiness, vertigo, headache, hypokalemia, hyperlipidemia, hypochloremic metabolic alkalosis, nausea, muscle cramps, pancreatitis, agranulocytosis, hemolytic anemia, hepatitis, parasthesia, pre-renal azotemia, hyperuricemia, hyperglycemia, blood changes, allergic reaction
Caution: Sulfonamide cross sensitivity
Metolazone
Zaroxolyn
Indications for use:  increases urine production.  This will reduce blood volume, thus reducing the workload on the heart.
Onset of action:1 hour
Mode of action: Blocks sodium re-absorption at distal renal tubules
Side effects: Hepatic dysfunction, calcium retention, GI upset, orthostatic hypotension, , hypokalemia, hypochloremic metabolic alkalosis, hyperglycemia, hypomagnesemia, hyperuricemia, tinnitus
Drug interactions: Increase hypokalemia with other potassium wasting drugs, e.g. furosemide
Caution: Hepatic disease, oral absorption varies between products, sulfonamide cross sensitivity
Spironolactone
Aldactone
Indications for use:  increases urine production slightly.  Its main use is to make the kidney hold on to potassium, which is typically wasted by other diuretic drugs.  therefore, it is used with other diuretics to augment their effect and hold on to potassium from being lost.
Onset of action: Hours
Mode of action: Aldosterone blocker, therefore decrease potassium loss
Side effects: Potassium retention, GI irritation rash, gynecomastia, hyperchloremia metabolic acidosis, amenorrhea, anorexia, agranulocytosis, hyponatremia
Contraindications: Renal failure
Caution: May potentate ganglionic blocking agents and antihypertensives
Drug interactions: Hyperkalemia when used with other potassium sparing drugs. May decrease clearance of digoxin, may decrease hypoprothrombinemia effect of anticoagulants

Drugs used in cardiac emergencies 

Atropine
Indications for use:  causes the heart to beat faster.
Onset of action: Rapid
Mode of action: Blocks acetylcholine activity
Side effects: Dry mouth, blurred vision, tachycardia, dry hot skin, restlessness, fatigue, difficult micturition, impaired GI motility, CNS symptoms, hyperthermia, palpitation, delirium, headache, tremor
Contraindication: Glaucoma, tachycardia, thyrotoxicosis, GI obstruction, uropathy
Diphenhydramine
Benadryl
Indications for use:  anti-histamine agent.  Used to counter allergic reactions. 
Onset of action: PO: 20-40 min, IV: 10-20 min
Mode of action: Histamine 1 receptor antagonist
Side effects: Sedation, drowsiness, insomnia, vomiting, anorexia, constipation, diarrhea, anticholinergic effect, hypotension, palpitation, tachycardia, paradoxical excitement, fatigue, photosensitivity, rash, dry mouth, urinary retention, blurred vision, thickened bronchial secretions
Caution: Peptic ulcers, hyperthyroidism
Contraindication: Angle closure glaucoma, GI or urinary tract obstruction
Bretylium Tosylate
Bretylol
Indications for use:  improves heart rhythm.
Onset of action: Rapid
Mode of action: Sodium channel blocker, inhibits post-ganglionic norepinephrine release
Side effects: Hypertension followed by hypotension, PVC, arrhythmias, increased sensitivity to digitalis and catecholamines, nausea, vomiting, hyperthermia, nasal congestion, conjunctivitis, diaphoresis,
Caution: Renal dysfunction, severe hypotension,
Contraindication: Digitalis induced arrhythmias
Calcium Chloride
Indications for use:  improves heart muscle contraction.
Onset of action: rapid
Mode of action: Enhances contractility through regulation of action potential
Side effects: Bradycardia, hypotension, peripheral vasodilation, hypercalcemia, hypomagnesemia, hyperchloremic acidosis, hypercalcemia
Caution: Central venous line recommended. Max. conc. is 20 mg/ml infusion Extravasation may lead to tissue necrosis, use local hyaluronidase if occur, may precipitate arrhythmia in digitalised patient.
Contraindication: Hypercalcemia, ventricular fibrillation
Epinephrine Hydrochloride
1:10,000
Adrenaline
Indications for use:  improves heart rate, increases blood pressure and contraction of heart muscles.
Onset of action: Rapid
Mode of action: Stimulates alpha, beta 1 and 2 adrenergic receptors
Side effects: Anxiety, tremor, headache, tachycardia, hypertension, arrhythmias
Lidocaine
Xylocaine
Indications for use:  improves heart rhythm.
Onset of action: Rapid
Mode of action: Class Ib antiarrhythmic agent, sodium channel blocker , local anesthetic depressing myocardial irritability
Side effects: Hypotension, shock, nausea, seizures, respiratory depression, anxiety, euphoria, drowsiness, agitation
Caution: Hepatic disease, heart failure
Contraindication: AV block
Therapeutic level: 2-5 mcg/ml
Sodium Bicarbonate
Indications for use:  corrects abnormal acid accumulation in the blood.
Onset of action:: IV rapid
Mode of action: Alkalization
Side effects: Increased oxygen affinity to Hgb, alkalosis, edema, hyperosmolality, hypernatremia cerebral hemorrhage, hypokalemia, hypocalcemia,
Caution: In infants under 3 mo., use conc. of 0.5 mEq/ml. Do not mix with calcium salts or catecholamines. Extravasation may cause tissue necrosis, infiltrate with hyalurunidase to minimize tissue necrosis
Contraindication: Inadequate alveolar ventilation
Pancuronium
Pavulon
Indications for use:  relaxes muscles of body.
Onset of action: Rapid
Mode of action: Post-synaptic acetylcholine receptor blocker
Side effects: Tachycardia
Caution: Secure airway prior to administration. Effect increased by hypothermia, acidosis, decreased renal function, volatile anesthetics, succinycholine, hypokalemia, and aminoglycoside
Vecuronium bromide
Norcuron
Indications for use:  relaxes muscles of body.
Onset of action: Rapid
Mode of action: Post-synaptic acetylcholine receptor blocker
Caution: Hepatic impairment, neuromuscular disease. Longer recovery period in infant less than one year. Potency and duration of effect may be prolonged by volatile anesthetics, aminoglycoside, metronidazole, tetracycline, bacitracin, and clindamycin.
Antidotes: Neostigmine, pyridostigmine, or edrophonium.

Sedatives 

Chloral Hydrate
Noctec
Indications for use:  causes relaxation and sedation.
Onset of action: 10-20 min..
Mode of action: CNS depressant
Side effects: Irritates mucosa causing upset GI, laryngospasm if aspirated.
Myocardial and respiratory depressant. CNS depression
Contraindications: Hepatic or renal impairment
Caution: Heart disease
Chlorpromazine
Thorazine
Indications for use:  causes relaxation and sedation.
Onset of action: Rapid
Mode of action: Tranquilization, central dopaminergic antagonist and a blocker
Side effects: Alpha blocking, hypotension, jaundice, lower seizure threshold, extrapyramidal symptoms, agranulocytosis, leukopenia, hepatotoxicity.
Contraindications: Narrow angle glaucoma, severe liver and cardiac disease
Caution: Patients with cardiac disease, seizure disorder
ECG changes: prolonged PR, flattened T, ST depression
Diazepam
Valium
Indications for use:  causes relaxation and sedation.
Onset of action: Rapid
Mode of action: CNS depression through enhanced GABA at the limbic system
Side effects: Hypotension, CNS and respiratory depression, physical dependence
Contraindications: Narrow angle glaucoma
Caution: Glaucoma, shock, depression, hypoalbuminemia, hepatic dysfunction. No faster than 1-2 mg/min(IV)
Fentanyl
Sublimaze
Indications for use:  causes relaxation and sedation.
Onset of action: Rapid
Mode of action: Semisynthetic opiate analgesic
Side effects: Respiratory depression (beyond period of analgesia). Chest wall rigidity with large bolus doses. Bradycardia, functional ileus., physical dependence
Contraindications: Increase ICP and IOP
Caution: IV dose over 3-5 min, hepatic and renal insufficiency, respiratory disease
Ketamine
Ketalar
Indications for use:  an anesthetic agent.
Onset of action: Rapid
Mode of action: Dissociative anesthesia by direct action on the cortex and limbic system
Side effects: Hypertension, tachycardia, respiratory depression, laryngospasm, hypersalivation, delirium. CNS symptoms (dream like state, confusion, agitation)
Contraindications: Elevated ICP, thyrotoxicosis, CHF, angina and psychosis
disorder.
Caution: Must be used in conjunction with antisialagouge due to increase secretions
Meperidine
Demerol
Indications for use:  causes relaxation and sedation.
Onset of action: Rapid
Mode of action: Semi-synthetic opiate analgesic
Side effects: Nausea, vomiting, respiratory depression, smooth muscle spasm, physical dependence, seizures
constipation and lethargy. Tachycardia.
Contraindications: Cardiac arrhythmia, asthma, increased ICP, renal failure
Caution: potentate by MAO inhibitors, phenothiazines and
other CNS depressants, biliary colic.
Midazolam
Versed
Indications for use:  causes relaxation and sedation.
Onset of action: IV: Rapid, IM: 5-15 min, PO/PR: 15-30 min
Mode of action: CNS depression by inducing GABA at limbic system
Side effects: Respiratory depression, hypotension, bradycardia, myclonic jerking in neonates
Contraindications: Narrow angle glaucoma, shock, physical dependence.
Caution: Lower dose by 25% when used with narcotics, cimetidine or anesthetic agents. Care should be observed in the post-operative open-heart patient, and with hemodynamic instability.
Morphine sulfate
Duramorph, Centin, Astramorph
Indications for use:  causes relaxation and sedation.
Onset of action: IV: Rapid, PO: 15-30 min
Mode of action: Strongest narcotic analgesic. Unspecified aid with CHF, pulmonary edema and anoxic spells
Side effects:
Physical dependence, CNS and respiratory depression, bronchospam, nausea, vomiting,
constipation, hypotension, bradycardia, increases ICP, meiosis, biliary or urinary
spasm
Contraindications: Increase ICP and IOP (unless ventilated), shock.
Caution: Hepatic failure, renal failure
Naloxone
Narcan
Sedative reversal agent
Indications for use:  used to reverse the effect of excessive sedation by some drugs.
Onset of action: Rapid
Mode of action: Opioid antagonist
Side effects: Narcotic withdrawal symptoms in opioid dependence, with abrupt reversal of narcotic may cause nausea, vomiting, diaphoresis, tachycardia, hypertension, and tremulousness
Caution: Chronic cardiac disease.
Promethazine
Phenergan
Indications for use:  causes relaxation and sedation.
Onset of action: Rapid
Mode of action: Antihistaminic, anti-emetic, phenothiazine
Side effects: CNS depression, anticholinergic effect, antihistaminic effect, photosensitivity, extrapyramidal reaction
Contraindications: Increase IOP
Caution: Seizure, liver disease, CV disease

Miscellaneous 

Acetylsalicylic Acid
Aspirin
Indications for use:  in cardiology it is used to prevent clot formation.
Mode of action: Inhibits prostaglandin synthesis which prevents thromboxane A2 formation, leading to decrease platelet aggregation.
Side effects: Rash, nausea, hepatotoxicity, GI bleeding, bronchospasm, GI distress, tinnitus
Caution: Renal dysfunction, erosive gastritis, peptic ulcer or gout
Contraindication: Hepatic failure, bleeding disorder, hypersensitivity to other NSAID, children <16 yr with chicken pox or flu symptoms, due to the association with Reye's syndrome
Ammonium Chloride
Indications for use:  to provide the body with chloride and correct alkalosis (opposite to high acidity)
Mode of action: Chloride supplementation in severe hypochloremic metabolic alkalosis, as seen with loop diuretics
Side effects: Bradycardia, phlebitis and necrosis with infiltration, headache, hyperammonemia, GI irritation, hyperventilation.
Caution: Max conc for infusion: 0.2 mEq/kg/hr peripheral and 0.4 mEq/ml central; max rate of infusion 1 mEq/kg/hr (53 mg of NH4Cl = 1 mEq of Cl)
Contraindication: Severe hepatic or renal dysfunction
Argeninine HCl (10%)
R-Gene
Indications for use:  to supplement the body with chloride.
Mode of action: Chloride supplementation in severe hypochloremic metabolic alkalosis, as seen with loop diuretics
Side effects: Flushing and headache with rapid infusion, hyperglycemia, hyperkalemia, GI upset, phlebitis, necrosis with infiltration.
Caution: Max rate of infusion one gm/kg/hr
Contraindication: Renal or hepatic failure
Dexamethasone
Decadron
Indications for use:  a steroid used to reduce inflammation and swelling.
Mode of action: Anti-inflammatory effect by suppression of migration of polymorphonuclear leukocytes and reversal of increased capillary permeability
Side effects: Hypertension, headache, vertigo, psychosis, heart failure, adrenal suppression, hyperglycemia, hypokalemia, Cushing's syndrome, gastric ulceration, muscle weakness, osteoporosis, fractures, cataract, glaucoma
Caution: Active infections, hypertension, CHF, liver failure, hypothyroidism, thromboembolic disease
Heparin
Indications for use:  to prevent blood clotting.
Onset of action: IV rapid
Mode of action: Potentates antithrombin III which inactivates thrombin and prevents the conversion of fibrinogen to fibrin
Side effects: Bleeding, allergy, alopecia, thrombocytopenia, fever, headache, chills, urticaria, increased LFTs
Caution: Adjust dose to desired clotting time. Use preservative free heparin in neonates.
Antidote: Protamine sulfate.
Contraindication: Severe thrombocytopenia, suspected intracranial hemorrhage.
Drug interactions: Increase susceptibility to bleeding with other anticoagulants.
Ibuprofen
Advil, Motrin
Indications for use:  to reduce inflammation.
Mode of action: Non-steroidal anti-inflammatory agent (inhibits PG synthesis)
Side effects: Drowsiness, fatigue, headache, GI irritation, inhibition of platelet aggregation, hepatitis, acute renal dysfunction, blood dyscrasias.
Caution: CHF, renal disease, hepatic disease
Drug interaction: may increase digoxin, methotrexate lithium serum levels. May decrease effect of furosemide & bumetanide.
Contraindication: Active GI bleeding, GI ulcers, platelet dysfunction
Indomethacin
Indocin
Indications for use:  in cardiology it is used to induce the ductus arteriosus to close.
Onset of action: variable.
Mode of action: Prostaglandin synthesis inhibitor
Side effects: Decrease platelet aggregation, GI disease: ulcers, diarrhea, blood dyscrasias, GI bleeding, hypertension, oligurea, renal failure, somnolence, hyperkalemia, hypoglycemia, hepatitis, tinnitus
Caution: Monitor renal and hepatic function. Keep urine output >0.6 ml/kg/hr
Contraindication: Neonates with BUN >30 mg/dl, Cr >1.8 mg/dl., thrombocytopenia, recent IVH, NEC, or active bleeding
Isoproterenol
Isuprel
Indications for use:  increases heart rate.
Onset of action: 30-60 sec
Mode of action:
Chronotropy: beta adrenergic receptor stimulation
Side effects: Tachyarrhythmias, hypertension, myocardial ischemia, hypotension, dizziness, headache, vertigo, nausea, tremor, sweating
Caution:. Do not use discolored solution
Contraindication: Angina, ventricular arrhythmia, narrow-angle glaucoma, digitalis intoxication, IHSS
Prostaglandin E1
Prostin
Indications for use:  keeps the ductus arteriosus open.
Onset of action:1.5-3 hr
Mode of action: Direct effect on vascular smooth muscles causing pulmonary, systemic and ductus arteriosus vasodilation
Side effects: Hypotension, flushing, tachycardia, fever, seizure like activity, apnea, hypocalcemia, diarrhea, hypoglycemia, inhibition of platelet aggregation, cortical hyperostosis (chronic therapy)
Caution: Apnea occur in 10-12 % of neonates, usually appear in first hour of therapy
Protamine sulfate
Indications for use:  used to counter the effect of heparin in patients who are bleeding because of heparin therapy.
Onset of action: 5 min
Mode of action: Forms a stable salt with Heparin, thus neutralizing it's effect
Side effects: Hypotension, bradycardia, flushing, pulmonary hypertension, nausea, dyspnea
Caution: Known allergic reaction to fish or previous exposure to protamine.
Max. infusion rate: 5 mg/min
Streptokinase
Streptase, Kabikinase
Indications for use:  dissolves blood clots.
Onset of action: Rapid
Mode of action: Converts plasminogen to plasmin, thus promoting thrombolysis
Side effects: Hypotension, arrhythmia, flushing, fever, urticaria, bleeding, bronchospasm
Caution: Avoid IM injection
Contraindication: Major surgery within 10 days, GI bleeding, recent trauma, severe hypertension, internal bleeding, CVA (within 2 months), intra-cranial or intra-spinal surgery, brain carcinoma
Tolazoline HCl
Priscoline
Indications for use:  drops blood pressure.
Onset of action: minutes, peak effect 30 min
Mode of action: Alpha adrenergic receptor antagonist, peripheral vasodilation is mediated by histamine like action
Side effects: Hypotension, flushing, tachycardia, hypochloremic metabolic alkalosis, increased secretions, nausea, diarrhea, gastric bleeding, thrombocytopenia, agranulocytosis, mydriasis, oligurea, pulmonary hemorrhage.
Urokinase
Abbokinase
Indications for use:  dissolves blood clots.
Onset of action: Rapid
Mode of action: Direct activation of plasminogen to plasmin, thus causing thrombolysis
Side effects: Allergic reaction, fever, rash, bronchospasm, bleeding.
Caution: Avoid IM injection
Contraindication: Bleeding, AV malformation, history of CVA or recent trauma, brain carcinoma, intra-cranial or intra-spinal surgery
Vitamin K (phytonadione)
Aqua Mephyton, Mephyton
Indications for use:  enhance blood clotting.
Onset of action: PO 6-12 hr. IV 1-2 hr
Mode of action: Cofactor in the synthesis of the clotting factors II, VII, IX and X
Side effects: Flushing, hypotension, dizziness, GI upset, changes in taste, sweating, anaphylactoid-like reaction with IV administration
Caution: IV administration should be restricted for emergencies only, since risk of severe adverse reaction could occur. Do not use in patients with prosthetic valves.
Warfarin
Coumadin, Sofarin
Indications for use:  prevents blood clotting.
Onset of action: 36-72 hr
Mode of action: Inhibits hepatic synthesis of vitamin K-dependent factors (I, VII, IX, X)
Side effects: Fever, skin lesions, anorexia, hemorrhage, hemoptysis
Caution: Adjust to desired PT, INR, fever, skin lesions with necrosis, anorexia, hemorrhage, hemoptysis . Give 0.1 mg/kg loading dose with impaired liver function.
Drug interactions: Warfarin effect increases with ethacrynic acid, indomethacin, mefenamic acid, phenylbutazone, aspirin,
Antidote: Vitamin K
Contraindication: Bleeding, liver or renal failure, malignant hypertension