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
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 |
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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
|
|
|
Adenosine
|
Bumetanide |
| Emergency Drugs | Sedatives
|
Miscellaneous
|
| Chloral Hydrate |
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 |
| 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. |
| 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 |
| 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 |
| 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. |
| 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 |
| 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 |