Atropine*

• Atropine

Classification:

• Parasympatholytic, anticholinergic

Mechanism of Action:

• Atropine Sulfate is a potent parasympatholytic.  It inhibits actions of acetylcholine at postganglionic parasympathetic receptor sites.  Blocked vagal effects result in increased heart rate and enhanced AV conduction with limited or no inotropic effects.

Indications:

• Symptomatic bradycardia
• Organophosphate poisoning
• Premedication for succinylcholine in children 16 or less years old

Contraindications:

• Uncorrected tachydysrhythmia
• Hypothermic bradycardia
• 2^nd Degree - Type 2 and 3^rd Degree Heart block (relative)

Precautions:

• Monitor EKG
• Monitor BP
• Use cautiously in patients taking meds with anticholinergic effects
• Use cautiously in patients taking tricyclic antidepressants
• Use cautiously in patients taking anti Parkinson drugs
• Use cautiously during acute MI, can extend the infarct
• Use very cautiously in patients with glaucoma

Adverse Effects:

• Tachycardia
• Paradoxical bradycardia when pushed too slowly or when used at doses lower than 0.5 mg
• Palpitations
• Dysrhythmias
• Headache
• Dizziness
• Anticholinergic effects: dry mouth/nose/skin photophobia, blurred vision, urinary retention, constipation; nausea and vomiting, flushed hot dry skin, allergic reactions

Dose:

Adult:

• For bradycardia: 1 mg every 3-5 minutes as needed (maximum total dose 3 mg).
• For organophosphate poisoning: 2-4 mg repeated every 20 minutes until muscarinic1 symptoms reverse.

• For bradycardia: 0.02 mg/kg (minimum dose 0.1 mg; maximum single dose 0.5 mg). Dose may be repeated once in 3-5 minutes. Maximum total dose for child is 1 mg and 3 mg for an adolescent.
• For organophosphate poisoning 12 years of age and over: 1 mg initially; then repeated and doubling the dose every 5 minutes until muscarinic symptoms reverse.
• For organophosphate poisoning less than 12 years of age: 0.05 mg/kg initially; then repeated and doubling the dose every 5 minutes until muscarinic1 symptoms reverse. 

• IV, IO

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