atropine sulfate
Anticholinergic Agent
Atropine sulfate is a potent parasympatholytic. It inhibits actions of acetylcholine at postganglionic parasympathetic neuroeffector sites, primarily at muscarinic receptors. Small doses inhibit salivary and bronchial secretions, moderate doses dilate pupils and increase heart rate. Large doses decrease GI motility, inhibit gastric acid secretion. Blocked vagal effects result in positive chronotropy and positive dromotropy (limited or no inotropic effect). In emergency care, it is primarily used to increase the heart rate in life-threatening bradycardias. You can think of the effects of atropine as being 'anti-SLUDGE'.
Rapid
2 - 6 hours
Hemodynamically significant bradycardia
Asystole
PEA
Organophosphate poisoning (drug of choice)
Pretreatment in pediatric patients receiving RSI.
Tachycardia
Hypersensitivity
Unstable cardiovascular status in acute hemorrhage with myocardial ischemia
Tachycardia
Possible paradoxical bradycardia when pushed slowly or when used at doses less than 0.5mg
Palpitations, dysrhythmias, headache, dizziness, nausea/vomiting, flushed and dry skin, allergic reactions.
Anticholinergic effects (dry mouth/nose, photophobia, blurred vision, urine retention)..think anti-SLUDGE.
Use with other anticholinergics may increase vagal blockade.
Potential adverse effects when administered in conjunction with digitalis, cholinergics, neostigmine.
The effects of atropine may be enhanced by antihistamines, procainamide, quinidine, antipsychotics, antidepressants, and benzodiazepines.
Various injection preparations. For emergency situations, atropine is usually supplied in prefilled syringes containing 1.0 mg in 10 ml of solution.
0.5 – 1.0 mg IV, may be repeated at 5 min intervals until desired rate achieved. (max 0.03-0.04mg/kg)
0.02 mg/kg IV, IO, ET(diluted to 3-5ml). Min dose 0.1mg; max single dose fo 0.5 mg for a child and 1.0 mg for an adolescent; may be repeated in 5 minutes for a max total fo 1.0 mg for a child and 2.0 mg for an adolescent.
1.0 mg IV, ET, (1-2 mg diluted to a total of 10ml); may be repeated every 3-5 minutes (max 0.03 – 0.04mg/kg)
unknown efficacy
1 mg IV (if bradycardic), repeat every 3-5 minutes, max 0.03 – 0.04mg/kg.
unknown efficacy
2 mg IV push every 5-15 minutes to dry secretions. No max dose.
0.05 mg/kg/dose (usual dose 1-5 mg) IV, may be repeated in 15 minutes.
Pregnancy Safety: Category C
Follow ET administration with several positive pressure ventilations.