Atropine

Question 1

Class / Action

Answer 1

Class: Parasympathetic blocker, anticholinergic
Action:
1. Cardiac
a. Increases firing rate of SA node by blocking action of vagus nerve, which results in an increase HR
b. Increases conduction velocity through the AV node
2. Non-Cardiac
a. Decrease of all body secretions
b. Dilation of pupils and paralysis of the ciliary muscle
c. Decrease in bladder tone resulting in urinary retention
d. CNS stimulation

Question 2

Onset / Duration of Action

Answer 2

1. IV: Immediate onset / 4hrs Duration of Action

2. IM: 1min onset / 4hrs Duration of Action

Question 3

Indications

Answer 3

1. Symptomatic bradycardic rhythms associated with hypotension, decreased mentation, ventricular irritability (PVCs), Chest Pain
2. May be beneficial in AV nodal block, but not likely to be effective for 2nd Degree AV Block Type-2 or 3rd Degree AV Block, PEA, or Asystole
3. Organophosphate anticholinesterase poisoning
4. Nerve Agent Poisoning

Question 4

Contraindications

Answer 4

1. Atrial fibrillation or flutter
2. Tachycardia
3. Bradycardia s/t increased ICP (i.e. Stroke, Head Trauma)
4. Unstable cardiovascular status in acute hemorrhage

Question 5

Precautions

Answer 5

1. Do Not Mix with Sodium Bicarbonate
2. Be certain pt with bradycardia is not hypoxia or head injured in origin
3. Ineffective for bradycardia treatment in a transplanted heart

Question 6

Dosages / Administration

Answer 6

1. Bradycardia
   a. ADULT:
   i. IV: 0.5mg every 3-5min PRN
   a. Minimum Single Dose: 0.5mg
   b. Maximum Total Dose: 0.04mg/kg (TOTAL 3mg)
   c. Use shorter dosing interval (3min) and higher doses in severe clinical conditions
   ii. ET: 1mg/10mL NS
   b. PED:
   i. IV: 0.02mg/kg
   a. Minimum Single Dose: 0.01mg
   b. Maximum CHILD Dose: 0.5mg; Maximum CHILD TOTAL Dose 1mg
   c. Maximum ADOLESCENT Single Dose: 1mg; Maximum ADOLESCENT TOTAL Dose 2mg
   d. May double for second IV Dose
   ii. ET: 0.05mg/kg/5mL NS
2. Anticholinesterase/Organophosphate/Nerve Agent Poisoning
   a. Adult: 1mg IV every 1min until symptoms (bradycardia, bronchial secretions, etc.) clear, up to 10mg
   b. If using the DuoDote/Mark 1 Antidote Kit, give one atropine injector (2mg) into the thigh followed by 2-PAM chloride injection. May give up to 3 sets.
   c. PED: Age <12years old Start with 0.5mg IV/IO and repeat every 1min until symptoms clear, up to 10mg Total.
   Age >12years old follow ADULT Dosing.

Question 7

Adverse Reactions

Answer 7

1. Cardiac: Tachycardia, Palpitations, Ventricular Fibrillation
2. Non-Cardiac: Dryness of mouth (common), Pain in eyes or blurred vision (precipitates glaucoma), Restless, Irritability, Change in mental state, Injection site pain