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drug cards > Atropine > Flashcards

Atropine Flashcards

1
Q

Class

A
  1. Parasympatholytic

2. Anticholinergic Agent

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2
Q

Action

A
  1. Atropine is a competitive inhibitor of acetylcholine @
    muscarinic receptor sites.
  2. The increase of sympathetic activity seen with atropine
    administration is due to the drug’s parasympatholytic
    effects.
  3. In the setting of symptomatic bradycardias, atropine
    decreases vagal effects on the heart resulting in
    increased chronotropy & dromotropy (with little or no
    inotropic effects).
  4. It is used in cholinergic exposures as a direct antidote
    for the poison.
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3
Q

Indications

A
  1. Symptomatic Bradycardias
  2. Pre-intubation in children >1 month of age
  3. Poisoning w/
    • oganophosphates, carbamates, mushrooms, nerve
      gas, other cholinergic agents
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4
Q

Contraindications

IN ARREST SETTING

A

none

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5
Q

Contraindications

NON-ARREST

A
  1. myasthenia gravis 2. closed-angle glaucoma 3. atrial fibrillation and flutter 4. known hypersensitivity 5. thyrotoxicosis 6. urinary tract obstruction
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6
Q

Precautions

A
  1. Atropine may actually worsen 2nd degree Type II & 3rd degree AV blocks. Many experts go as far as to indicate atropine is relatively contraindicated in this setting & transcutaneous pacing is preferred.
  2. Cardiovascular disease including: CAD & CHF
  3. COPD
  4. HTN
  5. Renal/hepatic disease
  6. Geriatrics
  7. Pregnancy I
  8. Minimum Doses <0.5 mg in adults<0.1 mg in children Smaller doses can cause a paradoxical bradycardia.
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7
Q

Dosage

ADULTS

A
  1. Symptomatic Bradycardia: IV: 0.5 mg to 1 mg every 3-5
    minutes.Max dose: 0.04 mg/kg (full vagal
    blockade).
  2. Poisonings : IV/IM/ETT/IO: 1-2 mg as needed to
    decrease cholinergic symptoms.
    AUTOINJECTOR (MARK 1 KIT): 2 mg
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8
Q

Dosage

PEDI

A

Symptomatic Bradycardias: IV/IO: 0.02 mg/kg repeated
every 3-5 minutes as needed. Child: Minimum—0.1
mgMaximum—0.5 mgAdolescent:Minimum—0.1
mgMaximum—1 mgETT: 2-3 times the IV dose diluted in
3-5 ml NS
•Poisonings: IV/IM: 0.05 mg/kg IV every 3-5 minutes as
needed to decrease cholinergic symptoms.
•Pediatric Pre-Intubation: IV/IO: 0.02 mg/kg

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9
Q

Onset

A

Rapid

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10
Q

Duration

A

2-6 hrs

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11
Q

Side Effects

A

•Anticholinergic Effects: Remember the mneumonic:DRY
AS A BONE—Dry mucous membranes, urinary retention,
constipationMAD AS A HATTER—Restlessness,
tachycardia, palpitations, HA, dizzinessRED AS A BEET—
Flushed, hot, & dry skin BLIND AS A BAT—Pupillary dilation
(mydriasis), blurred vision (cycloplegia), photophobia •Tachydysrhythmias, Ventricular Tachycardia/Fibrillation
•Of course…N/V

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12
Q

Interactions

A
  1. Anticholinergics increase vagal blockade.
  2. Potential adverse effects when administered with
    digitalis, cholinergics, neostigmine.
  3. Enhanced effects are possible with antihistamines,
    procainamide, quinidine, antipsychotics,
    antidepressants, benzodiazepines, phenothiazines.
  4. When administered too soon after NaHCO3 (i.e. Without
    allowing sufficient fluid to flush the line), a precipitate will
    form.
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13
Q

Special Notes

A
  1. To recognize cholinergic poisonings remember the
    SLUDGE, DUMBELS, and Days of the week mnemonics. 2. Pushing a less than the minimum dose or pushing
    atropine too slowly may elicit a paradoxical
    bradycardia.
  2. Remember most bradycardias in pediatrics are a result of
    hypoxia/hypoxemia rather than a primary cardiac
    problem. Ventilation is always preferred over
    pharmacological intervention.
  3. Avoid being splashed in the eyes with atropine.•Be
    prepared, on physician order, to deliver massive
    amounts (10-40mg) in the setting of cholinergic
    poisoning.
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14
Q

SLUDGE

A 
Salivation
Lacrimation
Urination
Defecation
GI distress
Emesis
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15
Q

DUMBELS

muscarinic

A 
Diarrhea
Urination
Miosis
Bradycardia/bronchospasm/bronchorrhea
Emesis
Lacrimation
Salivation/secretion/sweating
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16
Q

BAM

A 
Breathing difficulty (wheezing)
Arrhythmias (bradycardia, ventr. arrhythmias, AV blocks)
Miosis (pinpoint pupils)
17
Q

Three C’s of CNS effects

A

Confusion
Convulsions
Coma

18
Q

Days of the Week (Nicotenic)

A 
Mydriasis
Tachycardia
Weakness
Hypertension, Hyperglycemia
Fasciculations

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