Atropine Sulfate

Question 1

ATROPINE SULFATE

CLASS/ACTION:

Answer 1

ACTION: Anticholinergic (Vagolytic)

• Blocks acetylcholine receptors resulting in reduction of parasympathathetic tone and increased conduction through the AV node.
• Increases sinus node automaticity and AV conduction when suppressed by abnormal parasympathetic or vagal discharges.
• Antagonizes action of organophosphate agents.

Question 2

ATROPINE SULFATE

INDICATIONS:

Answer 2

INDICATIONS:

• Symptomatic bradycardia

• Adult:
  
  • Signs or symptoms of poor perfusion caused by bradycardia
    • Consider: Atropine 0.5 mg IV/ IO while waiting for TCP
• ​​PED:
  
  • After EPI
  • If increased vagal tone or primary AV block

• Nerve agent exposure

Question 3

ATROPINE SULFATE

CONTRAINDICATIONS:

Answer 3

CONTRAINDICATIONS:

• Atrial fibrillation or atrial flutter
• Glaucoma

Question 4

ATROPINE SULFATE

POTENTIAL SIDE EFFECTS:

Answer 4

POTENTIAL SIDE EFFECTS:

• Increase heart rate causing tachycardias.
• Post-atropine tachycardias can precipitate V-Fib or V-Tach.
• Can worsen patient’s ischemia or extend size of infarct.
• Dry mouth.
• Doses lower than 0.5 mg can produce slowing of the heart.
• Dilated pupils.
• Decreased salivation.
• Flushed, hot skin.

Question 5

ATROPINE SULFATE

ADULT DOSE/ROUTE:

Answer 5

ADULT DOSE/ROUTE:

• Symptomatic bradycardia
  
  • Signs or symptoms of poor perfusion caused by bradycardia
    
    • Consider: Atropine 0.5 mg IV/ IO while waiting for TCP. May repeat q 3‐5 minutes to a total dose of 3 mg.
• Nerve agent exposure
  
  • Patient: 2 mg IV/IM
    
    • Autoinjector antidote kit: 2 mg in 0.7mL
    • 1 - 3 kits depending on exposure (given with Pralidoxime chloride)
    • ►►Additional atropine may be needed until a positive response is achieved

Question 6

ATROPINE SULFATE

PEDIATRIC DOSE/ROUTE:

Answer 6

PEDIATRIC DOSE/ROUTE:

• Symptomatic Bradycardia (after EPI + if increased vagal tone or primary AV block):
  
  • First Dose: 0.02 mg/kg IVP or IO (min dose 0.1mg, max dose 1 mg)

 Organophosphate Poisoning: 0.02 mg/kg IVP or IO (min dose 0.1mg, no max dose)

Question 7

ATROPINE SULFATE

NOTES:

Answer 7

NOTES:

• External pacing is the treatment of choice for symptomatic bradycardia if there is suspected myocardial ischemia, or 2nd or 3rd degree AV blocks are present.
• Can be given IM in thigh for suspected organophosphate poisoning /nerve agent exposure.
• Note: the primary cause of bradycardia in pediatric patients is hypoxia.

*Atropine is no longer recommended for adult or pediatric asystole.

Question 8

ATROPINE:

How Supplied:

Answer 8

Supplied:

►Atropine Sulfate 1 mg / 10 mL

►Autoinjector antidote kit (optional)
(atropine 2mg in 0.7mL’s & pralidoxime chloride 600mg in 2 mL’s)