atropine sulfate

Question 1

atropine sulfate
CLASS

Answer 1

Anticholinergic

Question 2

atropine sulfate
PHARMACOLOGY AND ACTIONS

Answer 2

Inhibits acetylcholine at postganglionic parasympathetic neuroeffector sites.
Increases heart rate in cardiac origin symptomatic bradycardia. Reverses muscarinic effects of cholinergic
poisoning.

Question 3

atropine sulfate
ONSET, DURATION, PEAK EFFECT

Answer 3

Onset: Immediate Duration: 2-4 hours Peak Effect: 2-4 minutes

Question 4

atropine sulfate
Indications and contraindications

Answer 4

Indications
● Hemodynamically unstable bradycardia
● Acetylcholinesterase inhibitor poisonings
● RSI in pediatrics
IV. Contraindications
Note: all the following contraindications listed are relative
● Evolving MI
● Narrow-angle glaucoma
● GI obstruction
● Severe ulcerative colitis
● Toxic megacolon
● Bladder outlet obstruction
● Myasthenia gravis
● Hemorrhage with cardiovascular instability
● Thyrotoxicosis

Question 5

atropine sulfate
adverse reactions and side effects

Answer 5

Note: Expected effects of anticholinergics include pupillary dilation, dry mouth/nose/skin, urinary
retention, and constipation.
Cardiovascular: Palpitations, dysrhythmias
Neurological: drowsiness, confusion, headache, blurred vision

Question 6

atropine sulfate
dosage

Answer 6

Adult
Symptomatic bradycardia: 0.5-1mg (1mg per AHA) IV/IO every 3-5 minutes. Maximum dose:
3mg
ACH poisoning: extremely large doses
Pediatric
Symptomatic bradycardia: 0.02mg/kg IV/IO. Maximum single dose: 0.5mg. Maximum total dose:
1mg (children under 13 years) or 3mg (children over 13 years). If administering via ETT: 0.04-
0.06mg/kg.
ACH poisoning: Younger than 12 years: First dose of 0.05mg/kg. Repeat and double the dose
every 5 minutes until symptoms resolve. 12 years and older: First dose 1mg IV/IO. Repeat and
double the dose every 5 minutes until symptoms resolve.
RSI: 0.01-0.02mg/kg IV/IO or 0.02mg/kg IM. Maximum IV/IO dose: 0.5mg. No maximum IM
dose.

Question 7

atropine sulfate
special considerations

Answer 7

● Paradoxical bradycardia can occur with doses less than 0.1mg
● Ineffective in hypothermic bradycardia and patients with AV blocks or heart transplants.
● Use with caution in myocardial ischemia.

Question 8

atropine sulfate
drug interactions

Answer 8

● Potential adverse effects with administered with digitalis, cholinergics, and
physostigmine.
● Effects enhanced by antihistamines, procainamide, quinidine, antipsychotics,
benzodiazepines and antidepressants