Atropine Sulfate

Question 1

Drug Classification

Answer 1

Anticholinergic/Parasympatholytic

Question 2

Mechanism of Action

Answer 2

Muscarinic ACH-R antagonist ->inhibits parasympathetic stimulation in SA and AV nodal cells ->prevents K+ eflux and hyperpolarization -> positive chronotropy, no inotropic effect

Question 3

Pharmacokinetics

Answer 3

Onset of Action- immediate
Peak Effects- 2-4 minutes
Duration of Effects- 4 hours
Half-Life- 2-3 hours

Question 4

Indications/Field Use

Answer 4

• Symptomatic bradycardia
• Premedication for RSI with bradycardia < 50 bpm
• Organophosphate poisoning

Question 5

Contraindications

Answer 5

None in emergency setting

Question 6

Side Effects/Adverse Reactions

Answer 6

Blurred Vision, dilated pupils, dry mouth, tachycardia, drowsiness, confusion

Question 7

Dose

Answer 7

Adult

    - Bradycardia-0.5mg slow IV/IO q 3-5min up to 3mg
    - RSI- 0.5-1mg IV/IO
    - Organophosohate-2-5mg IV/IO/IM q20-30 until s/s resolve

Pedi

    - Bradycardia- 0.02mg/kg IV/IO; minimum single dose 0.1 mg, max single dose 0.5mg
    - RSI- 0.02mg/kg IV/IO
    - Organophosohate- 0.05 mg/kg IV/IO/IM q 20-30min until s/s resolve

Question 8

Precautions

Answer 8

• Do not give less than 0.5mg(adult) or 0.1mg(pedi)- causes paradoxical effect.
• May cause paradoxical slowing or may be ineffective if used for 2nd degree type II/ 3rd degree heart block
• Caution with acute MI-increases myocardial oxygen demand

Question 9

Drug-Drug Interactions

Answer 9

Few EMS