Atropine Sulfate

Question 0

Actions (4)

Answer 0

1. Inhibits parasympathetic stimulation by blocking acetylcholine receptors
2. Decreases vagal tone resulting in increased heart rate and AV conduction
3. Dilates bronchioles and decrease respiratory tract secretions
4. Decrease gastrointestinal secretion

Question 1

Drug classification (3)

Answer 1

1. Parasympathetic blocker
2. anticholinergic
3. vagolytic

Question 2

Indication (2)

Answer 2

1. Symptomatic Bradydysrhythmias

2. Insecticide poisoning (organophosphates) (if HR < 60, respiratory depression, and/or extreme salivation)

Question 3

Contraindication

Answer 3

Not significant in indications

Question 4

Adverse effects - Cardiovascular (2)

Answer 4

Tachycardia

Increased oxygen demand

Question 5

Adverse effects - respiratory

Answer 5

Mucus plugs

Question 6

Adverse effects - gastrointestinal (2)

Answer 6

Dry mouth

Difficulty swallowing

Question 7

Adverse effects - neurological (5)

Answer 7

Pupillary dilation
Blurred vision
Dizziness
Confusion/restlessness
Seizures

Question 8

Adverse effects - other (2)

Answer 8

Hot, dry skin

Worsens glaucoma

Question 9

Administration - Bradydysrhythmias

Answer 9

0.5 mg rapid IVP or IO.

May repeat dose every 3-5 minutes to a maximum of 3 mg

Repeat until heart rate > 60 or signs of adequate perfusion

Question 10

Administration - insecticides

Answer 10

2 mg rapid IVP, IM.

May repeat dose every 5 minutes until patient is asymptomatic

Symptomatic: HR

Question 11

Pediatrics (>1month) - Bradydysrhythmias

Answer 11

Epinephrine and oxygen are the initial medications. If no response to epinephrine:

0.02 mg/kg rapid IVP or IO. Minimum single dose is 0.1mg

Question 12

Peds insecticide

Answer 12

R

Question 13

Onset

Answer 13

2-5 minutes

Question 14

Duration

Answer 14

20 minutes

Question 15

Precaution

Administer supplemental oxygen

Answer 15

Rationale

Increased heart rate may increase myocardial oxygen demand

Question 16

Precaution

Give rapid IVP

Answer 16

Rationale

May cause paradoxical slowing of the heart rate if given slowly - or if less than a therapeutic dose is given - for adults that is

Question 17

Precaution

Monitor ECG rhythms

Answer 17

Rationale

Increased myocardial ischemia may cause dysrhythmias

Question 18

Precaution

Monitor vital signs

Answer 18

Rationale

Observe for signs/symptoms of increased perfusion, other treatments may be required

Question 19

Note

Answer 19

If atropine is ineffective, TCP or Dopamine may be indicated.

Not recommended in asymptomatic bradycardia due to possibility of increasing myocardial oxygen demand, including or extending a myocardial infarction.

May dilate pupils - so pupils are not a reliable indicator of hypoxic brain damage after the administration of atropine. Pupils should however still react to light which may help in separating atropine effect from brain damage.

Worsens glaucoma due to papillary dilation.

Standard dosing may be exceeded in organophosphates poisoning.

2-3 mg of atropine may be given down the ET

Do not administer to neonates

Increased bagel tone may be caused by increased intracranial pressure, or betablockers, calcium channel blockers overdose, infection, congenital heart disease, sleep apnea, infection, hypothyroidism, or hypoglycemia