Atropine Sulfate Flashcards
Class
Anticholinergic agent
Antidote
Anti-spasmodic agent
Antiarrhythmic
Antimuscarinic
Mech of action
Pharmacological: blocks the action of acetylcholine as a competitive antagonist at muscarinic receptors sites is smooth muscle, secretory glands and the CNS. It works by blocking parasympathetic response and allowing sympathetic response to take over, resulting in an increase in cardiac output and the drying of secretions. Atropine reverses the muscarinic effects of cholinergic poisoning by primarily reversing bronchorrhea and bronchoconstriction. At high enough doses, atropine may have an effect on nicotinic receptors responsible for restlessness, hallucination, disorientation and or delirium.
Clinical: CV: increased heart rate (positive chronotropic effect) increased conduction velocity; increased force of contraction (slight) increase cardiac output.
RESP: decrease mucus production; increased bronchial smooth muscle relaxation ( Bronchodilation)
GI: decreased G.I. secretion and motility.
MISC: mydriasis (pupillary dilation) decreased sweat production
Indications
Sympthomatic bradycardia
(Sinus, junctional, AV blocks causing significant hypertension, ventricular ectopy, chest pain, altered level of consciousness, etc. monitored patient only.
Acetylcholinesterase inhibitor poisoning ( organophosphate, carbamate cholinergic poisoning)
Adverse reactions
Major: Tachydysrhythmias; flushing; ventricular irritability;exacerbation/initiation of angina; acute narrow angle glaucoma; blurred vision; mydriasis; agitation to delirium; bloating; constipation; decreased gastric emptying.
Adult dose
Special instructions
IV/IO administer undiluted by rapid IV injection; slow injection may result in paradoxical bradycardia. Dose<0.5 mg increase vagal tone resulting in paradoxical Bradycardia
IM- atropen should be administered to outer thigh. May be given through clothing as long as pockets at injection site are clear. Hold autoinjector in place for 10 secs following injection; massage injection site.
Symptomatic bradycardia
IV/IO .5mg q 5 min. Don joy exceed 3mg/0.04mg/kg if symptoms profound
Consider atropine before pacing in mild symptomatic pts
Do not delay in unstable pts, particularly with 3degree against block
Do not rely on atropine in mobitz type II 2 or 3 degree Avondale block
Hemodynamically unstable and clinically deteriorating pts require immediate pacing
Organophosphate or carbamate poisoning
IV/IO initially 1 to 5 mg. Those should be doubled every five minutes until signs of muscarinic excess abate (cleaning a bronchial secretions, bronchospasm, and adequate oxygenation)
IV infusion 0.5–1 mg per hour or 10 to 20% of loading per hour
IM atropen mild symptoms. And minister to milligrams as soon as exposure is known or suspected. If severe symptoms develop after one dose, two additional doses should be repeated in 10 minutes, not to exceed more than three doses. Severe symptoms immediately administer 3 2mg doses
Route
Onset
IV/IO/ET
1 min
contraindications
Hypersensitivity to atropine or any component of the formulation – belladonna alkaloid allergy
Glaucoma, acute narrow angle(relative contraindication to pt with symptomatic bradycardia) adhesions between the iris and the lens
Tachycardia
Obstructive GI disease, paralytic ileus, intestinal atony of the elderly or debilitated pt, severe ulcerative colitis or toxic mega colon ulcerative colitis
Hepatic disease
Renal disease, obstructive uropathy
Myasthenia gravis( unless used to treat side effects of acetycholinstrerase inhibitor
Asthma
Thyrotoxicosis
Mobitz type II block
3rd degree hear block
Pregnancy risk factors
Animal reproduction studies have not been conducted. Atropine has been found to cross the human placenta. Trace amount of atropine can enter breast milk; use caution. Anticholinergic agents may suppress lactation.
Pediatric doses
Symptomatic bradycardia
IV/I/O 0.02 mg per kilogram minimum of 0.1 mg, may repeat it five minute intervals to a maximum total dose of 1 mg in children and 2milligram in adolescence
Maximum single-dose: child 0.5 mg; adolescent 1 mg
Organophosphate or carbamate cholinergic poisoning
IV/IO .03–0.05 mg per kilogram every 10 to 20 minutes until cholinergic symptoms minimize, and every 1 to 4 hours for at least 24 hours
IM administer those as listed below as soon as exposures known or suspected. If severe symptoms develop after first dose, two additional does this should be repeated in 10 minutes. Do not administer more than three doses. For severe symptoms, immediately and minister three doses as follows
