F - 10 - Atropine Flashcards
What is the medication class of atropine?
Anticholinergic (specifically anti-muscarinic)
What is the adult dose of IV atropine in symptomatic bradycardia? Max dose?
0.5 mg IV q5 min; 3 mg Max
What is the adult dose of IM/IV atropine in symptomatic organophosphate poisoning? Max dose?
2 mg IV/IM q5min until effect; No max dose
What is the pediatric dose of IV atropine in symptomatic bradycardia? Max miligrams per individual dose?
0.02 mg/kg q5 minutes; Max 0.5 mg/dose
What is the pediatric dose of IV atropine in organophosphate poisoning? Max miligrams per individual dose?
0.05 mg/kg IV q5 min; Max 1 mg/dose
What is the MOA of atropine?
Competitive antagonist of Ach on muscarinic receptors. Reduces secretions, increases heart rate, produces bronchodilation
Doses of atropine less than 0.5mg given at slow rates may produce ______.
paradoxical bradycardia
mechanism?
What are the symptoms of severe organophosphate poisoning?
- confusion
- severe respiratory distress/secretions
- muscle twitching/weakness
- involuntary urination/defecation
- seizures
- unconsciousness
What are the symptoms of mild organophosphate poisoning? What may prompt administration of atropine?
2+ of:
- blurred vision
- salivation
- chest tightness/dyspnea
- N/V
- muscle twitching
- unexplained wheezing/coughing
- acute stomach cramping
- tachycardia
- bradycardia
Contraindications of atropine
- Glaucoma
- Myasthenia gravis
- STEMI (relative)
- 3* HB (relative)
- COPD (relative)
What are the mnemonics for cholinergic toxidromes?
SLUDGE (muscarinic):
- salivation
- lacrimation
- urination
- defecation
- GI cramps
- emesis
MTWTF (nicotinic):
- Muscle cramps
- Tachycardia
- Weakness
- Twitching
- Fasiculations
By what mechanism do organophosphates (OPs) produce their effects?
OPs primarily act on acetylcholinesterase (AChE, an enzyme). AChE is an enzyme that breaks down acethycholine at neuromuscular junctions, CNS/PNS, and RBCs.
OPs produce elevated ACh in synapses that activate two receptors in the peripheral nervous system:
- nicotinic
- muscarinic
Clinical effects are manifested via activation of the autonomic and central nervous systems and at nicotinic receptors on skeletal muscle.
Muscarinic receptors are involved in a large number of physiological functions including heart rate and force, contraction of smooth muscles and the release of neurotransmitters.
