Group 4 - Atropine Sulfate

Question 1

Atropine Sulfate

Drug Class?

Answer 1

Atropine Sulfate Drug Class:

• Anticholinergic Agent
• Antidote
• Antispasmodic Agent
• Antimuscarinic

Question 2

Atropine Sulfate

Mechanism of Action?

Answer 2

Atropine Sulfate Mechanism of Action:

• CV: increased heart rate, increased conduction velocity, increased force of contraction, increased cardiac output
• Resp: Decreased mucus production, increased bronchial smooth muscle relaxation (bronchodilation)
• GI: Decreased GI secretion and motility
• GU: Decreased urinary bladder tone
• Misc: Mydriasis (pupillary dilation); decreased sweat production

Question 3

Atropine Sulfate

Indications?

Answer 3

Atropine Sulfate Indications:

• Symptomatic bradycardia
• Acetylcholinesterase inhibitor poisoning (organophosphate, carbamate cholinergic poisoning)

Question 4

Atropine Sulfate

Contraindications?

Answer 4

Atropine Sulfate Contraindications:

• Hypersensitivity to atropine
• Acute narrow angle glaucoma (relative)
• Asthma
• 2nd degree Type II and 3rd degree AV Blocks
• Myasthenia gravis
• Obstructive GI disease, renal disease, hepatic disease

Question 5

Atropine Sulfate

Adverse Reactions?

Answer 5

Atropine Sulfate Adverse Reactions:

• Major: tachydysrhythmias, blurred vision, ventricular irritability
• Minor: nausea, vomiting, decreased sweating/increased body temperature

Question 6

Atropine Sulfate

Adult Dose?

Answer 6

Atropine Sulfate Adult Dose:

• Symptomatic Bradycardia:
• (Old Guideline) IV/IO: 0.5 mg every 3 - 5 minutes. Max total dose of 3 mg
• (2020 AHA) IV/IO: 1 mg every 3 - 5 min Max dose 3 mg
• Organophosphate or carbamate poisoning:
• IV/IO: 1 - 5 mg. Dose should be doubled every 5 minutes until signs of muscarinic excess abate
• IV Infusion: 0.5 - 1 mg/hr

Question 7

Atropine Sulfate

Pediatric Dose?

Answer 7

Atropine Sulfate Pediatric Dose:

• Symptomatic Bradycardia:
• IV/IO: 0.02 mg/kg (minimum of 0.1 mg) every 5 minutes. Max total dose of 1 mg in children, 2 mg in adolescents.
• Organophosphate or carbamate poisoning:
• IV/IO: 0.03 - 0.05 mg/kg every 10 to 20 minutes until cholinergic symptoms minimize.

Question 8

Atropine Sulfate

Onset of Action?

Answer 8

Atropine Sulfate Onset of Action:

• 1 minute

Question 9

Atropine Sulfate

Peak Effects?

Answer 9

Atropine Sulfate Peak Effects:

• IV: 2 - 5 minutes
• IM: 30 minutes

Question 10

Atropine Sulfate

Duration of Action?

Answer 10

Atropine Sulfate Duration of Action:

• Half-life 2 - 3 hours

Question 11

Atropine Sulfate

AZ Drug Box Minimum Supply?

Answer 11

Atropine Sulfate

AZ Drug Box Minimum Supply:

• 3 (1 mg/10 ml) prefilled syringes
• Optional: 1 (8 mg/20 ml) multidose vial

Question 12

Atropine Sulfate

Special Notes?

Answer 12

Atropine Sulfate Special Notes:

• Administering too small doses or too slowly may result in paradoxical bradycardia.
• Signs and symptoms of cholinergic/organophosphate poisoning: excess salivation, lacrimation, urination, defecation, bradycardia, coma.
• Patients that describe their glaucoma as painful probably have acute narrow angle glaucoma.