Atropine

Aka: Atropine, Hyoscyamine

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II. Pharmacology

  1. Tertiary ammonium alkaloid ester of tropic acid
  2. Naturally occurs in plant sources
    1. Atropa belladonna (Deadly nightshade)
    2. Datura stramonium (Jimsonweed, Thorn apple)
  3. Described as Belladonna (beautiful woman) alkaloid
    1. Women of past used Atropine to dilate pupils
    2. Mydriasis was perceived as more attractive
  4. Related isomer to Scopolamine (hyoscine)

III. Mechanism

  1. Antimuscarinic Cholinoceptor blocking drug
  2. Causes parasympathetic blockade (parasympatholytic)
  3. Inhibits vagal nerve activity (vagolytic)
    1. Enhances Sinus node automaticity
    2. Enhances Atrioventricular Node (AV) conduction

IV. Indications

  1. Symptomatic Bradycardia associated with
    1. Poor perfusion
    2. Hypotension
  2. Relative Bradycardia
  3. Prevent vagally mediated Bradycardia with intubation
  4. Symptomatic Bradycardia with AV Block
  5. Asystole or Pulseless Electrical Activity
    1. No evidence that survival is improved with Atropine
    2. Asystole is nearly always fatal despite intervention

V. Pediatric Dosing

  1. IV Dose
    1. Dose: 0.02 mg/kg IV or IO
    2. Minimum Dose: 0.1 mg
    3. Maximum Dose
      1. Child: 0.5 mg
      2. Adolescent: 1.0 mg
  2. Endotracheal Dose
    1. Dose: 2-3x IV dose (0.06 mg/kg) diluted in 3-5cc NS
    2. Follow dose with several positive pressure breaths

VI. Adult Dosing

  1. Bradycardia
    1. Dose: 0.5-1.0 mg IV
    2. May repeat q3-5 min to max total dose of 0.04 mg/kg
  2. Asystole or Bradycardic Pulseless Electrical Activity
    1. Dose: 1 mg IV
    2. Consider giving entire 0.04 mg/kg at start)
    3. May repeat q3-5 min to max total dose of 0.04 mg/kg
  3. Endotracheal Dosing
    1. Dose: 1-2 mg per dose
    2. Dilute to 10 ml with sterile water or saline

VII. Precautions

  1. Avoid repeat dosing if possible
    1. Increases myocardial oxygen demand
    2. Atropine may provoke Ischemic Heart Disease
  2. Consider external pacing if repeat dosing needed
  3. Avoid dosing Atropine below recommended dose
    1. Causes paradoxical Bradycardia
    2. May precipitate Ventricular Fibrillation

VIII. Adverse effects

  1. Rebound Tachycardia
  2. Paradoxical Bradycardia (if low dose Atropine used)
  3. Pupil dilatation (Mydriasis)
  4. Paradoxical rate slowing
    1. Type II Second degree AV Block
    2. Third Degree AV Block
  5. Arrhythmia (especially in Coronary Artery Disease)
    1. Ventricular Fibrillation
    2. Ventricular Tachycardia
  6. Anticholinergic Toxicity with overdosage
  7. Decreased Sweating and secretions
  8. Mild sedation to Delirium

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Related Studies

Cost: Medications

atropine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ATROPINE 1% EYE DROPS Generic $15.88 per ml
hyoscyamine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
HYOSCYAMINE 0.125 MG ODT Generic $0.14 each
HYOSCYAMINE 0.125 MG TAB SL Generic $0.12 each
HYOSCYAMINE SULF 0.125 MG TAB Generic $0.14 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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