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Atropine
Aka: Atropine, Hyoscyamine
- Pharmacology
- Tertiary ammonium alkaloid ester of tropic acid
- Naturally occurs in plant sources
- Atropa belladonna (Deadly nightshade)
- Datura stramonium (Jimsonweed, Thorn apple)
- Described as Belladonna (beautiful woman) alkaloid
- Women of past used Atropine to dilate pupils
- Mydriasis was perceived as more attractive
- Related isomer to Scopolamine (hyoscine)
- Mechanism
- Antimuscarinic Cholinoceptor blocking drug
- Causes parasympathetic blockade (parasympatholytic)
- Inhibits vagal nerve activity (vagolytic)
- Enhances Sinus node automaticity
- Enhances Atrioventricular Node (AV) conduction
- Indications
- Symptomatic Bradycardia associated with
- Poor perfusion
- Hypotension
- Relative Bradycardia
- Prevent vagally mediated Bradycardia with intubation
- Symptomatic Bradycardia with AV Block
- Asystole or Pulseless Electrical Activity
- No evidence that survival is improved with Atropine
- Asystole is nearly always fatal despite intervention
- Pediatric Dosing
- IV Dose
- Dose: 0.02 mg/kg IV or IO
- Minimum Dose: 0.1 mg
- Maximum Dose
- Child: 0.5 mg
- Adolescent: 1.0 mg
- Endotracheal Dose
- Dose: 2-3x IV dose (0.06 mg/kg) diluted in 3-5cc NS
- Follow dose with several positive pressure breaths
- Adult Dosing
- Bradycardia
- Dose: 0.5-1.0 mg IV
- May repeat q3-5 min to max total dose of 0.04 mg/kg
- Asystole or Bradycardic Pulseless Electrical Activity
- Dose: 1 mg IV
- Consider giving entire 0.04 mg/kg at start)
- May repeat q3-5 min to max total dose of 0.04 mg/kg
- Endotracheal Dosing
- Dose: 1-2 mg per dose
- Dilute to 10 ml with sterile water or saline
- Precautions
- Avoid repeat dosing if possible
- Increases myocardial oxygen demand
- Atropine may provoke Ischemic Heart Disease
- Consider external pacing if repeat dosing needed
- Avoid dosing Atropine below recommended dose
- Causes paradoxical Bradycardia
- May precipitate Ventricular Fibrillation
- Adverse effects
- Rebound Tachycardia
- Paradoxical Bradycardia (if low dose Atropine used)
- Pupil dilatation (Mydriasis)
- Paradoxical rate slowing
- Type II Second degree AV Block
- Third Degree AV Block
- Arrhythmia (especially in Coronary Artery Disease)
- Ventricular Fibrillation
- Ventricular Tachycardia
- Anticholinergic Toxicity with overdosage
- Decreased Sweating and secretions
- Mild sedation to Delirium