Pharm
Atropine
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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
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