Atropine Sulfate

Question 1

Drug Class

Answer 1

Anticholinergic agent

Question 2

Mechanism of Action

Answer 2

Inhibits acetylcholine at postganglionic parasympathetic neuroeffector sites
Increases heart rate in symptomatic bradydysrhythmias, reverses musinaric effects of cholinergic poisoning

Question 3

Indications and Contraindications

Answer 3

Indications: Hemodynamically unstable bradycardia, cholinergic poisoning, RSI in pediatrics, and beta/ calcium channel blocker overdoses

Contraindications (Relative): Narrow-angle glaucoma, GI obstruction, ulcerative colitis, toxic megacolon, myasthenia gravis, hemorrhage with corresponding cardiovascular instability, thyrotoxicosis.

Question 4

Effects & Interactions

Answer 4

Effects: Drowsiness, confusion, palpitations/ dysrhythmias, N+V, hot dry skin

Interactions: Potential adverse when given with digitalis, cholinergics, physostigmine. Effects enhanced by antihistamines, procainamide, quindine, antipsychotics, benzos, antidepressants

Question 5

Dosage and Administration

Answer 5

Bradycardia: (Adult): 0.5-1.0mg IV/IO every 3-5 minutes for max of 3mg. (Peds): 0.02mg/kg IV/IO for a max single dose of 0.5mg, 1mg total dosage. (ET Dose): 0.04-0.06 mg/kg

Cholinergic poisoning: (Adult): 2-4mg or higher may be needed. (Peds): Under 12: 0.05mg/kg initially, then repeat and double dose every 5 minutes until muscarinic symptoms reverse. 12 and older: 1 mg IV/IO initiatlly, then repeat and double dose every 5 minutes until muscarinic symptoms reverse

RSI: 0.01-0.02mg/kg IV/IO max 0.5mg; 0.02mg/kg IM

Question 6

Duration of Action

Answer 6

Onset: Immediate
Peak Effect: 2-4 minutes
Duration: 2-4 hours