Atropine

Atropine [minijet $18.69; vial for injection 64 cents] ADMINISTRATION ROUTES:

IV, IM, SC, ENDOTRACHEAL

ALTERNATIVE NAMES: Atropine

ICU INDICATIONS: 1. To temporarily increase heart rate or decrease AV-block until definitive

intervention can take place 2. Asanantidoteforinadvertentoverdoseofcholinergicdrugsorforcholinesterase

poisoning such as from organophosphorus insecticides

PRESENTATION AND ADMINISTRATION: Atropine ampoules contain 600mcg in 1ml or 1200mcg in 1ml Atropine mini-jets contain 1mg in 10ml (i.e. 100mcg/ml) Compatible with the following IV fluids: Dilution in IV fluids is not recommended Atropine sulphate is stated to be compatible, when mixed in a syringe immediately before use, with the following: Chlorpromazine Droperidol Metoclopramide Midazolam Prochlorperazine Promethazine If the solution is cloudy, do not use. Store at room temperature below 25°C

DOSAGE:

IV:

Bradycardia: 0.6mg IV Organophosphate poisoning: 2mg IV then 2mg every 15 minutes until atropinised, then 0.02-0.08mg/kg/hr for several days Endotracheal route(only if IV access cannot be obtained) The recommended adult dose of atropine for endotracheal administration is 1 to 2 mg diluted to a total not to exceed 10 ml of sterile water or normal saline. Note: – The administration of less than 0.5 mg can produce a paradoxical bradycardia because of the central or peripheral parasympathomimatic effects of low dose in adults.

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY: Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

IV

Bradycardia: 0.02mg/kg

CLINICAL PHARMACOLOGY: Atropine is commonly classified as an anticholinergic or antiparasympathetic (parasympatholytic) drug. More precisely, however, it is termed an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters.

Atropine

Fentanyl Morphine Ranitidine

Glycopyrrolate Pethidine

Version 30/08/2010

49CONTRAINDICATIONS: There are no absolute contraindications to atropine. contraindicated in:

1. pyloricstenosis 2. glaucoma 3. prostatichypertrophy

See WARNINGS.

However, atropine is relatively

WARNINGS In adults, the administration of less than 0.5 mg can produce a paradoxical bradycardia because of the central or peripheral parasympathomimatic effects of low dose in adults. Conventional systemic doses may precipitate acute glaucoma in susceptible patients, convert partial organic pyloric stenosis into complete obstruction, lead to complete urinary retention in patients with prostatic hypertrophy or cause inspissation of bronchial secretions and formation of dangerous viscid plugs in patients with chronic lung disease.

PRECAUTIONS

General

See WARNINGS

Laboratory Tests:

No laboratory tests in addition to routine tests are required.

Drug/Laboratory Test Interactions

None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU None of note.

ADVERSE REACTIONS

Body as a Whole:

thirst,

Cardiovascular System:

Tachycardia

Gastrointestinal System:

Dryness of the mouth, constipation

Neurological System:

Blurred vision, dilated pupils, difficulty in swallowing, tremor,

Urological System:

Difficulty in micturition