Atropine sulfate

Dosages
Parenteral and oral preparations:
ADULTS
AtroPen, Minims (CAN), Sal-Tropine  Surgery: 0.5 mg (0.4–0.6 mg) IM (or SC, IV)
Ophthalmic solution: prior to induction of anesthesia; during surgery,
Atropine Sulfate S.O.P., Atropisol, Isopto Atropine give IV; reduce dose to < 0.4 mg with
Ophthalmic cyclopropane anesthesia

Drug classes PEDIATRIC PATIENTS

 Surgery: 0.1 mg (newborn) to 0.6 mg (12 yr)

 Anticholinergic
injected SC 30 min before surgery
 Antimuscarinic
 Parasympatholytic
Adverse effects
 Antiparkinsonian
 Antidote
 Dry mouth
 Diagnostic agent (ophthalmic preparations)
 Decreased sweating and predisposition
 Belladonna alkaloid
to heat prostration
 Weakness
Therapeutic actions
 dizziness

 Competitively blocks the effects of

acetylcholine at muscarinic cholinergic Interventions
receptors that
 Ensure adequate hydration.
mediate the effects of parasympathetic
 Provide environmental control (temperature) to
postganglionic impulses, depressing salivary and
prevent hyperpyrexia.
bronchial secretions, dilating the bronchi,
inhibiting vagal influences on the heart,
relaxing the GI and GU tracts, inhibiting
gastric acid secretion (high doses), relaxing the
pupil of the eye (mydriatic effect), and
preventing accommodation for near vision
(cycloplegic effect); also blocks the effects of
acetylcholine in the CNS.

Indications

 Antisialagogue for preanesthetic medication to

prevent or reduce respiratory tract secretions

Contraindications

 Contraindicated with hypersensitivity to

anticholinergic drugs
 Contraindicated with stenosing pepticulcer;
pyloroduodenal obstruction; paralytic ileus;
intestinal atony; severeulcerative colitis; toxic
megacolon; symptomatic prostatic hypertrophy;
bladderneck obstruction; bronchial asthma;
COPD; cardiac arrhythmias;
tachycardia;myocardial ischemia; impaired
metabolic, liver, or kidney function;
myastheniagravis.

Available forms
Tablets—0.4 mg; injection—0.05, 0.1, 0.3, 0.4, 0.5, 0.8, 1
mg/mL; ophthalmic ointment Epinephrine
—1%; ophthalmic solution—0.5%, 1%, 2%; auto-injector
—0.5, 1, 2 mg Aerosols:
Primatene Mist Available forms
epinephrine borate
Ophthalmic solution: Solution for inhalation—1:100, 1:1,000, 1.125%, 1%;
Epinal
aerosol—0.35 mg, 0.5%, 0.22 mg;
epinephrine hydrochloride
injection—1, 5 mg/mL; solution for injection—1:1,000,
Injection, OTC nasal solution:
Adrenalin Chloride 1:2,000, 1:10,000, 1:100,000;
Ophthalmic solution: suspension for injection—1:200; ophthalmic solution—
Epifrin, Glaucon 0.1%, 0.5%, 1%, 2%
Insect sting emergencies:
EpiPen Auto-Injector (delivers 0.3 mg IM adult dose),
EpiPen Jr. Auto- Dosages
Injector (delivers 0.15 mg IM for children) ADULTS
OTC solutions for nebulization:
AsthmaNefrin, microNefrin, Nephron, S2  Intraspinal 0.2–0.4 mL of a 1:1,000
solution added to anesthetic spinal
Drug classes fluid mixture.

 Sympathomimetic  Other use with local anesthetic:

Concentrations of 1:100,000–1:20,000
 Alpha-adrenergic agonist
are usually used
 Beta1 and beta2-adrenergic agonist
 Cardiac stimulant
 Vasopressor Adverse effects
 Bronchodilator
 Headache
 Antasthmatic drug
 Weakness
 Nasal decongestant
 blurred vision
 Mydriatic  palpitations

Therapeutic actions Interventions

 Naturally occurring neurotransmitter, the
effects of which are mediated by alpha or beta
receptors in target organs. Effects on alpha
receptors include vasoconstriction, contraction
of dilator muscles of iris. Effects on beta
receptors include positive chronotropic and
inotropic effects on the heart (beta1
receptors); bronchodilation, vasodilation, and
uterine
relaxation (beta2 receptors); decreased
production of aqueous humor.
 Use extreme caution when calculating and
preparing doses; epinephrine is a very
potent drug; small errors in dosage can cause
serious adverse effects.
 Protect drug solutions from light, extreme
heat, and freezing; do not use pink or brown
solutions. Drug solutions should be clear and
colorless (does not apply to suspension for
injection).

Indications

 additive to local anesthetic solutions for

injection to prolong their duration of
action and limit systemic absorption

Contraindications

 Contraindicated with allergy or hypersensitivity

to epinephrine or components of
preparation
 narrow-angle glaucoma
 general anesthesia with halogenated
hydrocarbons or cyclopropane
 cerebral arteriosclerosis
 hypertension;
 renal dysfunction
Epinephrine
As a hormone, epinephrine acts on nearly all body tissues. Its actions vary
by tissue type and tissue expression of adrenergic receptors. For example,
epinephrine causes smooth muscle relaxation in the airways, but causes
contraction of the smooth muscle that lines most arterioles.
Use in local anestheticsEpinephrine is added to injectable forms of a
number of local anesthetics, such as bupivacaine and lidocaine, as a
vasoconstrictor to retard the absorption and therefore prolong the action
of the anesthetic agent. Some of the adverse effects of local anesthetic
use, such as apprehension, tachycardia and tremor, may be caused by
epinephrine

Epinephrine acts by binding to a variety of adrenergic receptors. Atropine

Adrenaline is a nonselective agonist of all adrenergic receptors, including
α₁, α₂ , β₁, β₂, and β₃ receptors.[8] Epinephrine's binding to these receptors
triggers a number of metabolic changes. Binding to α-adrenergic
receptors inhibits insulin secretion by the pancreas, stimulates
glycogenolysis in the liver and muscle, and stimulates glycolysis in
muscle.[9] β-Adrenergic receptor binding triggers glucagon secretion in
the pancreas, increased adrenocorticotropic hormone (ACTH) secretion
by the pituitary gland, and increased lipolysis by adipose tissue. Together
these effects lead to increased blood glucose and fatty acids, providing
substrates for energy production within cells throughout the body.[9]
In addition to these metabolic changes, epinephrine also leads to broad
alterations throughout all organ systems.
Renal Function
Atropine sulfate is a potent parasympatholytic. It inhibits actions of
acetylcholine at postganglionic parasympathetic neuroeffector sites,
primarily at muscarinic receptors. Small doses inhibit salivary and
bronchial secretions, moderate doses dilate pupils and increase heart rate.
Large doses decrease GI motility, inhibit gastric acid secretion. Blocked
vagal effects result in positive chronotropy and positive dromotropy
(limited or no inotropic effect). In emergency care, it is primarily used to
increase the heart rate in life-threatening bradycardias. You can think of
the effects of atropine as being 'anti-SLUDGE'.
Atropine increases firing of the sinoatrial node (SA) and conduction
through the atrioventricular node (AV) of the heart, opposes the actions
of the vagus nerve, blocks acetylcholine receptor sites, and decreases
bronchial secretions.

Parenterally administered epinephrine initially may produce constriction In general, atropine lowers the parasympathetic activity of all muscles
of renal blood vessels and decease urine blood flow. and glands regulated by the parasympathetic nervous system. This occurs
because atropine is a competitive antagonist of the muscarinic
Special Risk Patients acetylcholine receptors (acetylcholine being the main neurotransmitter
used by the parasympathetic nervous system). Therefore, it may cause
swallowing difficulties and reduced secretions.
Use with caution in elderly patients; in patients with CV disease, diabetes,
hypertension or hyperthyroidism, and psychoneurotic individuals; in
patients with long-standing bronchial asthma and emphysema who have
developed degenerative heart disease; in patients with ventricular
fibrillation; in patients with prefibrillatory rhythm; and in pregnancy.

Sulfite Sensitivity

Some products contain sulfites; in serious allergic, emergency, or life-

threatening situations, use with caution in sulfite-sensitive individuals.

CV effects

Inadvertently induced high arterial BP may result in angina pectoris or

aortic rupture; potentially serious cardiac arrhythmias may occur in
patients not suffering from heart disease and patients with organic heart
disease or who are receiving drugs that sensitize the myocardium; a
paradoxical but transient lowering of BP, bradycardia, and apnea may
occur immediately after injection.

Cerebrovascular hemorrhage

May result from overdosage or inadvertent IV injection.

Extravasation

Tissue necrosis may develop if extravasation occurs.

Hypovolemia

Epinephrine use is not a replacement for blood, plasma, fluids, and

electrolytes, which should be restored promptly when loss has occurred.

Pulmonary edema

May cause fatalities because of peripheral constriction or cardiac

stimulation.

Overdosage

Symptoms

Cerebrovascular hemorrhage from extremely elevated arterial pressure,

dyspnea, elevated BP, extreme pallor and coldness of the skin, fatal
cardiac arrhythmia, headache, kidney failure, metabolic acidosis,
pulmonary edema, precordial distress, premature ventricular contractions
followed by multifocal ventricular tachycardia and occasionally by AV
block, transient bradycardia, vomiting.