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 Use extreme caution when calculating and
effects of which are mediated by alpha or beta preparing doses; epinephrine is a very
receptors in target organs. Effects on alpha potent drug; small errors in dosage can cause
receptors include vasoconstriction, contraction serious adverse effects.
of dilator muscles of iris. Effects on beta Protect drug solutions from light, extreme
receptors include positive chronotropic and
heat, and freezing; do not use pink or brown
inotropic effects on the heart (beta1
solutions. Drug solutions should be clear and
receptors); bronchodilation, vasodilation, and
colorless (does not apply to suspension for
uterine
injection).
relaxation (beta2 receptors); decreased
production of aqueous humor.
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
Use in local anestheticsEpinephrine is added to injectable forms of a
number of local anesthetics, such as bupivacaine and lidocaine, as a
As a hormone, epinephrine acts on nearly all body tissues. Its actions vary vasoconstrictor to retard the absorption and therefore prolong the action
by tissue type and tissue expression of adrenergic receptors. For example, of the anesthetic agent. Some of the adverse effects of local anesthetic
epinephrine causes smooth muscle relaxation in the airways, but causes use, such as apprehension, tachycardia and tremor, may be caused by
contraction of the smooth muscle that lines most arterioles. 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 Atropine sulfate is a potent parasympatholytic. It inhibits actions of
receptors inhibits insulin secretion by the pancreas, stimulates acetylcholine at postganglionic parasympathetic neuroeffector sites,
glycogenolysis in the liver and muscle, and stimulates glycolysis in primarily at muscarinic receptors. Small doses inhibit salivary and
muscle.[9] β-Adrenergic receptor binding triggers glucagon secretion in bronchial secretions, moderate doses dilate pupils and increase heart rate.
the pancreas, increased adrenocorticotropic hormone (ACTH) secretion Large doses decrease GI motility, inhibit gastric acid secretion. Blocked
by the pituitary gland, and increased lipolysis by adipose tissue. Together vagal effects result in positive chronotropy and positive dromotropy
these effects lead to increased blood glucose and fatty acids, providing (limited or no inotropic effect). In emergency care, it is primarily used to
substrates for energy production within cells throughout the body.[9] increase the heart rate in life-threatening bradycardias. You can think of
the effects of atropine as being 'anti-SLUDGE'.
In addition to these metabolic changes, epinephrine also leads to broad
alterations throughout all organ systems. 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
Renal Function 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.
