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atropine (Atropair, Atropine-Care)

Indications: 1) surgery a) used with general anesthesia b) pre-operative medication to reduce salivation & excessive secretions of the respiratory tract c) used to prevent cholinergic effects during surgery 2) cardiology a) hypotension b) bradycardia - treatment of choice for symptomatic bradycardia (class I) c) AV block - may be beneficial (class IIa) for treatment of AV block at the nodal level or ventricular asystole 3) amblyopia 4) antidote for muscarinic toxidrome - organophosphate poisoning (pesticides), carbamate toxicity, anticholinesterase toxicity (physostigmine) - mushroom poisoning 5) ophthalmic agent - mydriasis & cycloplegia for examination of the retina & optic disc 6) diarrhea: used in combination with diphenoxylate in Lomotil 7) irritable bowel syndrome [6] 8) urinary incontinence, neurogenic bladder 9) sialorrhea [6] Contraindications: 1) asthma 2) narrow angle glaucoma (ophthalmic) 3) atropine is no longer recommended for pulseless electrical activity (PEA) 4) atropine may be best avoided in patients with a) type II second degree heart block b) new onset type III heart block with wide QRS complexes, c) these rhythms are frequently secondary to anteroseptal myocardial infarction, resulting in a conduction system defect at the His-Purkinje level d) diminished vagal tone will not help these patients Dosage: 1) 0.4-0.6 mg PO, SC, IM, IV every 4-6 hours 2) pre-operative: give 30-60 minutes prior to induction of anesthesia 3) ACLS: 1 mg IV, repeat in 3-5 minutes, max 0.03 mg/kg 4) endotracheal: 2-2.5 x the IV dose in 10 ms of normal saline Tradenames: Isopto Atropine, Atropair, Atropine-Care. Mydriasis: 1 drop QD-TID for 7-14 days Cycloplegia: 1 drop QD-TID for 5-10 days 0.5 % 1.2% Pharmacokinetics: 1) well absorbed throught the GI tract: a) absorbed in upper small intestine b) peak plasma levels in 1 hour 2) IM injection: peak plasma levels in 30 min 3) endotracheal administration: a) absorbed well through the endotracheal route b) peak plasma concentrations in 1.5-4 hours c) a total dose of 3 mg produces total vagal block in humans 4) limited amounts cross the blood-brain barrier 5) maximal mydriasis in 30-40 minutes with duration of action of 7-12 days 6) maximal cycloplegia in several hours with duration of action of 2 weeks Adverse effects: 1) common (> 10%) - dry, hot skin - impaired GI motility - constipation - dry mouth & throat - irritation at site of injection - dry nose - decreased sweating 2) not common (1-10%) - photophobia, decreased flow of breast milk, dysphagia 3) uncommon (< 1%) - orthostatic hypotension, tachycardia, palpitations, ventricular fibrillation, confusion, drowsiness, ataxia, fatigue, delirium, headache, memory impairment, restlessness, rash, nausea/vomiting, difficulty urinating, tremor, weakness, intraocular pain, blurred vision, mydriasis 4) other [1] - dizziness, bronchospasm 5) toxicity - fever, delirium [4] Drug interactions: 1) additive effects when co-administered with other anticholinergic agents 2) may alter absorption of other drugs Laboratory: - atropine in hair - atropine in blood - atropine in serum/plasma - atropine in urine Mechanism of action: 1) antimuscarinic agent that competitively inhibits action of acetylcholine 2) dose-dependent anti-muscarinic activity 3) relative degree of sensitivity a) secretions of salivary, bronchial & sweat glands b) pupillary dilatation c) ocular accomodation d) increased heart rate e) contraction of the detrussor muscle of the bladder & smooth muscle of the GI tract f) gastric acid secretion & motility 4) blocks action of acetylcholine at muscarinic receptor sites in the smooth muscle of the iris

Interactions

drug interactions drug adverse effects of parasympatholytics

Related

bradyarrhythmia (bradycardia) pulseless electrical activity; electromechanical dissociation (PEA)

Specific

hyoscyamine (Anaspaz, Levsin)

General

antidote anti-motility agent; antiperistaltic agent belladonna alkaloid cycloplegic agent mydriatic agent parasympatholytic (anticholinergic, antimuscarinic agent)

Properties

KINGDOM: plant MISC-INFO: elimination route KIDNEY 1/2life 2-3 HOURS pregnancy-category C safety in lactation - ?

Database Correlations

PUBCHEM correlations

References

  1. Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. Prescriber's Letter 9(5):28 2002
  4. Medical Knowledge Self Assessment Program (MKSAP) 14, American College of Physicians, Philadelphia 2006
  5. 2010 American Heart Association Guidelines for CPR and Emergency Cardiovascular Care Oct. 18, 2010 Comparison Chart of Key Changes http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317267.pd
  6. Deprecated Reference

Component-of

atropine/attapulgite/hyoscyamine/scopolamine (Donnagel) atropine/belladonna/hyoscyamine/phenobarbital/scopolamine (Donnatal) atropine/benzoic acid/hyoscyamine/methenamine/methylene blue/phenyl salicylate atropine/chlorpheniramine/hyoscyamine/pseudoephedrine/scopolamine atropine/difenoxin (Motofen) atropine/diphenoxylate (Lomotil, Lonox) atropine/edrophonium atropine/hyoscyamine/phenobarbital/scopolamine atropine/hyoscyamine/scopolamine atropine/pralidoxime (Duodote)