Page 122 - 2023 SMOG Digital

ATROPINE Sulfate Lactation: Yes, Use Caution Trade Name: AtroPen
Class / Mechanism of Action
Anticholinergic, Antidysrhythmic, Antidote for Carbamate Anticholinesterase poisoning
Blocks acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS;
increases cardiac output, and dries secretions. Atropine reverses the muscarinic effects of cholinergic
poisoning. Reverses bronchorrhea and bronchoconstriction, but does not affect the nicotinic receptors
responsible for muscle weakness, fasciculations, and paralysis.
Indications
Labeled Indications: Treatment of
• Symptomatic Sinus Bradycardia, AV block (nodal level)
• Antidote for anticholinesterase poisoning (carbamate insecticides, nerve agents, organophosphate
insecticides)
Contraindications
• Hypersensitivity to atropine or any component of the formulation
• Narrow-angle glaucoma; adhesions between the iris and lens (ophthalmic product)
• Pyloric stenosis
• Prostatic hypertrophy
• Note: NO contraindications should prevent use of atropine in setting of life threatening
organophosphate, carbamate, or nerve agent poisoning
Adverse Reactions / Precautions
• Tachycardia and arrhythmia (VTach, VFib), Hypotension, Palpitations
• Dilated Pupils, Angle-closure glaucoma
• Headache, Dry Mouth, constipation, urinary retention, flushing
• Paradoxical Bradycardia noted with doses less than 0.1mg
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Symptomatic Bradycardia Symptomatic Bradycardia
IV/IO IV/IO
• 1mg q3-5min, not to exceed a total of 3mg or • 0.02mg/kg (Minimum dose is 0.1mg.
0.04mg/kg (ARC, 2020) Maximum single dose of 0.5mg. May repeat
once in 3-5 minutes. Maximum total dose is
Organophosphate or carbamate insecticide or 1mg (PALS, 2020)
nerve agent poisoning:
IV/IM: (Used with 2-Pam Chloride auto injector) Organophosphate or carbamate insecticide:
• Initial: 1-6mg; repeat q3-5minprn, doubling the • IV/IO: Initial: 0.05-0.1mg/kg; repeat q5-10min
dose if previous dose did not induce as needed, double dose if previous dose does
atropinization. Maintain with repeat doses as not induce atropinization. Maintain with repeat
needed for ≥2-12 hours based on recurrence of doses as needed for ≥2-12 hours based on
symptoms. recurrence of symptoms.
IM (AtroPen®): anterolateral aspect of thigh and
hold in place for 10 seconds. Follow with 2-Pam Severe Nerve Agent Poisoning:
Chloride auto injector. • IV/IO 1mg every 3 min. Monitor Patient for
• Mild symptoms (≥2 mild symptoms): 2 mg once signs and symptoms of atropinization,
an exposure is known or strongly suspected. (drying up of secretions). Once clinical
• Severe symptoms (≥1 severe symptom): Three improvement is achieved restric to 10-20%
2mg doses in rapid succession. of original dose (approximately 2-4mg/hr
Mild and Severe Symptoms are noted on product
labeling and Pralidoxime Chloride drug card.

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