![]() ![]() ![]() ![]() However, relative contraindications are overridden by the clinical need, especially in unstable or poisoning patients.Ĭlinicians need to exercise caution in patients with coronary heart disease, acute myocardial ischemia, congestive heart failure, tachycardia, or hypertension as the increased cardiac demand and possible further worsening of tachycardia and hypertension can prove detrimental to patient outcomes.įurthermore, caution is necessary for use with elderly patients, chronic lung disease patients, acute angle glaucoma, obstructive diseases (uropathy, toxic megacolon, paralytic ileus, pyloric stenosis, prostatic hypertrophy), myasthenia gravis, or in situations with environmental heat exposure.Ĭlinician understanding the adverse reactions makes the above cautionary situations easily recognizable by compounding effects on preexisting conditions. Multiple conditions carry a cautionary status. Ītropine does not carry an FDA Boxed Warning nor any absolute indications. Pregnancy Class B: It does cross the placenta and may lead to fetal tachycardia however, it does not cause fetal abnormalities. Glucagon is the first line to treat beta-blockade-induced symptoms. The AHA has removed all indications for atropine in the pulseless patient.Ītropine is not indicated in beta-blocker-induced bradycardias or hypotension, though its use is unlikely to be harmful. Under current ACLS protocols, atropine is indicated for symptomatic bradycardia and not in a pulseless patient. It may potentiate barbiturates, alcohol, or tranquilizers, and therefore, its use requires caution. Subtherapeutic amounts of atropine are included in the dosage form to discourage diphenoxylate abuse. Post induction bradycardia is seen more commonly in the pediatric population due to the predominance of vagal response, even without the use of succinylcholine.Ītropine/diphenoxylate is an antimotility agent that can be useful in the treatment of diarrhea as second-line therapy by allowing the central acting opioid effect of diphenoxylate and capitalization on its anticholinergic side effect of constipation to slow motility. In the setting of post-intubation-related bradycardia, atropine is indicated. Rapid Sequence Intubation (RSI) PretreatmentĪlthough not recommended as a routine agent, atropine may be used 3 to 5 minutes before initiation of RSI to prevent bradycardia. If bradycardia persists despite adequate respiratory support, atropine is indicated. Pediatric bradycardia is rarely cardiac and often secondary to hypoxia and hypoventilation. However, transient improvements with repeat dosing are an indication to continue treatment with atropine (which may exceed standard cumulative dosing maximums). ![]() If there is no improvement in the clinical state after repeat doses of atropine, additional treatments with atropine are unlikely to be effective. The structural disease may or may not require resuscitation and should be closely monitored with medication and pacing readily available. Approximately 20% of bradydysrhythmias are due to endogenous cardiac electrical systems. Treatments for bradydysrhythmias are indicated when there is a structural disease of the infra-nodal system or if the heart rate is less than 50 beats/min with unstable vital signs. Pupils and heart rate are poor indications of appropriate dosing in these patients.Ītropine is the first-line therapy (Class IIa) for symptomatic bradycardia in the absence of reversible causes. Titrate to effect by monitoring the patient’s ability to clear excess secretions. Ingestions especially require higher doses (up to 20 mg). Large doses and repeat doses may be required. Intravenous (IV) atropine indications include patients with hypersalivation, bronchial secretions, or bradycardia. If there are local symptoms to the eyes or respiratory tract, atropine is not indicated. Atropine is only useful to counter muscarinic effects (pralidoxime and benzodiazepines act on the others). It is not formally recommended for routine use in controlled airways, though it can be used off-label for minimizing secretions in the intubated patient.Īcetylcholine works on three different receptors that merit attention in nerve agent poisonings. While atropine can be used independently for anti-salivation effects, it most commonly is secondary to anticholinergic or antimuscarinic poisoning, as discussed below. It was originally synthesized from the plant Atropa belladonna which is where the drug derives its name. Atropine or atropine sulfate carries FDA indications for anti-sialagogue/anti-vagal effect, organophosphate/muscarinic poisoning, and bradycardia. ![]()
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