Names and pronunciation
(a′troe-peen) Atro-Pen
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Individual generic drug information
Extracted information for atropine only.
(a′troe-peen) Atro-Pen
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Func. class.: Antidysrhythmic, anticholinergic parasympatholytic, antimuscarinic
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Chem. class.: Belladonna alkaloid
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ACTION: Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus
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USES: Bradycardia <40-50 bpm, brady- dysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking car- diac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU, bili- ary surgery, bronchodilator, AV heart block
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Unlabeled uses: Stress endocardiopathy
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Extracted information for atropine only.
CONTRAINDICATIONS: Hyper- sensitivity to belladonna alkaloids, closed- angle glaucoma, GI obstructions, myasthe- nia gravis, thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia/ tachydysrhythmias, asthma, acute hemor- A rhage, severe hepatic disease, myocardial ischemia, paralytic ileus Precautions: Pregnancy, breastfeeding, children <6 yr, geriatric patients, renal disease, HF, hyperthyroidism, COPD, hyper- tension, intraabdominal infection, Down syndrome, spastic paralysis, gastric ulcer
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SIDE EFFECTS CNS: Headache, dizziness, involuntary movement, confusion, flushing, drowsiness CV: Tachycardia, bradycardia EENT: Blurred vision, photophobia, dry eyes GI: Dry mouth, constipation RESP: Tachypnea, pulmonary edema GU: Retention, hesitancy, impotence INTEG: Flushing, decreased sweating
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INTERACTIONS Increase: mucosal lesions—potassium chloride tablet; avoid concurrent use Increase: anticholinergic effects—tricy- clics, amantadine, antiparkinson agents, phenothiazines, antidysrhythmics Increase: altered response—β-blockers Decrease: absorption—ketoconazole, levodopa Decrease: effect of atropine—antacids
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TREATMENT OF OVERDOSE: O2, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazePAM or thiopental for seizures; assess need for antidysrhythmics See Appendix B
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Extracted information for atropine only.
DOSAGE AND ROUTES Symptomatic bradycardia • Adult: IV BOLUS 0.5-1 mg given q3- 5min, max 3 mg • Child: IV BOLUS 0.02 mg/kg, may repeat ×1; max single dose 0.5 mg, max total dose 1 mg Bradysystolic arrest Adult: IV 1 mg q3-5min, max total dose 3 mg Organophosphate/carbamate/nerve agent poisoning • Adult and child: IM/IV 1-2 mg q20- 30min until muscarinic symptoms disap- pear; may need 6 mg every hr • Adult and child >90 lb, usually >10 yr: AtroPen 2 mg • Child 40-90 lb, usually 4-10 yr: Atro- Pen 1 mg • Child 15-40 lb: AtroPen 0.5 mg • Infant <15 lb: IM/IV 0.05 mg/kg q5- 20min as needed Presurgery • Adult and child >20 kg: SUBCUT/IM/ IV 0.4-0.6 mg 30-60 min before anesthe- sia • Child <20 kg: IM/SUBCUT 0.01 mg/ kg up to 0.4 mg, ½-1 hr preop, max 0.6 mg/dose Stress endocardiography (unlabeled) Adult: IV 0.25-0.5 up to a total dose of 1-2 mg until 85% of target HR is achieved
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Available forms: Injection 0.05, 0.1, 0.4, 0.8, 1 mg/mL; AtroPen 0.25, 0.5, 1, 2 mg/0.7 mL Injection prefilled autoinjectors
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Administer: IM route • Atropine flush may occur in children and is not harmful, usually 15-20 min after use AtroPen • Use no more than 3 AtroPen injections unless under the supervision of trained medical provider • Use as soon as symptoms appear (tearing, wheezing, muscle fascicula- tions, excessive oral secretions), may use through clothing IV route • Undiluted or diluted with 10 mL ster- ile water; give at 0.6 mg/min through Y- tube or 3-way stopcock; do not add to IV solution; may cause paradoxical brady- cardia for 2 min Y-site compatibilities: Amrinone, etomi- date, famotidine, heparin, hydrocortisone, meropenem, nafcillin, potassium chlo- ride, SUFentanil, vitamin B/C Endotracheal route • Dilute with 5-10 mL of 0.9% NaCl, inject into endotracheal tube, then posi- tive pressure ventilation
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Extracted information for atropine only.
Assess: • I&O ratio; check for urinary retention, daily output • VS during treatment, ECG for ectopic ventricular beats, PVC, tachycardia in cardiac patients • For bowel sounds, constipation, ab- dominal distention, if constipation oc- curs add fluids, bulk in diet • Beers: avoid in older adults; highly anticholinergic, high risk of delirium, in men decreased urinary flow
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Evaluate: • Therapeutic response: decreased dys- rhythmias, increased heart rate, secre- tions; GI, GU spasms; bronchodilation
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To report blurred vision, chest pain, al- lergic reactions, constipation, urinary re- tention; to use sunglasses to protect the eyes • Not to perform strenuous activity in high temperatures; heat stroke may result • To take as prescribed; not to skip or double doses • Not to operate machinery if drowsi- ness occurs • Not to take OTC products, herbals, sup- plements without approval of prescriber • Not to freeze or expose to light (Atro- Pen) • To use sunglasses for photophobia • Pregnancy/breastfeeding: identify if pregnant or if breastfeeding; use only if benefits outweigh fetal risk
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Extracted information for atropine only.
PHARMACOKINETICS Half-life 4-5 hr, excreted by kidneys unchanged (50%), metabolized in liver, crosses placenta, excreted in breast milk IM/SUBCUT: Onset 15-50 min, peak 30 min, duration 4-6 hr, well absorbed IV: Peak 2-4 min, duration 4-6 hr
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Filter the extracted dose blocks for this individual drug.
Symptomatic bradycardia
• Adult: IV BOLUS 0.5-1 mg given q3- 5min, max 3 mg
Candidate age grouping · source page 127
Symptomatic bradycardia
• Adult and child: IM/IV 1-2 mg q20- 30min until muscarinic symptoms disap- pear; may need 6 mg every hr
Candidate age grouping · source page 127
Symptomatic bradycardia
• Adult and child >90 lb, usually >10 yr: AtroPen 2 mg
Candidate age grouping · source page 127
Symptomatic bradycardia
• Adult and child >20 kg: SUBCUT/IM/ IV 0.4-0.6 mg 30-60 min before anesthe- sia
Candidate age grouping · source page 127