Atropine

Indications

  • Sinus Bradycardia (see Sinus Bradycardia, [[Sinus Bradycardia]])

  • Asystole (see Advanced Cardiac Life Support, [[Advanced Cardiac Life Support]]): atropine may be beneficial

    • Second Degree Atrioventricular Block-Mobitz Type II (see Second Degree Atrioventricular Block-Mobitz Type II, [[Second Degree Atrioventricular Block-Mobitz Type II]]: atropine is not effective (may slow heart rate)

      • Atropine-induced increase in SA nodal firing will be partially blocked and not be conducted to ventricle
    • Organophosphate Intoxication (see Organophosphates, [[Organophosphates]]): larger atropine doses may be required

    • Third Degree Atrioventricular Block/Complete Heart Block (see Third Degree Atrioventricular Block, [[Third Degree Atrioventricular Block]]): atropine is not effective (may slow heart rate)

      • Atropine-induced increase in sino-atrial nodal firing will be completely blocked and not be conducted to ventricle
  • Cholinergic Intoxication


Contraindications

  • Bradycardia in Heart Transplant Patient: atropine is ineffective, as heart transplants lack vagal innervation
  • Bradycardia Associated with Hypothermia (see Hypothermia, [[Hypothermia]]): it is recommended to avoid atropine

Pharmacology

  • Anti-Cholinergic: vagolytic (inhibits vagal effect)-> increases sino-atrial (SA) nodal firing (with minimal effect at the atrio-ventricular/AV node)

Clinical Efficacy

  • xxxx

Metabolism

  • xxxx

Administration

  • IV (During ACLS): 0.5-1 mg IV q3-5 min (Max: 3 mg IV)
    • Doses <0.5 mg IV may paradoxically slow heart rate
  • IV (Organophosphate Intoxication) (see Organophosphates, [[Organophosphates]]): larger doses (2-4 mg IV) may be required
  • ETT (During ACLS): 2 mg in 10 ml normal saline

Dose Adjustment

  • Hepatic
  • Renal

Adverse Effects

Cardiovascular Adverse Effects

  • Increased Myocardial Oxygen Consumption: cautious use in the setting of myocardial ischemia/infarction
  • Sinus Tachycardia (see Sinus Tachycardia, [[Sinus Tachycardia]])

Other Adverse Effects

  • xxx
  • xxx
  • xxx

References

  • xxx