Uses of Atropine – Dose & Routes

Uses of Atropine;

Important points:

1. Heart Rate less than 60 – Inj. Atropine 0.5 – 1 mg iv stat.
2. Complete Heart Block With Bradycardia – Iv Atropine 0.5 mg Stat
3. Antidote for organophosphates(OP) poisoning

• Side Effects :

1. Tachycardia
2. Dry Mouth
3. Urine Retention (Foleys Catheterization Important)
4. Agitation & Delirium

• Signs of Atropinazation:

1. Dilated Pupils
2. Dry mouth & Axillae
3. Tachycardia

Uses of Atropine:

1. Organophosphate Poisoning:

• Atropine emerges as a critical intervention in the management of organophosphate poisoning, where its competitive inhibition of muscarinic receptors proves invaluable. Administered intravenously, atropine swiftly counters toxic effects, particularly excessive secretions, hypersalivation, and bronchial secretions. In severe cases, escalating doses (up to 20 mg) may be warranted, with careful titration to control symptoms effectively.

2. Bradycardia:

• As the frontline therapy for symptomatic bradycardia, atropine plays a pivotal role in emergency settings. Intravenous administration of atropine bolsters cardiac output by counteracting vagal effects, offering rapid relief in critical scenarios. Precision dosing and vigilant monitoring are essential to optimize therapeutic outcomes.
• Atropine is use for bradycardia –
  • Sinus Bradycardia
  • AV Nodal Block
  • Hypoxia-Induced Bradycardia
  • Drug-Induced Bradycardia
  • Pediatric Bradycardia

3. Antisialogogue:

Though not formally recommended for routine use in controlled airways, atropine exhibits significant antisialagogue effects. Off-label application in minimizing secretions, particularly in intubated patients, underscores its utility in managing excessive salivation. While glycopyrrolate boasts superior potency, atropine remains a valuable adjunct in clinical practice.

Other Indications:

Beyond its primary applications, atropine finds utility in diverse medical scenarios:

1. Rapid Sequence Intubation (RSI) Pretreatment: In pediatric populations prone to vagal responses, atropine may be employed as a pretreatment strategy in RSI to mitigate post-intubation bradycardia.
2. Antispasmodic Agent: Atropine’s antimuscarinic properties extend to alleviating gastrointestinal spasms and hypermotility, making it valuable in conditions like irritable bowel syndrome and gastritis. Its role in mitigating gastrointestinal discomfort underscores its versatility in clinical practice.

Doses and Route of Administration:

Precise dosing and administration are crucial to optimize therapeutic outcomes:

1. Organophosphate Poisoning: Initial doses of 2 mg to 3 mg every 20 to 30 minutes, with potential escalation to higher doses (up to 20 mg) in severe cases, administered intravenously.
2. Bradycardia: Initial doses of 1 mg every 3 to 5 minutes, with a maximum cumulative dose of 3 mg for adults, administered intravenously. Pediatric dosing varies based on weight, with careful monitoring for efficacy.
3. Antisialogogue/Anti-vagal: 0.5 mg to 1 mg every 1 to 2 hours, administered intravenously for effective antisialagogue effects.

Side Effects:

While atropine offers therapeutic benefits, vigilance against potential adverse effects is paramount:

1. Antimuscarinic Effects:

• Xerostomia (dry mouth)
• Blurred vision
• Photophobia (sensitivity to light)
• Tachycardia (rapid heart rate)
• Flushing
• Hot skin

2. Gastrointestinal Disturbances:

• Constipation
• Difficulty with urination
• Anhidrosis (lack of sweating)

3. Central Nervous System Effects:

• Delirium
• Coma

4. Hypersensitivity Reactions:

• Skin rash
• Progression to exfoliation

Summary :

Atropine’s pivotal role in organophosphate poisoning underscores its status as a lifesaving medication. Its versatility extends beyond toxicological emergencies, encompassing critical interventions in bradycardia and antisialogogue therapy.

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