ATROPINE SULFATE

1. Therapeutic Effects
   1. By blocking parasympathetic (vagal) action on the heart, atropine increases the rate of discharge by the sinus node. Enhances conduction through the atrioventricular (AV) junction. Accelerates the heart rate, therby improving cardiac output. In addition, by speeding up a slow heart to a normal rate, atropine reduces the chances of ectopic activity in the ventricles and thus of ventricular fibrillation. Atropine is most effective in reversing bradycardia due to increased parasympathetic tone, morphine, or organophosphates; it is less effective in treating bradycardias due to actual damage to the AV or sinoatrial (SA) node.

2. Indications
   1. Sinus Bradycardia when patient is symptomatic.
   2. Second and Third-Degree Heart Block when accompanied by bradycardia.
   3. Asystole
   4. As an antidote in Organophosphate Poisoning.

3. Contraindications
   1. None when used for life-threatening emergencies. Use with caution in patient's with:
      1. Atrial flutter or Atrial fibrillation when there is a rapid ventricular response
      2. Glaucoma
      3. Chronic Obstructive Pulmonary Disease

4. Side Effects
   1. The patient should be warned that he or she may experience some of the following side effects and that these side effects are part of the drug's usual and expected actions:
      1. Blurred vision, headache, pupillary dilation
      2. Dry mouth, thirst
      3. Flushing of the skin
      4. Difficulty in urination
      5. Paradoxical bradycardia may occur if a dose less than 0.5 mg is given or if even the correct dose is given too slowly.

5. Administration and Dosage
   1. For bradycardia: 0.5mg IV, repeated at 5-minute intervals until desired heart rate is achieved; the total dose should not, however exceed 0.04mg/kg.
   2. For Asystole: 1 mg IV, repeated in 5 minutes if asystole persists up to 0.04mg/kg.
   3. For organophosphate poisoning: 2 mg IM and 1 mg IV. The IV dose may be repeated every 5-10 minutes as needed, until a decrease in secretions is observed.