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Parasympatholytic (inhibits stimulation from the parasympathetic nervous system).
Vagolytic (inhibits stimulation from the vagus nerve).
Inhibits vagal stimulation - allowing the sympathetic nervous system to dominate.
By allowing the sympathetic nervous system to dominate, impulse generation at the SA node and conduction through the AV node
Onset - 2 to 4 minutes
Peak - 2 to 4 minutes
Half-life - 13 to 40 hours
Duration - 4 to 6 hours
Restoration of cardiac rate in the presence of bradydysrhythmia.
Sinus bradycardia, less than 50 bpm - accompanied by hemodynamic compromise.
Acceptable, but controversial, in the setting of bradydysrhythmia secondary to AV blocks.
Treatment of organophosphate exposure/ingestion (high dose).
Antidote for poisoning by certain species of mushrooms (e.g. Amanita muscaria).
Hypersensitivity to anticholinergics
Hepatic or renal insufficiency
COPD - dries secretions/mucous plugging
Drug to Drug
Antimuscurinic effects will be increased in patients taking Dysopyramide.
0.6 mg IV push - initial dose
0.04 mg/kg (~3 mg for most adults) = maximum (“full vagolytic”) dose.
0.02 mg/kg (give no less than 0.1 mg)
Maximum or “full vagolytic” dose is 0.04mg/kg
Must be given in the correct dose and quickly - given in too low of a dose or too slowly may paradoxically slow the heart rate.
Considered controversial in the setting of 2nd degree type II AV block. It may paradoxically slow the heart rate if the block is infranodal.
Not likely to be effective in ventricular escape rhythms as there is minimal parasympathetic innervation in the ventricles.
Atropine also causes pupil dilation, therefore, assessment of pupils in the setting of asystole or PEA after Atropine has been administered may be unreliable.