Browse the corpus

Atropine is an anticholinergic agent that functions as a competitive, reversible antagonist of muscarinic receptors. This educational activity presents a detailed review of atropine's mechanism of action, FDA-approved indications, and off-label applications relevant to current clinical practice. Therapeutic uses include management of organophosphate poisoning, symptomatic bradycardia, and reduction of vagal tone or secretions during procedural care. Adverse drug reactions, contraindications, and warnings are addressed to support safe and effective use. This activity emphasizes appropriate administration techniques, drug-drug interactions, and key monitoring parameters. Special attention is given to atropine administration in emergency cardiac care, toxicologic interventions, and ophthalmic procedures. Individualized treatment planning and dosing considerations are emphasized to minimize risk and maximize therapeutic outcomes. Emphasis is placed on interprofessional collaboration to ensure accurate assessment and targeted intervention in diverse care settings. Objectives: Evaluate the mechanism of action of atropine. Assess the potential adverse effects associated with atropine administration. Identify the indications for atropine administration. Implement effective collaboration and communication among interprofessional team members to improve outcomes and treatment efficacy for patients who might benefit from atropine therapy. Access free multiple choice questions on this topic.

Signs and Symptoms of Overdose An overdose can lead to increased antimuscarinic adverse effects of dilated pupils, warm, dry skin, tachycardia, tremor, ataxia, delirium, and coma. In extreme toxicity, circulatory collapse secondary to respiratory failure may occur after paralysis and coma. Ten milligrams or less may be fatal to a child, while there is no known adult lethal dose. All Datura plant species have endogenous atropine and other assorted anticholinergic alkaloids. These include Jimson weed and angel’s trumpet, typically seen in warm or temperate climate areas. These patients may have ingested it accidentally, intentionally smoked it, or ingested it for recreation (hallucinations). While treatment for ingestions is similar to other toxic overdoses of anticholinergics, whole-bowel irrigation is recommended after a large quantity of seed ingestion. Clinicians need to avoid using phenothiazines in these patients. Central anticholinergic syndrome (CAS) has been described due to systemic absorption of ocular atropine. The clinical features are psychomotor agitation, acute psychosis, hallucinations, and mydriasis.[17][24] Management of Overdose Physostigmine is the basis of reversal. Treatment of overdose includes a short-acting barbiturate or diazepam as needed for convulsions or excitement. Avoid dosing for sedation as it can cause respiratory collapse. Physostigmine is useful as an antidote to treat delirium and coma. Repeat doses may be necessary, as physostigmine has a relatively short half-life. Monitor respiratory effort and supplement as needed.[31][32] Compressing the internal corner of the eye after administration and wiping off excess drops can help decrease systemic effects. Physostigmine should be administered for the central anticholinergic syndrome.[24]

Indications for atropine are limited, but this alkaloid is lifesaving. All interprofessional healthcare team members should be aware of how to administer atropine, including the correct dose and method of administration. Clinicians can use this drug in patients with bradycardia and poisoning from cholinergic agents; atropine can immediately reverse the slow heart rate and reduce mortality. Nursing staff should always ensure that atropine is available in the cardiac arrest cart. More importantly, a syringe and needle should also be available as the drug can only be administered parenterally. Similarly, nurse anesthetists should ensure that atropine is available in the operating room at all times. On almost every cardiology and cardiac surgery floor, atropine may be necessary, so it should be readily available. Ophthalmologists should employ strategies to minimize systemic absorption. Emergency medicine should stabilize patients who are experiencing atropine toxicity or overdose. The pharmacist is the team member responsible for ensuring that stock supplies of atropine are available in each department, verifying dosing, and performing medication reconciliation to identify potential drug-drug interactions.[33][34] Outcomes Atropine is a beneficial drug for reversing bradycardia from many causes. This medication takes effect immediately and is generally considered safe when used at therapeutic doses. There are countless reports on the number of lives saved through the use of atropine in patients with bradycardia or organophosphate poisoning.[35][36]