Atropine

Provider Level

AEMT/RN/Paramedic

Class

Anticholinergic, parasympatholytic

Mechanism of Action

Competitively blocks the effects of acetylcholine at muscarinic receptors, increasing heart rate and conduction through the AV node, and reducing parasympathetic secretions.

Indications

Hemodynamically significant symptomatic bradycardia, organophosphate or nerve agent poisoning.

Contraindications

Tachycardia, hypersensitivity, narrow-angle glaucoma, hypothermic bradycardia.

Routes

IV, IO, IM, ET

Onset / Duration

Onset: rapid. Duration: 2 to 6 hours.

Adverse Effects

Tachycardia, dry mouth, blurred vision, dilated pupils, urinary retention, confusion, flushed skin.

Precautions & Interactions

Use with caution in myocardial ischemia and hypoxia since it increases myocardial oxygen demand. Paradoxical bradycardia may occur with small doses or slow administration.

Special Considerations

Authorized for AEMT, RN, and Paramedic. May be ineffective for second-degree type II and third-degree heart blocks. Not effective in heart transplant patients due to lack of vagal innervation.