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Generic name for Atropine?
Atropine Sulfate
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Brand name for Atropine?
Atropine
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Class for Atropine?
- Parasympatholytic
- Anticholinergic
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Mechanism of Action for Atropine?
- Competitive antagonist to ACh at muscarinic receptor site
- Blocks parasypathetic response & allows sysmpathetic response to take over
- Heart
- Atrial effects
- Positive chronotrope
- Postive dromotrope
- Positive inotrope
- Slight effect
- Lungs
- Decreased mucous production
- Increased bronchial smooth muscle relaxation
- GI
- Decreased secretions
- Decreased motility
- Urinary
- Decreased bladder tone
- Other
- Pupil dilation
- Decreased sweat production
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Indications and field use for Atropine?
- Symptomatic Bradycardia
- Atrial mechanisms only
- Why?
- Blocks parasympathetic response increasing heart rate
- Acetylcholinesterase inhibitor poisoning
- Organophosphate poisoning
- Nerve agent poisoning
- Cholinergic posoning
- Why?
- Blocks the muscarinic receptors reducing the effects of ACh
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Dosage for Atropine?
All Dosages are IV Push or ETT - FAST
Adult
- Symptomatic Bradycardia
- Atrial mechanisms only
- Atropine 0.5mg IV Push - q 5 min - max 0.04mg/kg
- Acetylcholinestrase inhibitor poisoning
- Cholinergic poisoning
- Atropine 2.0 - 5.0 mg IV Push - q 5 min - until symptoms resolved
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Contraindications for Atropine?
- Allergy
- Wide complex 2nd Degree type II heart block
- 3rd degree heart block
- Acute narrow angle glaucoma
- Painful glaucoma probably narrow type
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Drug interactions for Atropine?
Sodium bicarbonate
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Side effects for Atropine?
- Dysrhythmias
- Angina / AMI
- Hyperthermia
- Agitation / Delirium
- Acute narrow angle glaucoma
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Onset of action for Atropine?
1 minute
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AZ Drug box supply for Atropine?
- 4 x Atropine 1mg in 10cc prefilled syringe
- 1 x Atropine 8mg in 20cc multidose vial
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Generic name for Dopamine?
Dopamine
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Brand name for Dopamine?
Intropin
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Class for Dopamine?
- Dopamine agonist
- Sympathomimetic
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Mechanism of Action for Dopamine?
MOA depends upon dosage
- Dopamine dose 1-2mcg/kg/min
- Activates dopamine receptors causing cerebral, renal, mesenteric vasodilation
- May increase urine output
- May drop BP
- Beta-1 Dose 2-10mcg/kg/min
- Activates Beta-1 receptors stimulates heart increasing cardiac output & BP
- Postive inotrope
- Positive chronotrope
- Postivite dropmotrope
- Alpha-1 dose 10-20mcg/kg/min
- Activates Alpha-1 receptors causing renal, mesenteric, & peripheral vasoconstriction
- Increases PVR increases BP
- Increased Preload
- >20mcg/kg/min similar to norepi with massive vasoconstriction
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Indications and field use for Dopamine?
- Hypotension without fluid loss
- Symptomatic bradycardia with hypotension
- Cardiogenic shock
- Septic shock
- Neurogenic shock
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Dosage for Dopamine?
All doses via IV infusion
- Add 400mcg to 250cc NS bag giving 1600mcg/cc
- Symptomatic bradycardia with hypostension &/or non-hypovolemic shock
- Dopamine 5mcg/kg/min initial infusion, increase if no repsonse
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Contraindication for Dopamine?
- Hypovolemic shock
- Pheochromocytoma (tumor of the adrenal gland)
- MAOI's
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Drug interactions for Dopamine?
- Incompatible with alkaline drugs/solutions
- MAOI use will cause hypertensive crisis
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Side effects for Dopamine?
- Dysrhthmias
- Hypertension
- Hypotension at dopamine dosage
- Chest pain
- Nausea/vomiting
- Renal failure at higher dosage
- Tissue necrosis if extravasation (notify hospital)
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Onset of action for Dopamine?
Immediate
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AZ Drug Box Supply for Dopamine?
- 2 x Dopamine 400mg in 5cc vial
- 2 x Dopamine 400mg in 250cc D5W premixed IV solution
- Note: Never run "wide open", always calculate dosage and drip rate
- Effects stop when infusion stops
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