Adult Dosing & Uses Dosing Forms & Strengths injectable solution 0.05mg/mL 0.1mg/mL 0.4mg/mL 0.5mg/mL 0.

8mg/mL 1mg/mL Anesthesia Premedication 0.4-0.6 mg IV/IM/SC 30-60 minutes before anesthesia; repeat q4-6hr PRN Sinus Bradycardia (ACLS) 0.5-1 mg or 0.04 mg/kg IV q5min, no more than 3 mg ET: Some experts suggest 2-2.5x IV dose diluted in 5-10 mL sterile water for inj ection/NS (sterile water for injection may facilitate absorption better than NS, but may produce more negative effect on arterial oxygen pressure) Bronchospasm 0.025 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose Asystole/Pulseless Electrical Activity (ACLS) 1 mg IV q3-5min PRN if asystole persist up to 0.04 mg/kg Cholinesterase Inhibitors (Organophosphates, Carbamates) AtroPen: 2 mg/dose IM Mild symptoms: 1 AtroPen If severe symptoms develop (eg, strange or confused behavior, wheezing, sialorrh ea, muscle fasciculations, involuntary urination/defecation, convulsion, unconsc iousness) give 2 additional AtroPen injections in rapid succession 10 minutes af ter initial dose Initial severe symptoms: give 3 AtroPen doses in rapid succession Other Indications & Uses General anesthesia, seizures with epilepsy, GI radiography Off-label: cerebral hypoxia, cerebral ischemia, AMI Pediatric Dosing & Uses Dosing Forms & Strengths injectable solution 0.05mg/mL 0.1mg/mL 0.4mg/mL 0.5mg/mL 0.8mg/mL 1mg/mL Anesthesia Premedication <5 kg: 0.02 mg/kg/dose 30-60 minutes preop; then q4-6hr PRN >5 kg: 0.01-0.02 mg/kg IV/IM/SC; no more than 0.4 mg Sinus Bradycardia 0.02 mg/kg IV/IO q5min x2-3 doses PRN; single dose no less than: 0.1 no more tha n 0.5 mg (children), 1 mg (adolescents) Total: No more than: 1 mg (children), 2 mg (adolescents)

ET: Some experts suggest 0.03 mg/kg, diluted in NS Bronchospasm 0.025-0.05 mg/kg in 2.5 mL NS q6-8hr via nebulizer; no more than 2.5 mg/dose Organophosphate or Carbamate Poisoning IV: 0.03-0.05 mg/kg IV/IM/IO/ET q10-20min PRN to effect; then q1-4hr for at leas t 24 hours IM (AtroPen): Mild symptoms: 1 AtroPen (see specific dose for weight below) If severe symptoms develop (eg, strange or confused behavior, wheezing, sialorrh ea, muscle fasciculations, involuntary urination/defecation, convulsion, unconsc iousness) give 2 additional AtroPen injections in rapid succession 10 minutes af ter initial dose Severe symptoms 3 AtroPen doses in rapid succession >41 kg: 2 mg/dose IM 18-41 kg: 1 mg/dose IM 6.8-18 kg: 0.5 mg/dose IM <6.8 kg: AtroPen formulation not recommended; administer atropine 0.05 mg/kg Bra dyarrhythmias Adverse Effects Frequency Not Defined Anticholinergic symptoms (mydriasis, hyperthermia, tachycardia, cardiac arrhythm ia, delayed gastric emptying) Dry mouth Dry skin Blurred vision Cycloplegia Photophobia Anhidrosis Palpitation Xerophthalmia Constipation May increase IOP in predisposed pts May cause CNS disturbances (especially in pediatric pts) Contraindications & Cautions Contraindications No absolute contraindications for ACLS Ineffective in hypothermic bradycardia Narrow-angle glaucoma, GI obstruction, severe ulcerative colitis, toxic megacolo n, bladder outlet obstruction, myasthenia gravis, hemorrhage w/ cardiovascular i

nstability, thyrotoxicosis Cautions Hepatic/renal impairment, BPH, CHF, tachyarrhythmias, toxin-mediated diarrhea, h yperthyroidism, Down syndrome, brain damage in children, salivary secretion d/o, urinary retention, hiatal hernia, reflux esophagitis, PUD, pregnancy (IV admin may produce tachycardia in fetusz Pregnancy & Lactation Pregnancy Category: C Lactation: trace amounts enter breast milk; use with caution (AAP Committee stat es "compatible with nursing") Pharmacology Half-Life: 2-3 hr Peak Plasma Time: 30 min (IM); 1.5-4 hr (oral inhalation) Bronchodilation: within 15 min; max within 15 min-1.5 hr (oral inhalation) Protein Bound: 18% to serum albumin Absorption: principally from the upper small intestine Metabolites: tropic acid, tropine, & possibly esters of tropic acid and glucuron ide conjugates Metabolism: hepatic Excretion: urine (77-94%); small amounts may also be eliminated in expired air a s carbon dioxide & in feces Inhibits: salivation, tracheobronchial secretions, bradycardia, hypotension Blocks adverse muscarinic effects that accompany neostigmine or pyridostigmine r eversal of neuromuscular blockade Mechanism of Action Competitively inhibits action of ACh on autonomic effectors innervated by postga nglionic nerves Antimuscarinic agent