Atrop|ne ALroen

CLASSIIICA1ICN
1herapeuLlc anLlarryLhmlcs harmacologlc
anLlchollnerglcs anLlmuscarlnlcs
DLSCkI1ICN
8locks vagal lmpulses Lo Lhe hearL whlch decreases Av conducLlon lncreases hearL raLe lncreases cardlac
ouLpuL anLlsecreLory acLlon suppresses sweaLlng lacrlmlnaLlon sallvaLlon and secreLlons from Lhe nose
mouLh pharynx and bronchl roduces mydrlasls (dllaLlon of puplls) and cycloplegla (paralysls of
accommodaLlon) by blocklng Lhe lrls sphlncLer muscle and clllary muscle
INDICA1ICNS
1reaLmenL of nerve agenL exposure Cardlac arrhyLhmla's (PearL 8locks 8radycardla ArresL) reoperaLlvely
Lo decrease oral and gasLrlc secreLlons ophLhalmlc Lo dllaLe eyes oral lnhalaLlon for shorL LreaLmenL and
prevenLlon of bronchospasms assoclaLed wlLh asLhma bronchlLls CCu and as a drylng agenL for upper
resplraLory lnfecLlons
ADMINIS1kA1ICN
lM preoperaLlvely Lo decrease oral and resplraLory secreLlons lv
LreaLmenL of slnus bradycardla and hearL block C
Ad[uncLlve Lherapy ln managemenL of pepLlc ulcer and l8S lv 8eversal
of adverse muscanrlnlc effecLs of anLlchollnersLerase agenLs / polsonlng lnhaln LreaLmenL of
bronchospasms
SIDL LIILC1S
llushlng of face drowslness confuslon hyperpyrexla blurred vlslonLachycardla dry mouLh consLlpaLlon
lmpalred Cl moLlllLy urlnary heslsLancyreLenLlon lmpoLency Lachypenea pulmonary edeama
CCN1kAINDICA1ICNS
AcuLe hemorrhage hypersenslLlvlLy Lo belladonna alkalolds bladder neck obsLrucLlon dlseases of Lhe Cl
Lrack severe ulceraLlve collLls Lachycardla secondary Lo cardlac lnsufflclency
kLCAU1ICNS Myocardlal lnfarcLlon hyperLenslon hypoLenslon coronary arLery dlsease CPl
LachyarrhyLhmlas gasLrlc ulcers Cl lnfecLlons hyperLhyroldlsm chronlc lung dlsease hepaLlc or renal
dlsease May cause heaL ln[urles ln hoL dry cllmaLes
DCSAGL ] kCU1L
nerve AgenL AuLoln[ecLors of 2mg for lM use re C 04mg 06mg lM Cardlac 03
1mg lv push (max 2mg) CphLhalmlc 1gLL of 1 soluLlon

Lp|nephr|ne
DLSCkI1ICN sLerlle soluLlon lnLended for subcuLaneous or lnLramuscular ln[ecLlon When dlluLed lL may
also be admlnlsLered lnLracardlally or lnLravenously lL may also be admlnlsLered lnLrasplnally by addlng Lo
anesLheLlc splnal fluld mlxLure Lach mllllllLer conLalns 1 mg Adrenalln (eplnephrlne) as Lhe hydrochlorlde
dlssolved ln WaLer for ln[ecLlon uS wlLh sodlum chlorlde added for lsoLonlclLy
1 mL V|a| ConLalns noL more Lhan 01 sodlum blsulflLe as an anLloxldanL and Lhe alr ln Lhe vlal has been
dlsplaced by nlLrogen 30 mL V|a|
ConLalns 03ChlorobuLanol (chloroform derlvaLlve) as a preservaLlve and noL more Lhan 013 sodlum
blsulflLe as an anLloxldanL Lplnephrlne ls Lhe acLlve
prlnclple of Lhe adrenal medulla chemlcally descrlbed as ()34ulhydroxy(meLhylamlno) meLhyl benzyl
alcohol and has Lhe followlng sLrucLural formula
SIDL LIILC1S 8efore uslng eplnephrlne a second Llme Lell your docLor lf your flrsL ln[ecLlon caused a serlous
slde effecL such as lncreased breaLhlng dlfflculLy or dangerously hlgh blood pressure (severe headache
blurred vlslon buzzlng ln your ears anxleLy confuslon chesL paln shorLness of breaLh uneven hearLbeaLs
selzure)Less serlous slde effecLs may lnclude lasL poundlng or uneven heaLbeaLs sweaLlng nausea and
vomlLlng pale skln dlzzlness weakness or Lremors
INDICA1ICNS
ln general Lhe mosL common uses of eplnephrlne are Lo relleve resplraLory dlsLress due Lo bronchospasm Lo
provlde rapld rellef of hypersenslLlvlLy reacLlons Lo drugs and oLher allergens and Lo prolong Lhe acLlon of
lnfllLraLlon anesLheLlcs lLs cardlac effecLs may be of use ln resLorlng cardlac rhyLhm ln cardlac arresL due Lo
varlous causes buL lL ls noL used ln cardlac fallure or ln hemorrhaglc LraumaLlc or cardlogenlc shock
Lplnephrlne ls used as a hemosLaLlc agenL lL ls also used ln LreaLlng mucosal congesLlon of hay fever rhlnlLls
and acuLe slnuslLls Lo relleve bronchlal asLhmaLlc paroxysms ln syncope due Lo compleLe hearL block or
caroLld slnus hypersenslLlvlLy for sympLomaLlc rellef of serum slckness urLlcarla angloneuroLlc edema for
resusclLaLlon ln cardlac arresL followlng anesLheLlc accldenLs ln slmple (open angle) glaucoma for relaxaLlon
of uLerlne musculaLure and Lo lnhlblL uLerlne conLracLlons Lplnephrlne ln[ecLlon can be uLlllzed Lo prolong
Lhe acLlon of lnLrasplnal and local anesLheLlcs
DCSAGL AND ADMINIS1kA1ICN arenLeral drug producLs should be lnspecLed vlsually for parLlculaLe
maLLer and dlscoloraLlon whenever soluLlon and conLalner permlL vlal and conLenLs musL be dlscarded 30
days afLer lnlLlal use
5ubcutoneous/y or intromuscu/or/y 02 to 1 ml (mq) 5tott wltb o smoll Jose ooJ locteose lf tepolteJ
noLe 1he subcuLaneous ls Lhe preferred rouLe lf glven lM ln[ecLlon lnLo Lhe buLLocks should be avolded
lor bronchlal asLhma and cerLaln allerglc manlfesLaLlons eg angloedema urLlcarla serum slckness
anaphylacLlc shock use eplnephrlne subcuLaneously lor bronchlal asLhma ln pedlaLrlc paLlenLs admlnlsLer
001 mg/kg or 03 mg/m Lo a maxlmum of 03 mg subcuLaneously repeaLed every four hours lf requlred
or cordioc resuscitotion A dose of 03 mL (03 mg) dlluLed Lo 10 mL wlLh sodlum chlorlde ln[ecLlon can be
admlnlsLered lnLravenously or lnLracardlally Lo resLore myocardlal conLracLlllLy LxLernal cardlac massage
should follow lnLracardlal admlnlsLraLlon Lo permlL Lhe drug Lo enLer coronary clrculaLlon 1he drug should be
used secondarlly Lo unsuccessful aLLempLs wlLh physlcal or elecLromechanlcal meLhods
Cphtho/mo/oqic use {for producinq conjunctivo/ deconqestion to contro/ hemorrhoqe produce mydriosis
ond reduce introocu/or pressure) use a concenLraLlon of 110000 (01 mg/mL) Lo 11000 (1 mg/mL)
lntrospino/ use usual dose ls 02 Lo 04 mL (02 Lo 04 mg) added Lo anesLheLlc splnal fluld mlxLure (may
prolong anesLheLlc acLlon by llmlLlng absorpLlon) lor use wlLh local anesLheLlcLplnephrlne 1100000 (001
mg/mL) Lo 120000 (003 mg/mL) ls Lhe usual concenLraLlon employed wlLh local anesLheLlcs
SIDL LIILC1S 1ranslenL and mlnor slde effecLs of anxleLy headache fear and palplLaLlons ofLen occur wlLh
LherapeuLlc doses especlally ln hyperLhyrold lndlvlduals 8epeaLed local ln[ecLlons can resulL ln necrosls aL
slLes of ln[ecLlon from vascular consLrlcLlon LplnephrlnefasLness" can occur wlLh prolonged use
DkUG IN1LkAC1ICNS use of eplnephrlne wlLh excesslve doses of dlglLalls mercurlal dlureLlcs or oLher
drugs LhaL senslLlze Lhe hearL Lo arrhyLhmlas ls noL recommended Anglnal paln may be lnduced when
coronary lnsufflclency ls presenL
1he effecLs of eplnephrlne may be poLenLlaLed by Lrlcycllc anLldepressanLs cerLaln anLlhlsLamlnes eg
dlphenhydramlne Lrlpelennamlne dchlorphenlramlne and sodlum lLhyroxlne
WAkNINGS AdmlnlsLer wlLh cauLlon Lo elderly people Lo Lhose wlLh cardlovascular dlsease hyperLenslon
dlabeLes or hyperLhyroldlsm ln psychoneuroLlc lndlvlduals and ln pregnancy
aLlenLs wlLh longsLandlng bronchlal asLhma and emphysema who have developed degeneraLlve hearL
dlsease should be admlnlsLered Lhe drug wlLh exLreme cauLlonCverdosage or lnadverLenL lnLravenous
ln[ecLlon of eplnephrlne may cause cerebrovascular hemorrhage resulLlng from Lhe sharp rlse ln blood
pressureLplnephrlne ls Lhe preferred LreaLmenL for serlous allerglc or oLher emergency slLuaLlons even
Lhough Lhls producL conLalns sodlum blsulflLe a sulflLe LhaL may ln oLher producLs cause allerglcLype
reacLlons lncludlng anaphylacLlc sympLoms or llfeLhreaLenlng or less severe asLhmaLlc eplsodes ln cerLaln
suscepLlble persons
kLCAU1ICNS Genera| Jteoollo (eploepbtloe lojectloo u5l) sboolJ be ptotecteJ ftom exposote to llqbt
1be solotloo sboolJ oot be oseJ lf lt ls ploklsb ot Jotket tboo sllqbtly yellow ot lf lt cootolos o pteclpltote
Lplnephrlne ls readlly desLroyed by alkalles and oxldlzlng agenLs ln Lhe laLLer caLegory are oxygen chlorlne
bromlne lodlne permanganaLes chromaLes nlLrlLes and salLs of easlly reduclble meLals especlally lron
regnancy CaLegory C 4dreno/in {epinephrine) hos been shown to be terotoqenic in rots when qiven in
doses obout 25 times the humon dose 1here ore no odequote ond we//contro//ed studies in preqnont
women 4dreno/in {epinephrine) shou/d be used durinq preqnoncy on/y if the potentio/ benefit justifies the
potentio/ risk to the fetus
CCN1kAINDICA1ICNS ploepbtloe ls coottoloJlcoteJ lo oottow ooqle (cooqestlve) qloocomo sbock Jotloq
qeoetol ooestbeslo wltb boloqeooteJ byJtocotboos ot cycloptopooe ooJ lo loJlvlJools wltb otqoolc btolo
Jomoqe ploepbtloe ls olso coottoloJlcoteJ wltb locol ooestbeslo of cettolo oteos eq floqets toes becoose
of tbe Jooqet of vosocoosttlctloo ptoJocloq slooqbloq of tlssoe lo lobot becoose lt moy Jeloy tbe secooJ
stoqe lo cotJloc Jllototloo ooJ cotoooty losofflcleocy