Atropine precautions

General supportive care should be provided as outlined above. Extra precautions should be taken to ensure that rescuers and health care providers are not poisoned by exposure to contaminated clothing or skin. This is especially critical for the most potent substances such as parathion or nerve gas agents. Antidotal treatment consists of atropine and pralidoxime (see Table 58-4). Atropine is an effective competitive inhibitor at muscarinic sites but has no effect at nicotinic sites. Pralidoxime given early enough is capable of restoring the cholinesterase activity and is active at both muscarinic and nicotinic sites. 

Clearly all experiments performed with the nerve gas, diisopropyl fluorophosphate (DFP), must be done in a fume hood with the utmost care. DFP rapidly hydrolyzes in 1 N NaOH, so that all glassware which comes in contact with the nerve gas should be soaked in this alkaline solution for at least 1 hr as a precaution prior to its reuse. (Warning DFP is a potent poison. Atropine is an effective antagonist. For details of treatment, see Goodman, L. S. and Gilman, A., 1965, The Pharmacological Basis of Therapeutics, The Macmillan Co., New York, 3rd Ed., p. 454). 

Atropine should not be injected automatically before a full-face phenol peel. It should be at hand, however, to treat any incidence of bradycardia. As a precaution, it has been recommended to inject a broad-spectrum antibiotic before a phenol peel, although this is not essential for the correct peel procedure. 

Difenoxin, a diphenoxylate derivative, is also combined with atropine and has the same uses, precautions, and side effects. Marketed as 1-mg tablet, the adult dosage is 2 mg initially followed by 1 mg after each loose stool, not to exceed 8 mg/day. 

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