Therapeutic Uses and Side Effects of Atropine, Adrenaline, and Beta Blockers

Therapeutic Uses of Atropine

Preanesthetic Medication

• Decrease salivary and bronchial secretions
• Prevent bronchospasm
• Antagonize respiratory center depressants
• Protect the heart from bradycardia induced by some general anesthetics
• Prevent vomiting

Disadvantages:

• Post-operative urine retention
• Intestinal hypomotility (paralytic ileus)

Other Uses

1. Heart block and marked bradycardia
2. In cholinergic poisoning to antagonize muscarinic effects (organophosphorus poisoning or physostigmine poisoning)
3. Colics, gut hypermotility, duodenal ulcer
4. Nocturnal enuresis and urinary urgency to reduce bladder motility
5. Parkinsonism
6. Motion sickness (Hyoscine (scopolamine) is better)
7. Hyperhidrosis
8. For fundus examination of the eye (derivatives are better)
9. Bronchial asthma (secretions become viscid, Ipratropium is a better choice)

Therapeutic Uses of Adrenaline

1. Allergy, angioneurotic edema, anaphylactic shock
2. With local anesthetic to:
   • Decrease absorption
   • Prolong duration
   • Provide hemostatic effect
   • Decrease toxicity
3. In nasal bleeding (epistaxis) locally
4. Cardiac arrest (intracardiac)
5. Glaucoma
6. Acute bronchial asthma
7. Insulin-induced hypoglycemia

Adverse Effects of Adrenaline

1. Restlessness, tremors, anxiety, headache
2. Tachycardia, palpitations, anginal pain
3. Cardiac arrhythmia with halothane and digoxin
4. Sudden rise in blood pressure leading to cerebral hemorrhage
5. Gangrene if used with local anesthetics in fingers and toes

Contraindications of Adrenaline

1. Coronary heart disease
2. Hypertension
3. Hyperthyroidism
4. Use with cardiac glycosides (e.g., digitalis) or halothane
5. Use with local anesthetics in fingers and toes
6. Use with non-selective beta-blockers

Uses of Beta Blockers

• Prophylaxis of angina pectoris (not variant angina)
• Myocardial infarction
• Treatment of arrhythmias (atrial, ventricular)
• Treatment of hypertension
• With alpha-blockers in the treatment of pheochromocytoma
• Prophylaxis of migraine
• Glaucoma (timolol)
• Anxiety and tremors
• Thyrotoxicosis

Side Effects of Beta Blockers

• If stopped suddenly after long use: Sympathetic overactivity due to upregulation of beta-receptors
• Bradycardia and heart block (atropine may be used)
• Acute administration can worsen heart failure when the heart is driven by sympathetic tone
• Bronchospasm with non-selective or beta2-blockers
• Increased effect of insulin in diabetic patients and masking of hypoglycemic manifestations except sweating
• Hypotension
• Cold extremities
• Sedation and fatigue
• Sexual dysfunction

Contraindications of Beta Blockers

• Heart block
• Heart failure if the heart is primarily driven by sympathetic tone
• Hypotension
• Rest (variant) angina
• Peripheral vascular diseases
• Diabetes mellitus
• Bronchial asthma (non-selective beta-blockers)
• Use alone in pheochromocytoma