Physical Compatibility and Chemical Stability of a Concentrated Solution of Atropine Sulfate (2 mg/mL) for Use as an Antidote in Nerve Agent Casualties.

Atropine is one of the preferred antidotes for nerve gas exposure. Effective therapy requires large doses. Stockpiling of atropine in forms currently available commercially can be costly and can require a large storage area. Other problems in using the commercial product are the time required to break the large number of ampules needed for treatement, and the large volume of medication that must be administered. A preparation of concentrated atropine for injection from atropine powder is the ideal solution, but the stability of this preparation is unknown. A formulation for concentrated atropine sulfate solution (2 mg/mL) was developed using pharmaceutical-grade powder. The solution was prepared in isotonic saline solution and packaged in polypropylene syringes, which were sealed with syringe caps. Assessment of physical stability under several storage conditions was based on clarity, color, and pH monitoring. Chemical stability of the preparation was determined by using a stability-indicating high-performance liquid chromatographic method. All solutions remained clear and colorless, and the pH changed only slightly over the study period. The potency of the atropine sulfate solution remained above the United States Pharmacopeia limit of 93% for the duration of the study. The solutions were physically compatible and chemically stable when stored for 28 days at 35 deg C and exposed to light, 364 days at 23 deg C and exposed to light, or 364 days at 5 deg C and protected from light. Concentrated solutions of atropine sulfate can be compounded quickly and easily by using commercially available pharmaceutical-grade powder as the active ingredient. The extended shelf-life allows the preparation to be readily available in the field as required.

Blood pressure management in acute stroke: comparison of current guidelines with prescribing patterns.

OBJECTIVE: Current recommendations for treating elevated blood pressure (BP) in the acute stroke are based largely on expert opinion and vary with regard to treatment thresholds and choice of antihypertensive agents. In this study we investigate the influence of these recommendations by comparing the management of hypertension in acute stroke at a tertiary care hospital with current guidelines. METHOD: Retrospective chart review of patients admitted with acute stroke at The Ottawa Hospital-General Campus over six consecutive months. The use of antihypertensive medications (type, dose, routes of administration, BP recordings) in the first seven days after admission was noted. RESULTS: Transdermal nitroglycerin paste was the most commonly used antihypertensive agent. In contrast to the 15% reduction in BP over 24 hours recommended for lowering BP in hypertensive patients with ischemic stroke, nitroglycerin caused a >15% reduction of BP over the first 24 hours on 60% of the occasions used. Furthermore, despite concerns about sublingual nifedipine, this was the second most commonly prescribed agent. Surprisingly, the mean time to first BP measurement following initiation of antihypertensive therapy was 117 +/- 43 minutes in ischemic stroke and 88 +/- 89 minutes in hemorrhagic strokes. CONCLUSIONS: The current guidelines for management of acute poststroke hypertension appear to have little influence on prescribing patterns, leading to considerable variations in practice. Such variations, likely due to uncertainty caused by lack of evidence from randomised controlled trials, are intolerable as patients maybe submitted to nonstandardised, potentially harmful care such as inappropriate choice of antihypertensives and inadequate BP monitoring as observed in this study.