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Dosage & Route
ATROPINE SULFATE (a'troe-peen) Atropair , Atropisol, Isopto Atropine Classifications: AUTONOMIC NERVOUS SYSTEM AGENT; ANTICHOLINERGIC (PARASYMPATHOLYTIC); ANTIMUSCARINIC
Preanesthesia Adult: IV/IM/SC 0.2–1 mg 30–60 min before surgery Child: IV/IM/SC <5 kg, 0.02 mg/kg; >5 kg, 0.01–0.02 mg/kg 30–60 min before surgery Arrhythmias Adult: IV/IM 0.5–1 mg q1–2h prn (max: 2 mg) Child: IV/IM 0.01– 0.03 mg/kg for 1– 2 doses Organophospha te Antidote Adult: IV/IM 1–2 mg q5–60min until muscarinic signs and symptoms subside (may need up to 50 mg) Child: IV/IM 0.05 mg/kg q10–30 min until muscarinic signs and symptoms subside COPD Adult: Inhalation 0.025 mg/kg diluted with 3–5 mL saline, via nebulizer 3–4 times daily (max: 2.5 mg/d) Child: Inhalation 0.03–0.05 mg/kg diluted with 3–5 mL saline, via nebulizer 3–4 times daily Uveitis Adult/Child: Ophthalmic 1–2 drops of solution or small amount of ointment in eye up to t.i.d.
Acts by selectively blocking all muscarinic responses to acetylcholine (ACh), whether excitatory or inhibitory. Selective depression of CNS relieves rigidity and tremor of Parkinson's syndrome. Antisecretory action (vagolytic effect) suppresses sweating, lacrimation, salivation, and secretions from nose, mouth, pharynx, and bronchi. Blocks vagal impulses to heart with resulting decrease in AV conduction time, increase in heart rate and cardiac output, and shortened PR interval.
Adjunct in symptomatic treatment of GI disorders (e.g., peptic ulcer, pylorospasm, GI hypermotility, irritable bowel syndrome) and spastic disorders of biliary tract. Relaxes upper GI tract and colon during hypotonic radiography. Ophthalmic Use: To produce mydriasis and cycloplegia before refraction and for treatment of anterior uveitis and iritis. Preoperative Use: To suppress salivation, perspiration, and respiratory tract secretions; to reduce incidence of laryngospasm, reflex bradycardia arrhythmia, and hypotension during general anesthesia. Cardiac Uses: For sinus bradycardia or asystole during CPR or that is induced by drugs or toxic substances (e.g., pilocarpine, betaadrenergic blockers, organophosphate pesticides, and Amanita mushroom poisoning); for management of selected patients with symptomatic sinus bradycardia and associated hypotension and ventricular irritability; for diagnosis of sinus node dysfunction and in evaluation of coronary artery disease during atrial pacing
CNS: Headache, ataxia, dizziness, excitement, irritability, convulsions, drowsiness, fatigue, weakness; mental depression, confusion, disorientation, hallucinations. CV: Hypertension or hypotension, ventricular tachycardia, palpitation, paradoxical bradycardia, AV dissociation, atrial or ventricular fibrillation. GI: Dry mouth with thirst, dysphagia, loss of taste; nausea, vomiting, constipation, delayed gastric emptying, antral stasis, paralytic ileus. Urogenital: Urinary hesitancy and retention, dysuria, impotence. Skin: Flushed, dry skin; anhidrosis, rash, urticaria, contact dermatitis, allergic conjunctivitis, fixeddrug eruption. Special Senses: Mydriasis, blurred vision, photophobia, increased intraocular pressure, cycloplegia, eye dryness, local redness.
Hypersensitivity to belladonna alkaloids; synechiae; angleclosure glaucoma; parotitis; obstructive uropathy, e.g., bladder neck obstruction caused by prostatic hypertrophy; intestinal atony, paralytic ileus, obstructive diseases of GI tract, severe ulcerative colitis, toxic megacolon; tachycardia secondary to cardiac insufficiency or thyrotoxicosis; acute hemorrhage; myasthenia gravis. Safety during pregnancy (category C) or lactation is not established.
Assessment & Drug Effects
Monitor vital signs. HR is a sensitive indicator of patient's response to atropine. Be alert to changes in quality, rate, and rhythm of HR and respiration and to changes in BP and temperature.
Initial paradoxical bradycardia following IV atropine usually lasts only 1– 2 min; it most likely occurs when IV is administered slowly (more than 1 min) or when small doses (less than 0.5 mg) are used. Postural hypotension occurs when patient ambulates too soon after parenteral administration.
Note: Frequent and continued use of eye preparations, as well as overdosage, can have systemic effects. Some atropine deaths have resulted from systemic absorption following ocular administration in infants and children. Monitor I&O, especially in older adults and patients who have had surgery (drug may contribute to urinary retention). Palpate lower abdomen for distention. Have patient void before giving atropine.