DRUG NAME MECHANISM INDICATION CONTRAINDICATION SIDE NURSING

OF ACTION EFFECT/ADVERS CONSIDERATION

E EFFECT
GENERIC NAME: Inhibits  Bradyasystolic  Contraindicated in Adverse Effect: Before:
Atropine sulfate muscarinic cardiac arrest patients  Check doctor’s
actions of  Organophosphorus hypersensitive to CNS: headache, order
BRAND NAME: acetylcholine at or muscarinic atovaquone, restlessness,  Determine if
AtroPen parasympathetic mushroom proguanil insomnia, dizziness, client is
neuroeffector poisoning hydrochloride, or ataxia, disorientation, sensitive to
junction,  Initial treatment of components of hallucinations, atropine.
AVAILABLE blocking vagal muscarinic drug and in those delirium, excitement,  Have patient
FORM: effects on SA symptoms of with severe renal agitation, confusion, void before
and AV nodes, insecticide impairment or fever. taking
Injection enhancing (organophosphorus severe renal medication if
0.05 mg/ml, 0.1 conduction or carbamate) impairment or CV: bradycardia, urinary retention
mg/ml, 0.4 mg/ml, 0.8 through AV poisoning or severe or palpitations, is a problem.
mg/ml, 1 mg/ml node and organosphosphoru complicated tachycardia, atrial and During:
increasing HR. s nerve agent malaria. ventricular  Assess the
Prefilled poisoning  Ophthalmic arrhythmias. peripheral IV
autoinjectors  Preoperatively to solution: insertion site for
0.25 mg/ml, 0.5 mg, 1 diminish secretions contraindicated GI: dry mouth, redness,
mg, 2 mg and block cardiac with glaucoma or constipation, thirst, swelling,
vagal reflexes tendency to nausea, vomiting increased or
Prefilled syringe  Stress glaucoma. decreased
0.5 mg/ml, in 5-ml echocardiography  Use cautiously in Hematologic: temperature, or
syringe (pediatric), 0.1  Symptomatic patients who are leukocytosis bleeding. If any
mg/ml in 5- and 10-ml bradycardia vomiting of these
syringe  Use cautiously in Metabolic: conditions are
elderly patients Hyperglycemia, present, do not
because they have hypoglycaemia, use this
DOSAGE/ROUTES: a greater hyponatremia, peripheral
Preanesthetic IV, IM, frequency of hypokalemia intravenous
Subcutaneous: decreased renal, catheter (PIV)
ADULTS, hepatic, and Skin: rash for
ELDERLY: 0.4–0.6 cardiac function. administering
mg 30–60 min preop.  Safety and Other: anaphylaxis the IV push
CHILDREN effectiveness medication.
WEIGHING 5 KG haven’t been  To prevent
OR MORE: 0.01– established for contamination
0.02 mg/ kg/dose to prevention in of the
maximum of 0.4 children who medication, be
mg/dose. Minimum weigh less than 11 careful not touch
dose: 0.1 mg. kg or for treatment the lid, lashes,
CHILDREN in children who or eye surface
WEIGHING LESS weigh less than 5 with the dropper
THAN 5 KG: 0.02 kg. or tip of the
mg/kg/ dose 30–60 ointment for
min preop. ophthalmic
solution.
Bradycardia IV: After:
ADULTS,  Monitor for
ELDERLY: 0.5–1 mg adverse effects
q5min not to exceed and
total of 3 mg or 0.04 discontinuation
mg/kg. CHILDREN: the medication if
0.02 mg/kg with a adverse effect
minimum of 0.1 mg to occurs
a maximum of 0.5 mg  Monitor changes
as a single dose. May in B/P, pulse,
repeat in 5 min. temperature.
Maximum total dose: 1  Observe for
mg. tachycardia if
client has
Cycloplegic cardiac
Refraction, Postop abnormalities.
Mydriasis, Uveitis  Assess skin
Ophthalmic Solution: turgor, mucous
ADULTS, membranes to
ELDERLY: Instill 1 evaluate
drop in affected eye(s) hydration status
up to 4 times a day. (encourage
Ophthalmic adequate fluid
Ointment: ADULTS, intake unless
ELDERLY: Apply NPO for
ointment several hours surgery), bowel
prior to examination sounds for
when used for peristalsis.
refraction.  Be alert for
fever
Antidote for (increased risk
Organophosphate or of
Carbamate Poisoning hyperthermia).
IM: ADULTS, Monitor I&O,
CHILDREN palpate bladder
WEIGHING MORE for urinary
THAN 90 LB: retention.
AtroPen 2 mg (green).  Monitor daily
May repeat in 10 min. pattern of bowel
Maximum: 3 doses. activity, stool
CHILDREN consistency.
WEIGHING 40–90
LB: AtroPen 1 mg
(dark red).
CHILDREN
WEIGHING 15–39
LB: AtroPen 0.5 mg
(blue). INFANTS
WEIGHING LESS
THAN 15 LB: 0.05
mg/kg. Do not use
AtroPen.

Why is atropine sulfate should be withheld if taken prior to the Goniotomy?

Atropine is commonly classified as an anticholinergic or antiparasympathetic (parasympatholytic) drug. More precisely,
however, it is termed an antimuscarinic agent since it antagonizes the muscarine-like actions of acetylcholine and other choline esters.
Anticholinergic and parasympatholytic drugs block the action of cholinergic and parasympathetic innervation on the muscles of the
iris and ciliary body. Parasympatholytic agents are commonly used topically to relax accommodation and to dilate the pupil. However,
paralysis of accommodation (cycloplegia) and pupillary dilation may be unwanted, unpleasant, and even dangerous side effects of
drugs administered systemically. Cycloplegia, from interference with the normal innervation of the ciliary muscle, can cause blurring
of vision for near objects in young (less than 40 years old) patients. Blocking of parasympathetic innervation to the ciliary muscle can
be dangerous to patients with borderline or actual, chronic open-angle glaucoma, because this may increase resistance to escape of
aqueous humor from the eye and increase intraocular pressure. Thus, atropine and other anticholinergics and parasympatholytics can
cause elevation of intraocular pressure by the following mechanisms: In eyes with abnormally narrow anterior chamber angles,
dilating the pupil may induce angle-closure glaucoma by allowing the iris to come in contact with the trabecular meshwork, blocking
the aqueous outflow. In eyes with chronic open-angle glaucoma, the intraocular pressure may be raised without closing the angle
independent of pupillary dilation through paralysis of ciliary muscle tone and subsequently increased aqueous outflow resistance
through the trabecular meshwork. There are two accepted theories regarding how increased IOP damages the optic nerve in glaucoma.
The direct mechanical theory suggests that high IOP damages the retinal layer as it passes through the optic nerve head. The indirect
ischemic theory suggests that high IOP compresses the microcirculation in the optic nerve head, resulting in cell injury and death.
Goniotomy is a surgical procedure in which the doctor uses a lens called a goniolens to see the structures of the front part of the eye
(anterior chamber). An opening is made in the trabecular meshwork, the group of tiny canals located in the drainage angle, where fluid
leaves the eye. The new opening provides a way for fluid to flow out of the eye. Atropine is contraindicated in angle-closure glaucoma
or in patients with a narrow angle between the iris and the cornea as it may raise intra-ocular pressure and precipitate an acute attack.

References:
Brunner, L, & Bare, B et al, 2006. Brunner and Suddarth Textbook of Medical-Surgical Nursing, Lippincott Williams and Wilkins:
Philadelphia

Bulletin of the New York Academy of Medicine, 1984, SYSTEMIC ATROPINE AND GLAUCOMA. Retrieved from URL of
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