Anticholinergics - Atropine
Classification of Anticholinergics
Atropine
atropine
FIXED-COMBINATION(S)
Donnatal: atropine/hyoscyamine (anticholinergic)/phenobarbital (sedative)/scopolamine (anticholinergic): 0.0194 mg/0.1037 mg/16.2 atropine 105 Canadian trade name Non-Crushable Drug High Alert dru
Lomotil: atropine/ diphenoxylate (peristaltic inhibitor): 0.025 mg/2.5 mg.
CLASSIFICATION
PHARMACOTHERAPEUTIC : Acetylcholine antagonist. CLINICAL : Antiarrhythmic, antispasmodic, antidote, cycloplegic, antisecretory, anticholinergic.
USES
Injection: Preop to inhibit salivation/secretions;
treatment of symptomatic sinus bradycardia; AV block; ventricular asystole; antidote for organophosphate pesticide poisoning. Adjuvant to decrease side effects during reversal of neuromuscular blockage.
Ophthalmic: Produce mydriasis and cycloplegia for examination of retina and optic disc; uveitis.
PRECAUTIONS
Contraindications: Narrow-angle glaucoma, pyloric stenosis, prostatic hypertrophy. Cautions:╇ Autonomic neuropathy, paralytic ileus, intestinal atony, severe ulcerative colitis, toxic megacolon, renal/ hepatic impairment, myocardial ischemia, hyperthyroidism, hypertension, tachyarrhythmias, HF, coronary artery disease, esophageal reflux or hiatal hernia associated with reflux esophagitis; infants, children with spastic paralysis or brain damage;
elderly; biliary tract disease, chronic pulmonary disease.
Ophthalmic: Spastic paralysis, brain injury, Down syndrome.
ACTION
Competes with acetylcholine for common binding sites on muscarinic receptors located on exocrine glands, cardiac and smooth muscle ganglia, intramural neurons.
Therapeutic Effect: Decreases GI motility, secretory activity, GU muscle tone (ureter, bladder); produces ophthalmic cycloplegia, mydriasis; abolishes various types of reflex vagal cardiac slowing or asystole.
PHARMACOKINETICS
Rapidly and well absorbed after IM administration. Widely distributed. Metabolized in liver. Excreted in urine (30%–50% as unchanged drug). Half-life: 2–3 hrs.
LIFESPAN CONSIDERATIONS
Pregnancy/Lactation: Crosses placenta; distributed in breast milk. Pregnancy Category C. Children/Elderly: Increased susceptibility to atropine effects.
INTERACTIONS
DRUG: Anticholinergics may increase effects.
AVAILABILITY
Injection Atropine 0.25 mg/0.3 ml, 0.5 mg/0.7 ml, 1 mg/0.7 ml, 2 mg/0.7 ml. Injection, Solution: 0.4 mg/ml, 1mg/ml.
Ophthalmic Ointment: Ophthalmic Solution:
ADMINISTRATION/HANDLING
IV
• Must be given rapidly (prevents paradoxical
slowing of heart rate). IM
• May be given subcutaneously or IM.
• Store at room temperature. • Give as soon as symptoms of organophosphate or carbamate poisoning appear.
• Do not use more than three AtroPen
autoinjectors for each person at
risk for carbamate or organophosphate
poisoning.
INDICATIONS/ROUTES/DOSAGE
Preanesthetic IV, IM, Subcutaneous:
ADULTS, ELDERLY: 0.4–0.6 mg 30–60 min preop.
CHILDREN WEIGHING 5 KG OR MORE: 0.01– 0.02 mg/kg/dose to maximum of 0.4 mg/ dose. Minimum dose: 0.1 mg. CHILDREN
WEIGHING LESS THAN 5 KG:╇ 0.02 mg/kg/
dose 30–60 min preop.
Bradycardia
IV:╇ ADULTS, ELDERLY:╇ 0.5–1 mg q5min,
not to exceed total of 3 mg or 0.04 mg/
kg. CHILDREN:╇ 0.02 mg/kg with a minimum
of 0.1 mg to a maximum of 0.5 mg
as a single dose. May repeat in 5 min.
Maximum total dose: 1 mg.
Cycloplegic Refraction, Postop Mydriasis,
Uveitis
Ophthalmic Solution
Ophthalmic Ointment:
Antidote for Organophosphate or Carbamate Poisoning IM repeat in 10 min. Maximum: 3 doses.
CHILDREN WEIGHING 40–90 LB:╇ AtroPen
1 mg (dark red). CHILDREN WEIGHING
15–39 LB:╇ AtroPen 0.5 mg (blue). INFANTS
SIDE EFFECTS
Frequent: Dry mouth, nose, throat (may be severe); decreased sweating; constipation; irritation at subcutaneous or IM injection site.
Occasional: Dysphagia, blurred vision, bloated feeling, impotence, urinary hesitancy. Ophthalmic: Mydriasis, blurred vision, photophobia, decreased visual acuity, tearing, dry eyes or dry conjunctiva, eye irritation, crusting of
eyelid.
ADVERSE EFFECTS/
TOXIC REACTIONS
Overdose may produce tachycardia, palpitations,
hot/dry/flushed skin, absence
of bowel sounds, increased respiratory
rate, nausea, vomiting, confusion, drowsiness,
slurred speech, dizziness, CNS
stimulation. Overdose may also produce
psychosis as evidenced by agitation, restlessness,
rambling speech, visual hallucinations,
paranoid behavior, delusions,
followed by depression. Ophthalmic
form may rarely produce increased IOP.
NURSING CONSIDERATIONS
BASELINE ASSESSMENT
Determine if pt is sensitive to atropine,
homatropine, scopolamine. Treatment
with AtroPen autoinjector may be instituted
without waiting for lab results.
INTERVENTION/EVALUATION
Monitor changes in B/P, pulse, temperature.
Observe for tachycardia if pt has
cardiac abnormalities. Assess skin turgor,
mucous membranes to evaluate hydration
status (encourage adequate fluid
intake unless NPO for surgery), bowel
avanafil 107
Canadian trade name Non-Crushable Drug High Alert drug
A
sounds for peristalsis. Be alert for fever
(increased risk of hyperthermia). Monitor
I&O, palpate bladder for urinary retention.
Monitor daily pattern of bowel
activity, stool consistency.
PATIENT/ FAMILY TEACHING
• For preop use, explain that warm
flushing feeling may occur
