Atropine
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Trade Name
Atropen (prefilled injector); generic atropine sulfate. No major brand for standard vials
Classification
Anticholinergic; muscarinic receptor antagonist; antidote, antiarrhythmic
Dosage/Route
- * Dosage:
- – IV/IM: 0.4 mg/mL, 1 mg/mL vials
- – Prefilled syringe (Atropen): 0.25 mg, 0.5 mg, 1 mg, 2 mg
- – Ophthalmic: 1% solution/drops
- * Route: Intravenous (IV), intramuscular (IM), subcutaneous (SC), ophthalmic
Usual Dosage
- * Bradycardia: 0.5-1 mg IV every 3-5 min; max 3 mg (full vagal block)
- * Organophosphate Poisoning: 1-6 mg IV/IM every 5-30 min until drying of secretions; may need 10s of mg
- * Pre-anesthetic: 0.4-0.6 mg IV/IM 30-60 min before surgery
- * Ophthalmic: 1-2 drops 1% solution 1-3 times daily
- * Dosing varies widely by indication
Mechanism of Action
Competitively blocks muscarinic acetylcholine receptors, inhibiting parasympathetic effects. Increases heart rate (blocks vagus), reduces secretions, dilates pupils (mydriasis), and relaxes smooth muscle (e.g., GI, bronchial)
Side Effects & Adverse Effects
- * Side Effects: Dry mouth, blurred vision, tachycardia, constipation, urinary retention
- * Adverse Effects:
- – Anticholinergic toxicity (severe: confusion, fever, delirium—“hot as a hare, dry as a bone”)
- – Arrhythmias (paradoxical bradycardia at low doses; tachy at high)
- – Worsened glaucoma (increases intraocular pressure)
- – Overdose: CNS excitation, seizures
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor HR, BP, ECG (esp. IV; watch for tachy or initial brady)
- – Assess neuro status (confusion), bowel/bladder (retention), lung sounds (secretions)
- – IV: Give undiluted, rapid push (emergency); avoid slow infusion
- – Contraindicated in narrow-angle glaucoma, obstructive GI/uropathy
- * Teachings:
- – Expect dry mouth, blurred vision; use sugar-free gum, sunglasses
- – Report fever, fast heartbeat, or difficulty urinating
- – Avoid heat (impaired sweating increases hyperthermia risk)
- – Ophthalmic: Don’t drive until vision clears
Indication for This Patient
- * Symptomatic bradycardia (e.g., ACLS protocol)
- * Organophosphate/cholinergic poisoning (reverses secretions, bronchospasm)
- * Pre-anesthetic (reduces secretions, bradycardia)
- * Ophthalmic: Uveitis, cycloplegia (pupil dilation)
Time
- * Timing:
- – Bradycardia: Every 3-5 min PRN
- – Poisoning: Every 5-30 min until secretions dry
- – Pre-op: 30-60 min before surgery
- * Onset: IV: 1-2 min; IM: 10-15 min; Ophthalmic: 30 min
- * Peak: IV: 2-4 min; PO/IM: 30-60 min
- * Duration: IV: 4-6 hours; Ophthalmic: days
