06 2014 Anticholinergic Agents- Atropine

Peak Development for ...
Medication Administration
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Vol. 15 Issue 6
June 2014
Anticholinergic Agents: Atropine
Peak Development Resources
P.O. Box 13267
Richmond, VA 23225

Phone: (804) 233-3707
Fax: (804) 233-3705
Email: [email protected]
After completion the learner should be able to:
1. Identify appropriate indications for use of
atropine.
2. Relate general characteristics of atropine to
specific patient situations.
3. Apply nursing process considerations for
atropine to specific patient situations.
4. Correctly calculate dosage for atropine.

Atropine
Atropine is a potent alkaloid drug extracted
from the belladonna plant, commonly known as
deadly nightshade. The belladonna plant,
meaning “beautiful woman”, was so named
because, long ago, women ingested the plant
to dilate their pupils. This was thought to make
them more attractive.
Atropine is an anticholinergic drug that
decreases the effects of the parasympathetic
nervous system. The parasympathetic nervous
system is responsible for most of the “rest and
digest” functions in the body, such as increased
digestion, intestinal motility and salivation,
decreased heart rate and blood pressure,
pupillary constriction, and increased circulation
to non-vital organs, such as the GI tract, skin
and reproductive system. In contrast, the
sympathetic nervous system produces the “fight
or flight” response, including increased heart
rate and blood pressure, dry mouth, shunting of
blood supply to vital organs and skeletal
muscles, and bronchodilation.
Acetylcholine is a key neurotransmitter of
the parasympathetic nervous system, causing
typical parasympathetic effects, such as
decreased heart rate. And, even though
sweating occurs as a result of stimulation of the
sympathetic nervous system, it is acetylcholine
that triggers these sweat receptors to help
maintain normal temperature control.
Acetylcholine is also important for cognitive
functions, such as memory and judgment.
When this neurotransmitter, or its receptors, is
blocked by drugs such as atropine or other
factors, these parasympathetic responses
decrease. Sympathetic responses then become
dominant, resulting in typical effects, such as
increased heart rate and bronchodilation.
Indications
Atropine is indicated in the management of
parasympathetic responses, such as reducing
salivary and respiratory secretions, and to
decrease the effects of vagal stimulation during
some surgeries and procedures. It may be used
to temporarily treat bradycardia and heart block
due to vagal stimulation. Atropine may also be
used to counter the effects of cholinergic drug
toxicity, poisoning due to certain types of
mushrooms, or cholinesterase poisoning due to
nerve agent or pesticide exposure.
Atropine may be used for treatment of
certain eye and GI conditions. Ophthalmic
drops and ointment may be used during eye
surgery, or to treat inflammatory conditions of
the eye, such as uveitis and iritis. In these
cases, pupillary dilation and paralysis of the
muscles that cause accommodation are desired
and promote healing. Atropine, in combination
with diphenoxylate (Lomotil), is available in oral
form for the treatment of diarrhea.
Pharmacodynamics
Atropine is an anticholinergic agent that
competes with acetylcholine in binding to
specific receptor sites. This inhibits the
response that acetylcholine produces in the
parasympathetic nervous system.
Pharmacokinetics
Absorption: Well-absorbed orally
Distribution: Low protein binding; rapidly
distributed throughout the body; crosses the
placenta and is excreted in breast milk
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Assessment Tool for Medication
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and may be reproduced for this
individual facility only. Sharing
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other freestanding facility within
or outside the licensee’s corporate
entity is expressly prohibited.
The information contained in
Peak Development for… Medication
Administration is intended only as
a guide for the practice of
licensed nursing personnel who
administer medications. Every
effort has been made to verify the
accuracy of the information
herein. Because of rapid changes
in the field of drug therapy, the
reader is advised to consult the
package insert, facility pharmacist
or patient’s physician for relevant
information. This is particularly
important for new or seldom used
drugs. Use of professional
judgment is required in all patient
care situations. It is the reader’s
responsibility to understand and
adhere to policies and procedures
set forth by the employing
institution. The editor and
publisher of this newsletter
disclaim any liability resulting
from use or misuse of
information contained herein.

Copyright © 2014
Metabolism: Metabolized in the liver
Elimination: Primarily via the kidneys
Major Interactions
Potassium: Solid forms of potassium should not be taken
orally when atropine is used. Atropine reduces GI motility,
increasing the risk of ulceration due to prolonged contact with
potassium.
Drugs with anticholinergic properties, such as quinidine,
procainamide, paroxetine, tricyclic antidepressants and some
antihistamines: Taken concurrently with atropine, these drugs
may cause an increase in anticholinergic adverse effects or
toxicity.
Adverse Effects/Toxicity
Adverse drug effects of atropine include blurred vision, dry
mouth, constipation, difficult urination, decreased sweating,
and tachycardia. Atropine toxicity may cause difficulty
swallowing, tremors, palpitations, delirium, coma and
circulatory collapse.
Precautions/Contraindications
Use of atropine should be avoided in patients with pyloric
stenosis, since complete obstruction may result. Atropine may
cause urinary retention and inability to void in patients with
prostatic hypertrophy. Use should be avoided in patients with
glaucoma, since pupillary dilation may cause a sudden
increase in intraocular pressure.
Atropine should be used cautiously in patients with
coronary artery disease or tachycardia, since increased heart
rate and increased myocardial workload may result. Cautious
use is also warranted in patients with asthma, since the drying
and thickening effects on respiratory secretions may cause
bronchial plugging.
Nursing Process
Assessment
Determine baseline status: Because atropine may affect
all body systems, a thorough patient assessment should be
performed and documented before drug administration,
including cardiovascular, respiratory, GI, urinary and
neurologic/mental status. Targeted assessment related to the
reason for atropine administration should include
documentation of any symptoms, including onset, duration,
location, severity and factors that worsen or alleviate them.
Identify risk factors: Review record and assess patient for
risk factors, such as glaucoma, coronary artery disease,
tachycardia, prostatic hypertrophy, pyloric stenosis or asthma.
Age-specific considerations: FDA pregnancy category C.
If atropine is administered to nursing mothers, caution should
be used and the baby monitored for possible adverse effects.
Safety and effectiveness have not been established in
pediatric populations. Infants and children are at greater risk
for adverse effects from atropine, especially fever due to
impaired temperature control from decreased sweating.
Atropine should be administered cautiously to elderly patients,
due to the increased likelihood of impaired cardiovascular,
renal and liver function, glaucoma, and prostatic hypertrophy,
as well as concurrent administration of other medications.
Planning and Analysis
The goal of therapy with atropine is to decrease
parasympathetic responses and/or to relieve symptoms of
underlying disorders.
Intervention
Medication administration: Atropine may be administered
by IV, IM, sub-Q and oral routes, or by endotracheal tube. For
parenteral use, atropine is available in a pre-filled syringe. It is
also marketed in eye drop and ophthalmic ointment form,
although these forms are not approved by the FDA. The drug
should be stored at room temperature, protected from light.
To treat bradycardia, atropine is given IV push. Rapid
administration helps to avoid the reflex bradycardia that may
occur with slow infusion. The usual adult dose is 0.5 to 1 mg.
Observe for therapeutic effects: Monitor the patient
closely for the desired therapeutic effect, such as an increase
in heart rate or a decrease in the number of bowel movements
and intestinal cramps.
Observe for adverse effects: Monitor the patient for signs
such as dry mouth, difficult urination, constipation, tachycardia,
and hyperthermia. Discontinue use and notify the physician if
serious adverse effects occur, such as difficulty swallowing,
dizziness, restlessness, palpitations or delirium.
Patient/Family teaching:
 Ask the patient to void before the drug is administered, to
reduce the risk of urinary retention.
 Extra dietary fiber and fluids may help prevent constipation.
 Inform the patient that blurred vision, photosensitivity and
decreased near vision may occur. Instruct the patient to
wear dark glasses as needed, and keep room lights low.
 Mouth dryness may occur, and can be managed with sugar
-free hard candy/gum, oral lubricants, and sipping fluids.
 Advise the patient that his/her ability to perspire and
regulate temperature may be affected, and to avoid
overheating.
Evaluation
Through careful assessment, drug administration, and
monitoring, the nurse can promote the safe and effective use
of atropine.
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Anticholinergic Agents: Atropine Page 2
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Competency Assessment Tool
Vol. 15 Issue 6
June 2014
Anticholinergic Agents: Atropine
Directions: Place the letter of the one best answer in the space provided.
NAME: DATE:
_____1. Atropine is an extract from a plant known as belladonna, so named because women
ingested this plant to:
A. give them fuller lips
B. dilate their pupils
C. make their cheeks blush
D. improve their skin tone

_____2. Atropine exerts its effects primarily by:
A. blocking sympathetic responses
B. stimulating receptors in the sympathetic nervous system
C. stimulating receptors to produce parasympathetic responses
D. blocking parasympathetic responses

_____3. The parasympathetic nervous system produces the “fight or flight” response.
A. True
B. False

_____4. Parasympathetic responses include which of the following:
A. increased heart rate
B. increased blood pressure
C. increased intestinal motility
D. all of the above

_____5. Atropine competes primarily with which of the following neurotransmitters:
A. acetylcholine
B. norepinephrine
C. serotonin
D. dopamine


UNIT:
Competency Assessment Tool
Anticholinergic Agents: Atropine
Page 2
_____6. Atropine is indicated for the treatment of:
A. excessive respiratory secretions
B. bradycardia
C. mushroom poisoning
D. all of the above

_____7. Adverse effects of atropine include:
A. pinpoint pupils
B. increased sweating
C. diarrhea
D. dry mouth

_____8. Which of the following patients is at highest risk for adverse effects related to atropine use:
A. Mr. G, who has type 2 diabetes
B. Mr. W, who has a duodenal ulcer
C. Mrs. F, who has glaucoma
D. Ms. C, who is having a hysterectomy

_____9. Measures to help the patient manage adverse effects of atropine include:
A. keeping the room lights bright, since near vision is impaired
B. placing extra blankets on the patient for warmth
C. using sugar-free hard candy or gum to relieve mouth dryness
D. keeping a bedpan or urinal nearby for urinary urgency and frequency

_____10. Drug order: Atropine sulfate 0.5 mg IV push now
Drug label: Atropine sulfate 0.1 mg/ml
Give:
A. 0.5 ml
B. 1 ml
C. 2.5 ml
D. 5 ml

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Month: June 2014
Issue: Anticholinergic Agents: Atropine
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