atropine sulfate

(a troe peen)
Parenteral and oral preparations:
AtroPen, Minims (CAN), Sal-Tropine
Ophthalmic solution:
Atropine Sulfate S.O.P., Isopto Atropine Ophthalmic
Pregnancy Category C

Drug classes of Atrophine Sulfate

Anticholinergic

Antimuscarinic

Parasympatholytic

Antiparkinsonian

Antidote

Diagnostic agent (ophthalmic preparations)

Belladonna alkaloid

Therapeutic actions of Atrophine Sulfate

Competitively blocks the effects of acetylcholine at muscarinic cholinergic

receptors that mediate the effects of parasympathetic postganglionic
impulses, depressing salivary and bronchial secretions, dilating the bronchi,
inhibiting vagal influences on the heart, relaxing the GI and GU tracts,
inhibiting gastric acid secretion (high doses), relaxing the pupil of the eye
(mydriatic effect), and preventing accommodation for near vision (cycloplegic
effect); also blocks the effects of acetylcholine in the CNS.

Dosage & Route

ADULTS
Systemic administration
0.40.6 mg PO, IM, IV, or subcutaneously.

Hypotonic radiography: 1 mg IM.

Surgery: 0.5 mg (0.40.6 mg) IM (or subcutaneously or IV) prior to induction

of anesthesia; during surgery, give IV; reduce dose to < 0.4 mg with
cyclopropane anesthesia.

Bradyarrhythmias: 0.41 mg (up to 2 mg) IV every 12 hr as needed.

Antidote: For poisoning due to cholinesterase inhibitor insecticides, give large

doses of at least 23 mg parenterally, and repeat until signs of atropine
intoxication appear; for rapid type of mushroom poisoning, give in doses
sufficient to control parasympathetic signs before coma and CV collapse
intervene. Auto-injector provides rapid administration.

Ophthalmic solution

For refraction: Instill 12 drops into eye 1 hr before refracting.

For uveitis: Instill 12 drops into eye qid.

PEDIATRIC PATIENTS
Systemic administration
Refer to the following table:
Weight

Dose (mg)

716 lb (3.27.3 kg)

0.1

1624 lb (7.310.9 kg)

0.15

2440 lb (10.918.1 kg)

0.2

4065 lb (18.129.5 kg)

0.3

6590 lb (29.540.8 kg)

0.4

> 90 lb (> 40.8 kg)

0.40.6

Surgery: 0.1 mg (newborn) to 0.6 mg (12 yr) injected subcutaneously 30 min

before surgery.

Antidote:

> 90 lb: 2 mg auto-injector.

4090 lb: 1-mg auto-injector.
1540 lb: 0.5 mg auto-injector.
< 15 lb: 0.25 mg auto-injector.

GERIATRIC PATIENTS

More likely to cause serious adverse reactions, especially CNS reactions, in

elderly patients; use with

Indications of Atrophine
Systemic administration

Antisialagogue for preanesthetic medication to prevent or reduce respiratory

tract secretions

Treatment of parkinsonism; relieves tremor and rigidity

Restoration of cardiac rate and arterial pressure during anesthesia when

vagal stimulation produced by intra-abdominal traction causes a decrease in
pulse rate, lessening the degree of AV block when increased vagal tone is a
factor (eg, some cases due to digitalis)

Relief of bradycardia and syncope due to hyperactive carotid sinus reflex

Relief of pylorospasm, hypertonicity of the small intestine, and hypermotility

of the colon

Relaxation of the spasm of biliary and ureteral colic and bronchospasm

Relaxation of the tone of the detrusor muscle of the urinary bladder in the
treatment of urinary tract disorders

Control of crying and laughing episodes in patients with brain lesions

Treatment of closed head injuries that cause acetylcholine release into CSF,
EEG abnormalities, stupor, neurologic signs

Relaxation of uterine hypertonicity

Management of peptic ulcer

Control of rhinorrhea of acute rhinitis or hay fever

Antidote (with external cardiac massage) for CV collapse from overdose of

parasympathomimetic (cholinergic) drugs (choline esters, pilocarpine), or
cholinesterase inhibitors (eg, physostigmine, isoflurophate,
organophosphorus insecticides)

Antidote for poisoning by certain species of mushroom (eg, Amanita

muscaria)

Ophthalmic preparations

Diagnostically to produce mydriasis and cycloplegia-pupillary dilation in acute

inflammatory conditions of the iris and uveal tract

Adverse effects of Atrophine

Systemic administration

CNS: Blurred vision, mydriasis, cycloplegia, photophobia, increased IOP,

headache, flushing, nervousness, weakness, dizziness, insomnia, mental
confusion or excitement (after even small doses in the elderly), nasal
congestion

CV: Palpitations, bradycardia (low doses), tachycardia (higher doses)

GI: Dry mouth, altered taste perception, nausea, vomiting, dysphagia,

heartburn, constipation, bloated feeling, paralytic ileus, gastroesophageal
reflux

GU: Urinary hesitancy and retention; impotence

Other: Decreased sweating and predisposition to heat prostration,

suppression of lactation

Ophthalmic preparations

Local: Transient stinging

Systemic: Systemic adverse effects, depending on amount absorbed

Contraindications of Atrophine

Contraindicated with hypersensitivity to anticholinergic drugs.

Systemic administration

Contraindicated with glaucoma; adhesions between iris and lens; stenosing

peptic ulcer; pyloroduodenal obstruction; paralytic ileus; intestinal atony;
severe ulcerative colitis; toxic megacolon; symptomatic prostatic
hypertrophy; bladder neck obstruction; bronchial asthma; COPD; cardiac
arrhythmias; tachycardia; myocardial ischemia; impaired metabolic, hepatic,
or renal function; myasthenia gravis.

Use cautiously with Down syndrome, brain damage, spasticity, hypertension,

hyperthyroidism, lactation.

Ophthalmic solution

Contraindicated with glaucoma or tendency to glaucoma.

Nursing considerations of Atrophine

Assessment

History: Hypersensitivity to anticholinergics; glaucoma; adhesions between

iris and lens; stenosing peptic ulcer; pyloroduodenal obstruction; paralytic
ileus; intestinal atony; severe ulcerative colitis; toxic megacolon;
symptomatic prostatic hypertrophy; bladder neck obstruction; bronchial
asthma; COPD; cardiac arrhythmias; myocardial ischemia; impaired
metabolic, liver, or renal function; myasthenia gravis; Down syndrome; brain
damage; spasticity; hypertension; hyperthyroidism; lactation

Physical: Skin color, lesions, texture; T; orientation, reflexes, bilateral grip

strength; affect; ophthalmic examination; P, BP; R, adventitious sounds;
bowel sounds, normal GI output; normal urinary output, prostate palpation;
LFTs, renal function tests, ECG

Interventions

Ensure adequate hydration; provide environmental control (temperature) to

prevent hyperpyrexia.

Have patient void before taking medication if urinary retention is a problem.

Teaching points
When used preoperatively or in other acute situations, incorporate teaching about
the drug with teaching about the procedure; the ophthalmic solution is mainly used
acutely and will not be self-administered by the patient; the following apply to oral
medication for outpatients:

Take as prescribed, 30 minutes before meals; avoid excessive dosage.

Avoid hot environments; you will be heat intolerant, and dangerous reactions
may occur.

You may experience these side effects: Dizziness, confusion (use caution
driving or performing hazardous tasks); constipation (ensure adequate fluid
intake, proper diet); dry mouth (sugarless lozenges, frequent mouth care may
help; may be transient); blurred vision, sensitivity to light (reversible; avoid
tasks that require acute vision; wear sunglasses in bright light); impotence
(reversible); difficulty in urination (empty the bladder prior to taking drug).

Report rash; flushing; eye pain; difficulty breathing; tremors, loss of

coordination; irregular heartbeat, palpitations; headache; abdominal

distention; hallucinations; severe or persistent dry mouth; difficulty

swallowing; difficulty in urination; constipation; sensitivity to light.