Atropine

Atropine/ atropine sulfate     Preg risk A

Classifications: anticholinergic

Indications: symptomatic bradycardia, bradyarrhythmia.

Action: an anticholinergic(antimuscarinic) that inhibits acetylcholine at the parasympathetic neuroeffector junction, blocking vagal effects on the SA and AV nodes; this enhances conduction throught the AV node and speeds heart rate.

Adverse reactions:

 CNS: headache, resltesness, ataxia, disorientation, hallucinations, delirium, insomnia, dizziness, excitement, agitation, confusion

·             CV: palpitations and bradycardia(low dose); tachycardia(high dose)

·            Eye: photophobia, bluured vision, mydriasis, cycloplegia, increase introcular pressure

·              GI: dry mouth, thirst, constipation, nausea, vomiting

·              GU: urine retention, impotence

·             Haematologic : leucocytosis

·              Other: severe allergic reaction(anaphylaxis, urticaria)

Contraindications: hypersensitivity, obstructive disease of GI tract, paralytic ileus,toxic megacolon, intestinal atony, unstable CV status in acute haemorrhage, tachycardia, myocardial ischaemia, asthma and myasthenia gravis

Drug-drug: antacids- decreases absorption of anticholinergics; Ketoconzole, levodopa: decreased absorption; drug herb: Jaborandi tree, euphorbia, Jimsonweed, Squaw vine

Care considerations:

·         use cautiously in individuals with Down syndrome

·         many adverse reactions

·         monitor for paradoxical initial bradycardia.

·         Watch for tachycardia in those with cardiac conditions

·         Monitor fluid intake

Teaching:

·          Teach how to handle distressing anticholinergic effects

·         Instruct to report serious or persistent adverse reactions promptly

Dose: Adults: 0.5 to 1 mg IV push, repeated q 2 to 5 mins to max of 2 mg.