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1 Contraindications/Precautions
Contraindicated in: Hypersensitivity; Angle-closure glaucoma; Acute hemor- PDF Page #1
atropine (at-ro-peen) rhage; Tachycardia secondary to cardiac insufficiency or thyrotoxicosis; Obstructive
Atro-Pen disease of the GI tract.
Classification Use Cautiously in: Intra-abdominal infections; Prostatic hyperplasia; Chronic re-
Therapeutic: antiarrhythmics nal, hepatic, pulmonary, or cardiac disease; OB, Lactation: Safety not established;
Pharmacologic: anticholinergics, antimuscarinics IV administration may produce fetal tachycardia; Pedi: Infants with Down syndrome
have increased sensitivity to cardiac effects and mydriasis. Children may have in-
Pregnancy Category C creased susceptibility to adverse reactions. Exercise care when prescribing to chil-
dren with spastic paralysis or brain damage; Geri: Increased susceptibility to adverse
Indications reactions.
IM: Given preoperatively to decrease oral and respiratory secretions. IV: Treatment
of sinus bradycardia and heart block. IV: Reversal of adverse muscarinic effects of
Adverse Reactions/Side Effects
anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine). IM, IV: CNS: drowsiness, confusion, hyperpyrexia. EENT: blurred vision, cycloplegia, pho-
Treatment of anticholinesterase (organophosphate pesticide) poisoning. Inhaln: tophobia, dry eyes, mydriasis. CV: tachycardia, palpitations, arrhythmias. GI: dry
Treatment of exercise-induced bronchospasm. mouth, constipation, impaired GI motility. GU: urinary hesitancy, retention, impo-
tency. Resp: tachypnea, pulmonary edema. Misc: flushing, decreased sweating.
Action
Inhibits the action of acetylcholine at postganglionic sites located in: Smooth muscle, Interactions
Secretory glands, CNS (antimuscarinic activity). Low doses decrease: Sweating, Sali- Drug-Drug:qanticholinergic effects with other anticholinergics, including an-
vation, Respiratory secretions. Intermediate doses result in: Mydriasis (pupillary di- tihistamines, tricyclic antidepressants, quinidine, and disopyramide. Anti-
lation), Cycloplegia (loss of visual accommodation), Increased heart rate. GI and GU cholinergics may alter the absorption of other orally administered drugs by slow-
tract motility are decreased at larger doses. Therapeutic Effects: Increased heart ing motility of the GI tract. Antacidspabsorption of anticholinergics. MayqGI
rate. Decreased GI and respiratory secretions. Reversal of muscarinic effects. May mucosal lesions in patients taking oral potassium chloride tablets. May alter re-
have a spasmolytic action on the biliary and genitourinary tracts. sponse to beta-blockers.
Pharmacokinetics Route/Dosage
Absorption: Well absorbed following subcut or IM administration. Preanesthesia (To Decrease Salivation/Secretions)
Distribution: Readily crosses the blood-brain barrier. Crosses the placenta and IM, IV, Subcut (Adults): 0.4 0.6 mg 30 60 min pre-op.
enters breast milk. IM, IV, Subcut (Children 5 kg): 0.01 0.02 mg/kg/dose 30 60 min preop to a
Metabolism and Excretion: Mostly metabolized by the liver; 30 50% excreted maximum of 0.4 mg/dose; minimum: 0.1 mg/dose.
unchanged by the kidneys. IM, IV, Subcut (Children 5 kg): 0.02 mg/kg/dose 30 60 min preop then q 4 6
Half-life: Children 2 yr: 4 10 hr; Children 2 yr: 1.5 3.5 hr; Adults: 4 5 hr. hr as needed.
TIME/ACTION PROFILE (inhibition of salivation)
Bradycardia
ROUTE ONSET PEAK DURATION
IV (Adults): 0.5 1 mg; may repeat as needed q 5 min, not to exceed a total of 2 mg
IM, subcut rapid 1550 min 46 hr (q 3 5 min in Advanced Cardiac Life Support guidelines) or 0.04 mg/kg (total vago-
IV immediate 24 min 46 hr lytic dose).
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
Name /bks_53161_deglins_md_disk/atropine 02/20/2014 01:39PM Plate # 0-Composite pg 2 # 2

2 Assess patients routinely for abdominal distention and auscultate for bowel
IV (Children): 0.02 mg/kg (maximum single dose is 0.5 mg in children and 1 mg in
adolescents); may repeat q 5 min up to a total dose of 1 mg in children (2 mg in ado-
lescents).
Endotracheal (Children): use the IV dose and dilute before administration.
Reversal of Adverse Muscarinic Effects of Anticholinesterases
IV (Adults): 0.6 12 mg for each 0.5 2.5 mg of neostigmine methylsulfate or 10
20 mg of pyridostigmine bromide concurrently with anticholinesterase.
Organophosphate Poisoning
IM (Adults): 2 mg initially, then 2 mg q 10 min as needed up to 3 times total.
IV (Adults): 1 2 mg/dose q 10 20 min until atropinic effects observed then q 1 4
hr for 24 hr; up to 50 mg in first 24 hr and 2 g over several days may be given in severe
intoxication.
IM (Children 10 yr 90 lbs): 2 mg.
IM (Children 4 10 yr 40 90 lbs): 1 mg.
IM (Children 6 mo 4 yr 15 40 lbs): 0.5 mg.
IV (Children): 0.02 0.05 mg/kg q 10 20 min until atropinic effects observed then
q 1 4 hr for 24 hr.
Bronchospasm
Inhaln (Adults): 0.025 0.05 mg/kg/dose q 4 6 hr as needed; maximum 2.5 mg/
dose.
Inhaln (Children): 0.03 0.05 mg/kg/dose 3 4 times/day; maximum 2.5 mg/
dose.
NURSING IMPLICATIONS
Assessment
Assess vital signs and ECG tracings frequently during IV drug therapy. Report any
significant changes in heart rate or BP, or increased ventricular ectopy or angina
to health care professional promptly.
Monitor intake and output ratios in elderly or surgical patients because atropine
may cause urinary retention.
sounds. If constipation becomes a problem, increasing fluids and adding bulk to
the diet may help alleviate constipation. PDF Page #2
Toxicity and Overdose: If overdose occurs, physostigmine is the antidote.
Potential Nursing Diagnoses
Decreased cardiac output (Indications)
Impaired oral mucous membrane (Side Effects)
Constipation (Side Effects)
Implementation
IM: Intense flushing of the face and trunk may occur 15 20 min following IM ad-
ministration. In children, this response is called atropine flush and is not harm-
ful.
IV Administration
Direct IV: Diluent: Administer undiluted. Rate: Administer over 1 min; more
rapid administration may be used during cardiac resuscitation (follow with 20 mL
saline flush). Slow administration (over 1 min) may cause a paradoxical brady-
cardia (usually resolved in approximately 2 min).
Y-Site Compatibility: abciximab, alfentanyl, amikacin, aminophylline, amioda-
rone, argatroban, ascorbic acid, azathioprine, aztreonem, benztropine, bivaliru-
din, bumetanide, buprenorphine, butorphanol, calcium chloride, calcium glu-
conate, cefazolin, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftazidime,
ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, clindamycin, cya-
nocobalamin, cyclosporine, dexamethasone, dexmedetomidine, digoxin, diphen-
hydramine, dobutamine, dopamine, doripenem, doxycycline, enalaprilat, ephed-
rine, epinephrine, epoetin alfa, eptifibatide, erythromycin, esmolol, etomidate,
famotidine, fenoldopam, fentanyl, fluconazole, folic acid, furosemide, ganciclovir,
gentamicin, glycopyrrolate, heparin, hydrocortisone sodium succinate, hydro-
morphone, imipenem/cilastatin, indomethacin, insulin, isoproterenol, ketamine,
ketorolac, labetalol, lidocaine, magnesium sulfate, mannitol, meperidine, mero-
penem, methadone, methyldopate, methylprednisolone, metoclopramide, meto-
prolol, midazolam, morphine, multivitamins, nafcillin, nalbuphine, naloxone, ni-
troglycerin, nitroprusside, norepinephrine, ondansetron, oxacillin, oxytocin,
palonosetron, papaverine, penicillin G, pentamidine, pentazocine, pentobarbital,
phenobarbital, phentolamine, phenylephrine, phytonadione, potassium chloride,
procainamide, prochlorperazine, promethazine, propranolol, protamine, pyri-
2015 F.A. Davis Company CONTINUED
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3
PDF Page #3
CONTINUED
atropine
doxime, ranitidine, sodium bicarbonate, streoptkinase, succinylcholine, sufen-
tanil, theophylline, thiamine, ticarcillin/clavulanate, tirofiban, tobramycin, tolaz-
oline, vancomycin, vasopressin, verapamil, vitamin B complex with C.
Y-Site Incompatibility: amphotericin B colloidal, dantrolene, diazepam, dia-
zoxide, pantoprazole, phenytoin, trimethoprim/sulfamethoxazole, thiopental.
Endotracheal: Dilute with 5 10 mL of 0.9% NaCl.
Rate: Inject directly into the endotracheal tube followed by several positive pres-
sure ventilations.
Patient/Family Teaching
May cause drowsiness. Caution patients to avoid driving or other activities requir-
ing alertness until response to medication is known.
Instruct patient that oral rinses, sugarless gum or candy, and frequent oral hygiene
may help relieve dry mouth.
Caution patients that atropine impairs heat regulation. Strenuous activity in a hot
environment may cause heat stroke.Advise patient to notify health care profes-
sional of all Rx or OTC medications, vitamins, or herbal products being taken and
to consult with health care professional before taking other medications.
Pedi: Instruct parents or caregivers that medication may cause fever and to notify
health care professional before administering to a febrile child.
Geri: Inform male patients with benign prostatic hyperplasia that atropine may
cause urinary hesitancy and retention. Changes in urinary stream should be re-
ported to health care professional.
Evaluation/Desired Outcomes
Increase in heart rate.
Dryness of mouth.
Reversal of muscarinic effects.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.