Atropine Injection: Uses, Dosage, Side Effects, Nursing Considerations

 

💉 Introduction:

Atropine is a fast-acting anticholinergic drug widely used in emergency medicine, especially in managing bradycardia (slow heart rate), organophosphate poisoning, and as a pre-anesthetic to reduce secretions. Derived from the Atropa belladonna plant, atropine is a key drug in Advanced Cardiac Life Support (ACLS) protocols.

In this article, we will explore Atropine’s complete pharmacological profile, including its uses, side effects, and the vital nursing implications every nurse should know.

💊 Generic Name:

Atropine Sulfate

💼 Trade Names:

• Atropen

• Atreza

• Sal-Tropine

• Isopto Atropine (for ophthalmic use)

🧪 Class / Action:

• Pharmacologic Class: Anticholinergic, muscarinic antagonist

• Therapeutic Class: Antiarrhythmic, antidote

• Action: Blocks the effects of acetylcholine at parasympathetic sites in smooth muscles, CNS, and secretory glands. This results in increased heart rate, bronchodilation, and reduced secretions.

💉 Route / Dosage:

Routes of Administration:

• Intravenous (IV)

• Intramuscular (IM)

• Subcutaneous (SC)

• Endotracheal (ET)

• Ophthalmic (eye drops for specific indications)

Dosage (Adults):

Bradycardia (IV):

• 0.5 mg IV every 3–5 minutes

• Max dose: 3 mg

Organophosphate Poisoning:

• 2–4 mg IV or IM every 5–10 minutes as needed

• Repeat until symptoms subside (dry secretions, improved heart rate)

Preoperative Use:

• 0.4–0.6 mg IM or SC 30–60 min before anesthesia

⚠️ High Alert Medication:

NO
While not officially classified as a high-alert drug, extreme caution is required due to its potent autonomic effects, especially in cardiac and pediatric patients.

💡 Indications:

• Symptomatic bradycardia

• Organophosphate or nerve agent poisoning

• Pre-anesthetic to reduce salivation and secretions

• AV block (mobitz type I)

• Reversal of muscarinic effects

• Ophthalmic exams (dilates pupils and paralyzes accommodation)

🔬 Mechanism of Action:

Atropine is a competitive antagonist of muscarinic acetylcholine receptors in the parasympathetic nervous system.

• Blocks vagal stimulation, resulting in increased heart rate

• Inhibits glandular secretions (salivary, bronchial, gastric)

• Relaxes smooth muscle of the GI and respiratory tract

• Dilates pupils by blocking parasympathetic input to the iris sphincter muscle

🚫 Contraindications:

• Glaucoma (especially angle-closure)

• Tachycardia or unstable cardiac conditions

• Myasthenia gravis (unless used for organophosphate poisoning)

• Obstructive uropathy

• GI obstruction or paralytic ileus

• Known hypersensitivity

⚠️ Adverse Reactions / Side Effects:

Common:

• Dry mouth

• Blurred vision

• Constipation

• Urinary retention

• Photophobia

• Flushing

• Tachycardia

• Pupil dilation

Serious:

• Ventricular arrhythmias

• Severe tachycardia

• Coma

• Delirium or hallucinations (especially in elderly)

• Heatstroke due to decreased sweating

• Paradoxical bradycardia at low doses

🩺 Nursing Implications:

• Monitor ECG and heart rate during IV administration, especially in bradycardia cases.

• Ensure resuscitation equipment is nearby during emergency use.

• Assess for urinary retention, especially in elderly males.

• Watch for signs of anticholinergic toxicity: dry skin, confusion, hallucinations, fever.

• For ophthalmic use: apply pressure on nasolacrimal duct after drops to prevent systemic absorption.

• Use caution in hot environments—can impair heat dissipation.

• Avoid in patients with GI obstruction, as it can worsen ileus.

• Do not mix atropine in the same syringe with other drugs—check compatibility.

🧑‍⚕️ Patient Education:

• Instruct patient that dry mouth, blurred vision, and light sensitivity are common.

• Encourage hydration and oral care for dry mouth.

• Advise to avoid driving or operating machinery due to visual changes or dizziness.

• Report palpitations, confusion, urinary retention, or rash promptly.

• Educate caregivers on anticholinergic overdose signs (e.g., “hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter”).

• Avoid hot environments and strenuous activity due to decreased sweating.

📋 Notes for Nurses:

• Dilute IV atropine and administer over at least 1 minute to reduce side effects.

• Do not delay administration in symptomatic bradycardia—time-sensitive in ACLS.

• Monitor for rebound bradycardia after effects wear off.

• In organophosphate poisoning, repeat dosing frequently until symptoms resolve.

• Store atropine in a cool, dry place, and ensure expiration dates are checked regularly in crash carts.

• Educate fellow staff on correct dose and concentration for different indications.

📌 Summary Table:

Feature	Description
Generic Name	Atropine Sulfate
Trade Names	Atropen, Sal-Tropine, Isopto Atropine
Class	Anticholinergic, muscarinic antagonist
Routes	IV, IM, SC, ET, ophthalmic
High Alert	No
Indications	Bradycardia, poisoning, pre-op, eye exams
Mechanism	Blocks parasympathetic activity
Side Effects	Dry mouth, tachycardia, blurry vision, delirium
Contraindications	Glaucoma, tachycardia, GI/GU obstruction
Nursing Implications	Monitor ECG, avoid in heat, watch for toxicity
Patient Education	Avoid driving, report confusion or rapid HR