NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Atropine
ACTION:
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by
blocking vagal stimulation in heart; dries secretions by blocking vagus
Therapeutic outcome:
Drying of secretions, increased heart rate, cycloplegia, mydriasis
USES:
Bradycardia <40-50 bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning,
blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU and biliary
surgery, bronchodilator, AV heart block, irinotecan-induced diarrhea, rapid-sequence intubation
CONTRAINDICATIONS
Hypersensitivity to belladonna alkaloids, closed-angle glaucoma, GI obstructions, myasthenia gravis,
thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia/tachydysrhythmias, asthma, acute
hemorrhage, severe hepatic disease, myocardial ischemia, paralytic ileus
Precautions:
Pregnancy, breastfeeding, child <6 yr, geriatric, renal disease, HF, hyperthyroidism, COPD, hypertension,
intraabdominal infections, Down syndrome, spastic paralysis, gastric ulcer
DOSAGE AND ROUTES
Bradycardia/bradydysrhythmias
Adult: IV bol 0.5-1 mg given q3-5min, not to exceed 2 mg
Child: IV 0.02 mg/kg, may repeat X1, min dose 0.1 mg to avoid paradoxical reaction, max single dose
0.5 mg, max total dose 1 mg
Organophosphate poisoning
Adult and child: IM (AtroPen)/IV 1-2 mg q 20-30 min until muscarinic symptoms disappear; may need
6 mg qhr
Adult and child ≥90 lb, usually >10 yr: 2 mg IM (AtroPen)
Child 40-90 lb, usually 4-10 yr: 1 mg IM (AtroPen)
Child 15-40 lb, 6 mo-4 yr: 0.5 mg IM (AtroPen)
Infant <15 lb: IM/IV 0.05 mg/kg q5-20min
Presurgery
Adult and child >20 kg: SUBCUT/IM/ IV 0.4-0.6 mg 30-60 min before anesthesia
Child <20 kg: IM/SUBCUT 0.01 mg/kg up to 0.4 mg ½-1 hr preop, max 0.6 mg/dose
Available forms:
Inj 0.05, 0.1, 0.4, 0.8, 1 mg/ml; inj prefilled autoinjectors (AtroPen) 0.25, 0.5, 1, 2 mg
,NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Implementation
IM route
• • Expect atropine flush 15-20 min after inj; it may occur in children and is not harmful
AtroPen
• • Use no more than 3 AtroPen injections unless under the supervision of trained provider
• • Use as soon as symptoms appear (tearing, wheezing, muscle fasciculations, excessive
oral secretions), may use through clothing
IV route
• • Give IV undiluted or diluted with 10 ml sterile water; give at a rate of 0.6 mg/min; give
through Y-tube or 3-way stopcock; do not add to IV sol; may cause paradoxical
bradycardia lasting 2 min
ADVERSE EFFECTS
CNS:
Headache, dizziness, involuntary movement, confusion, psychosis, anxiety, coma, flushing, drowsiness,
insomnia, weakness, delirium (geriatric)
CV:
Hypo/hypertension, paradoxical bradycardia, angina, PVCs, tachycardia, ectopic ventricular
beats, bradycardia, palpitations
EENT:
Blurred vision, photophobia, glaucoma, eye pain, pupil dilatation, nasal congestion, increased intraoccular
pressure
GI:
Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation, paralytic ileus, abdominal
distention, altered taste
GU:
Retention, hesitancy, impotence, dysuria
INTEG:
Rash, urticaria, contact dermatitis, dry skin, flushing
MISC:
Suppression of breastfeeding, decreased sweating, anaphylaxis
INTERACTIONS
Individual drugs
• Amantadine: increased anticholinergic effects
• Ketoconazole, levodopa: decreased absorption
• Potassium chloride (oral): increased mucosal lesions, avoid concurrent use
,NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Drug classifications
• Antacids: decreased absorption of atropine
• Antidepressants (tricyclic), antiparkinson agents, phenothiazines, antidysrhythmics:
increased anticholinergic effect
NURSING CONSIDERATIONS
Assessment
• • Monitor I&O ratio; check for urinary retention and daily output in geriatric or
postoperative patients
• • Monitor ECG for ectopic ventricular beats, PVC, tachycardia in cardiac patients
• • Monitor for bowel sounds; check for constipation; abdominal distention and
constipation may occur
• • Monitor respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins
• • Monitor cardiac rate: rhythm, character, B/P continuously
• • Monitor allergic reaction: rash, urticaria
• • Beers: Avoid in older adults, highly anticholinergic, high risk of delirium, in men
decreases urinary flow
• • Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected, use only if
benefits outweigh fetal risk
Patient/family education
• • Advise patient not to perform strenuous activity in high temperatures; heat stroke may result
• • Instruct patient to take as prescribed; not to skip doses
• • Instruct patient to report change in vision; blurring or loss of sight; trouble
breathing; sweating; flushing, chest pain, allergic reactions, constipation, urinary
retention, to use
sunglasses to protect the eyes
• • Caution patient not to operate machinery if drowsiness occurs
• • Advise patient not to take OTC products without approval of physician
• • Teach patient not to freeze or expose to light (Astropen)
Evaluation
Positive therapeutic outcome
• • Decreased dysrhythmias
• • Increased heart rate
• • Decreased secretions, GI, GU spasms
• • Bronchodilatation
TREATMENT OF OVERDOSE:
O2, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazepam or
thiopental for seizure; assess need for antidysrhythmics
Adrenaline
Baclofen
ACTION:
, NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Inhibits synaptic responses in CNS by stimulating GABAB receptor subtype, which decreases
neurotransmitter function, decreasing frequency, severity of muscle spasms
Therapeutic outcome:
Decreased spasticity of muscles
USES:
Spasticity in spinal cord injury, multiple sclerosis
CONTRAINDICATIONS
Hypersensitivity
Precautions:
Pregnancy, breastfeeding, geriatric, peptic ulcer, renal/hepatic disease, stroke, seizure disorder, diabetes
mellitus, psychosis. Abrupt discontinuation (Intrathecal)
DOSAGE AND ROUTES
Spasticity in multiple sclerosis/spinal cord injury
Adult, child ≥12 yr: PO 5 mg tid × 3 days, then 10 mg tid × 3 days, then 15 mg tid × 3 days, then 20 mg
tid × 3 days, then titrated to response, max 80 mg/day (20 mg qid); IT use implantable IT inf pump; use
screening trial of 3 separate bol doses if needed 24 hr apart (50 mcg/ml, 75 mcg/1.5 ml, 100 mcg/2 ml);
patients who do not respond to 100 mcg should not be considered for chronic IT therapy; spinal origin
spasticity 12-2003 mcg/day; cerebral origin spasticity 22-1400 mcg/day
Child 2-7 yr: PO 10-15 mg/day divided q8hr; titrate every 3 days by 5-15 mg/day to max 40 mg/day
Child ≥8 yr: As above, max 60 mg/day
Child: IT initial test dose same as adult; for small children, initial dose of 25 mcg/dose may be used; 25-
1200 mcg/day inf, titrated to response in screening phase
Available forms:
Tabs 10, 20 mg; IT inj 10,000 mcg/20 ml, 20,000 mcg/20 ml, 40,000 mcg/20 ml; 50 mcg/ml, 0.05
mcg/ml, 10 mg/20 ml, 10 mg/5 ml, 50 mg/20 ml; pharmacy can prepare extemporaneous liquid
preparations
Implementation
PO route
• • Give with meals for GI symptoms; gum, frequent sips of water for dry mouth
• • Store in airtight container at room temperature
IT route
• • For screening, dilute to a concentration of 50 mcg/ml with NaCl for inj (preservative
free); give test over 1 min; watch for decreasing muscle tone, frequency of spasm; if
inadequate, use two more test doses q24hr; maintenance inf via implantable pump of 500-
2000 mcg/ml dosage because individual titration is required
• • Do not give IT dose by inj, IV, IM, SUBCUT, epidural
B L A C K B O X WA R N I N G :
Don’t discontinue abruptly, may be fatal
Atropine
ACTION:
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by
blocking vagal stimulation in heart; dries secretions by blocking vagus
Therapeutic outcome:
Drying of secretions, increased heart rate, cycloplegia, mydriasis
USES:
Bradycardia <40-50 bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning,
blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU and biliary
surgery, bronchodilator, AV heart block, irinotecan-induced diarrhea, rapid-sequence intubation
CONTRAINDICATIONS
Hypersensitivity to belladonna alkaloids, closed-angle glaucoma, GI obstructions, myasthenia gravis,
thyrotoxicosis, ulcerative colitis, prostatic hypertrophy, tachycardia/tachydysrhythmias, asthma, acute
hemorrhage, severe hepatic disease, myocardial ischemia, paralytic ileus
Precautions:
Pregnancy, breastfeeding, child <6 yr, geriatric, renal disease, HF, hyperthyroidism, COPD, hypertension,
intraabdominal infections, Down syndrome, spastic paralysis, gastric ulcer
DOSAGE AND ROUTES
Bradycardia/bradydysrhythmias
Adult: IV bol 0.5-1 mg given q3-5min, not to exceed 2 mg
Child: IV 0.02 mg/kg, may repeat X1, min dose 0.1 mg to avoid paradoxical reaction, max single dose
0.5 mg, max total dose 1 mg
Organophosphate poisoning
Adult and child: IM (AtroPen)/IV 1-2 mg q 20-30 min until muscarinic symptoms disappear; may need
6 mg qhr
Adult and child ≥90 lb, usually >10 yr: 2 mg IM (AtroPen)
Child 40-90 lb, usually 4-10 yr: 1 mg IM (AtroPen)
Child 15-40 lb, 6 mo-4 yr: 0.5 mg IM (AtroPen)
Infant <15 lb: IM/IV 0.05 mg/kg q5-20min
Presurgery
Adult and child >20 kg: SUBCUT/IM/ IV 0.4-0.6 mg 30-60 min before anesthesia
Child <20 kg: IM/SUBCUT 0.01 mg/kg up to 0.4 mg ½-1 hr preop, max 0.6 mg/dose
Available forms:
Inj 0.05, 0.1, 0.4, 0.8, 1 mg/ml; inj prefilled autoinjectors (AtroPen) 0.25, 0.5, 1, 2 mg
,NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Implementation
IM route
• • Expect atropine flush 15-20 min after inj; it may occur in children and is not harmful
AtroPen
• • Use no more than 3 AtroPen injections unless under the supervision of trained provider
• • Use as soon as symptoms appear (tearing, wheezing, muscle fasciculations, excessive
oral secretions), may use through clothing
IV route
• • Give IV undiluted or diluted with 10 ml sterile water; give at a rate of 0.6 mg/min; give
through Y-tube or 3-way stopcock; do not add to IV sol; may cause paradoxical
bradycardia lasting 2 min
ADVERSE EFFECTS
CNS:
Headache, dizziness, involuntary movement, confusion, psychosis, anxiety, coma, flushing, drowsiness,
insomnia, weakness, delirium (geriatric)
CV:
Hypo/hypertension, paradoxical bradycardia, angina, PVCs, tachycardia, ectopic ventricular
beats, bradycardia, palpitations
EENT:
Blurred vision, photophobia, glaucoma, eye pain, pupil dilatation, nasal congestion, increased intraoccular
pressure
GI:
Dry mouth, nausea, vomiting, abdominal pain, anorexia, constipation, paralytic ileus, abdominal
distention, altered taste
GU:
Retention, hesitancy, impotence, dysuria
INTEG:
Rash, urticaria, contact dermatitis, dry skin, flushing
MISC:
Suppression of breastfeeding, decreased sweating, anaphylaxis
INTERACTIONS
Individual drugs
• Amantadine: increased anticholinergic effects
• Ketoconazole, levodopa: decreased absorption
• Potassium chloride (oral): increased mucosal lesions, avoid concurrent use
,NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Drug classifications
• Antacids: decreased absorption of atropine
• Antidepressants (tricyclic), antiparkinson agents, phenothiazines, antidysrhythmics:
increased anticholinergic effect
NURSING CONSIDERATIONS
Assessment
• • Monitor I&O ratio; check for urinary retention and daily output in geriatric or
postoperative patients
• • Monitor ECG for ectopic ventricular beats, PVC, tachycardia in cardiac patients
• • Monitor for bowel sounds; check for constipation; abdominal distention and
constipation may occur
• • Monitor respiratory status: rate, rhythm, cyanosis, wheezing, dyspnea, engorged neck veins
• • Monitor cardiac rate: rhythm, character, B/P continuously
• • Monitor allergic reaction: rash, urticaria
• • Beers: Avoid in older adults, highly anticholinergic, high risk of delirium, in men
decreases urinary flow
• • Pregnancy/breastfeeding: Identify if pregnancy is planned or suspected, use only if
benefits outweigh fetal risk
Patient/family education
• • Advise patient not to perform strenuous activity in high temperatures; heat stroke may result
• • Instruct patient to take as prescribed; not to skip doses
• • Instruct patient to report change in vision; blurring or loss of sight; trouble
breathing; sweating; flushing, chest pain, allergic reactions, constipation, urinary
retention, to use
sunglasses to protect the eyes
• • Caution patient not to operate machinery if drowsiness occurs
• • Advise patient not to take OTC products without approval of physician
• • Teach patient not to freeze or expose to light (Astropen)
Evaluation
Positive therapeutic outcome
• • Decreased dysrhythmias
• • Increased heart rate
• • Decreased secretions, GI, GU spasms
• • Bronchodilatation
TREATMENT OF OVERDOSE:
O2, artificial ventilation, ECG; administer DOPamine for circulatory depression; administer diazepam or
thiopental for seizure; assess need for antidysrhythmics
Adrenaline
Baclofen
ACTION:
, NURS EXAM-DRUGS FOR NUERO STUDY GUIDE 2022
Inhibits synaptic responses in CNS by stimulating GABAB receptor subtype, which decreases
neurotransmitter function, decreasing frequency, severity of muscle spasms
Therapeutic outcome:
Decreased spasticity of muscles
USES:
Spasticity in spinal cord injury, multiple sclerosis
CONTRAINDICATIONS
Hypersensitivity
Precautions:
Pregnancy, breastfeeding, geriatric, peptic ulcer, renal/hepatic disease, stroke, seizure disorder, diabetes
mellitus, psychosis. Abrupt discontinuation (Intrathecal)
DOSAGE AND ROUTES
Spasticity in multiple sclerosis/spinal cord injury
Adult, child ≥12 yr: PO 5 mg tid × 3 days, then 10 mg tid × 3 days, then 15 mg tid × 3 days, then 20 mg
tid × 3 days, then titrated to response, max 80 mg/day (20 mg qid); IT use implantable IT inf pump; use
screening trial of 3 separate bol doses if needed 24 hr apart (50 mcg/ml, 75 mcg/1.5 ml, 100 mcg/2 ml);
patients who do not respond to 100 mcg should not be considered for chronic IT therapy; spinal origin
spasticity 12-2003 mcg/day; cerebral origin spasticity 22-1400 mcg/day
Child 2-7 yr: PO 10-15 mg/day divided q8hr; titrate every 3 days by 5-15 mg/day to max 40 mg/day
Child ≥8 yr: As above, max 60 mg/day
Child: IT initial test dose same as adult; for small children, initial dose of 25 mcg/dose may be used; 25-
1200 mcg/day inf, titrated to response in screening phase
Available forms:
Tabs 10, 20 mg; IT inj 10,000 mcg/20 ml, 20,000 mcg/20 ml, 40,000 mcg/20 ml; 50 mcg/ml, 0.05
mcg/ml, 10 mg/20 ml, 10 mg/5 ml, 50 mg/20 ml; pharmacy can prepare extemporaneous liquid
preparations
Implementation
PO route
• • Give with meals for GI symptoms; gum, frequent sips of water for dry mouth
• • Store in airtight container at room temperature
IT route
• • For screening, dilute to a concentration of 50 mcg/ml with NaCl for inj (preservative
free); give test over 1 min; watch for decreasing muscle tone, frequency of spasm; if
inadequate, use two more test doses q24hr; maintenance inf via implantable pump of 500-
2000 mcg/ml dosage because individual titration is required
• • Do not give IT dose by inj, IV, IM, SUBCUT, epidural
B L A C K B O X WA R N I N G :
Don’t discontinue abruptly, may be fatal
