Nurses Compass
Drug Guide
Atropine Sulfate and Meperidine Hydrochloride
Classification
Therapeutic: Analgesic, Antispasmodic, Anticholinergic
Pharmacological: Muscarinic Antagonist (Atropine), Opioid Agonist (Meperidine)
FDA Approved Indications
- Demerol (Meperidine): Relief of moderate to severe pain.
- Atropine Sulfate: Preoperative medication to reduce salivation and respiratory secretions; treatment of bradycardia; to induce mydriasis during eye examinations.
Mechanism of Action
Atropine Sulfate blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the central nervous system, leading to antimuscarinic effects. Meperidine is a opioid receptor agonist, primarily acting on mu-opioid receptors to produce analgesia.
Dosage and Administration
Adult: Demerol: 50-150 mg every 3-4 hours as needed. Atropine: 0.4-0.6 mg IM or IV before surgery, may repeat every 30-60 minutes as needed, maximum 3 mg.
Pediatric: Demerol: dosing varies based on weight and age. Atropine: 0.02 mg/kg IV, may repeat every 10-20 minutes if needed.
Geriatric: Use with caution; start at lower doses due to increased sensitivity and risk of adverse effects.
Renal Impairment: Adjust dosage based on renal function; monitor for accumulation.
Hepatic Impairment: Use with caution; adjust doses accordingly.
Pharmacokinetics
Absorption: Rapidly absorbed from injection site.
Distribution: Widely distributed, crosses the blood-brain barrier and placenta.
Metabolism: Metabolized in the liver.
Excretion: Excreted primarily in urine.
Half Life: Demerol: approximately 3 hours; Atropine: varies, around 2 hours.
Contraindications
- Known hypersensitivity to opioids or atropine.
- Obstructive bowel disease.
- Severe asthma or respiratory depression.
Precautions
- Use with caution in patients with impaired hepatic or renal function.
- Monitor for signs of CNS toxicity, respiratory depression, dry mouth, tachycardia, urinary retention, or blurred vision.
Adverse Reactions - Common
- Dry mouth (common)
- Dizziness (common)
- Nausea (common)
- Constipation (common)
Adverse Reactions - Serious
- Respiratory depression (rare)
- Allergic reactions including rash, pruritus (rare)
- Urinary retention (rare)
- Tachycardia (rare)
Drug-Drug Interactions
- Other CNS depressants, sedatives, antihistamines, antipsychotics.
- Monoamine oxidase inhibitors (MAOIs).
Drug-Food Interactions
- Alcohol.
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor respiratory status, bowel function, neurological status, and pain levels.
Diagnoses:
- Risk for respiratory depression
- Impaired comfort related to pain or medication side effects.
Implementation: Administer drug as ordered; monitor vital signs and pain relief; manage side effects.
Evaluation: Assess effectiveness in pain control and monitoring for adverse reactions.
Patient/Family Teaching
- Do not operate heavy machinery until the effects are known.
- Avoid alcohol and CNS depressants.
- Report any signs of respiratory depression, allergic reactions, or gastrointestinal issues.
Special Considerations
Black Box Warnings:
- Risk of respiratory depression and addiction with opioids.
- Use with caution in patients with head injuries or increased intracranial pressure.
Genetic Factors: Genetic variations can affect opioid metabolism, influencing efficacy and toxicity.
Lab Test Interference: May affect liver function tests.
Overdose Management
Signs/Symptoms: Respiratory depression, sedation, miosis, coma.
Treatment: Administer opioid antagonist narcan (naloxone), provide supportive respiratory care, and monitor vital signs.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable when stored properly.