Home Drug Guide Atropine Sulfate and Meperidine Hydrochloride

Drug Guide

Generic Name

Atropine Sulfate and Meperidine Hydrochloride

Brand Names Atropine Sulfate, Demerol

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/A

Nursing 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.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.