A patient is given Atropine Sulphate as a premedication before surgery and develops Tachycardia and dry mouth?

WCL Staff Nurse - 2019

Pharmacology

Easy

Appeared in: WCL Staff Nurse - 2019

Explanation

Tachycardia and dry mouth are well-documented, expected pharmacological effects of Atropine, not an adverse or allergic reaction.
Atropine is an anticholinergic (or antimuscarinic) drug that works by blocking the parasympathetic nervous system.
It increases heart rate by blocking the vagal nerve's influence on the heart's sinoatrial (SA) node.
It causes dry mouth (xerostomia) by inhibiting acetylcholine's stimulation of salivary glands.
These effects are therapeutically useful in premedication to prevent bradycardia and reduce secretions during surgery.

Option A: A drug allergy would present with different symptoms, such as a rash, hives, itching, wheezing, or hypotension, not the expected pharmacological effects of the drug.
Option B: The development of tachycardia and dry mouth indicates that the drug is already exerting its effect. A higher dose would not be therapeutic and would only increase the intensity and risk of side effects.
Option D: While anxiety can cause tachycardia, it does not typically cause a profoundly dry mouth. The combination of both symptoms, appearing after the administration of atropine, strongly points to the drug as the cause.

Clinical Relevance

Nursing practice connection: Safe nursing care depends on performing Pharmacological Side Effects of Atropine in the correct sequence, documenting the action clearly, and monitoring for the expected response.
A core nursing responsibility is to differentiate between expected side effects and adverse or allergic reactions to medications.
Recognizing these as normal side effects prevents unnecessary and potentially harmful interventions (like administering an antihistamine for a presumed allergy) and allows the nurse to provide appropriate comfort measures (like oral care for dry mouth).
What if? If the patient had tachycardia, dry mouth, AND became very flushed, hot to the touch, and confused, this would indicate atropine toxicity (anticholinergic poisoning), requiring immediate medical attention and possible administration of an antidote like physostigmine.

How to Approach the Question

First, identify the drug administered: Atropine Sulphate.
Recall the drug class and its primary mechanism. Atropine is a classic anticholinergic/antimuscarinic agent.
Connect the patient's symptoms (tachycardia, dry mouth) to the known pharmacological effects of that drug class. Anticholinergics are known to cause these specific effects.
Evaluate the other options. An allergy would have different signs. A higher dose is illogical if the drug is already working. Anxiety is a less complete explanation for the symptom cluster.
Conclude that the symptoms are the normal, expected side effects of the medication in this clinical context.

Concept Tested & Keywords

Concept Tested: Pharmacological Side Effects of Atropine
Stem keywords: Atropine Sulphate, premedication, Tachycardia, dry mouth
Lead-in keywords: BEST, MOST RELEVANT CLUE
Clinical cues: Administration of Atropine followed by specific symptoms (tachycardia, dry mouth)

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E6 Pharmacology KD Tripathi Essentials 9e Part 1 p. 161-163

E6 Pharmacology Nurses Shanbhag 3e pp. 74-76, 72-74