Sedation scopolamine

Sradycard/a Atropine is used in the suppression of vagally mediated bradycardias. Preoperative medication Atropine, scopolamine, hyoscyamine, and glycopyrrolate are used as preanesthetic medication to control bronchial, nasal, pharyngeal, and salivary secretions and to block cardiac vagal inhibitory reflexes during induction of anesthesia and intubation. Scopolamine is used for preanesthetic sedation and for obstetric amnesia. 

Even low doses of scopolamine have central effects. Sedation, amnesia, and drowsiness are common during the clinical use of this drug. Large doses of scopolamine can produce all of the responses seen with atropine. Other tertiary amine compounds with muscarinic receptor blocking activity have similar central effects. 

Mechanism of Action Competitive inhibitors of the muscarinic actions of acetylcholine, acting at receptors located in exocrine glands, smooth and cardiac muscle, and intramural neurons. Composed of 3 main constituents atropine, scopolamine, and hyoscyamine. Scopolamine exerts greater effects on the CNS, eye, and secretory glands than the constituents atropine and hyoscyamine. Atropine exerts more activity on the heart, intestine, and bronchial muscle and exhibits a more prolonged duration of action compared to scopolamine. Hyoscyamine exerts similar actions to atropine but has more potent central and peripheral nervous system effects. TherapeuticEffect Peripheral anticholinergic and antispasmodic action, mild sedation. Pharmacokinetics None known... 

To reveal the cognition-enhancing potential of the S-HTj antagonists, studies in age-related memory impairment have been carried out with psy-chiatrically healthy subjects impaired with scopolamine and patients with dementia. In a randomized double-blind, double-dummy, four-way crossover study in a small number of subjects, each psychiatrically healthy male subject received placebo, scopolamine [0.4 mg im], scopolamine plus alosetron [10 J,g iv], or alosetron [250 Jg] [Preston 1994 Preston et al. 1991). Assessments of verbal and spatial memory, sedation, and sustained attention were performed before and after treatment. The main results from the study were that scopolamine induced robust deficits on all primary variables measured, the reduction in verbal and spatial memories being attenuated by 10- Jg and 250- Jg doses of alosetron, respectively. No effects on the sedation or on changes in attention were noted. 

Certain vestibular disorders respond to antimuscarinic drugs (and to antihistaminic agents with antimuscarinic effects). Scopolamine is one of the oldest remedies for seasickness and is as effective as any more recently introduced agent. It can be given by injection or by mouth or as a transdermal patch. The patch formulation produces significant blood levels over 48-72 hours. Useful doses by any route usually cause significant sedation and dry mouth. 

Dimenhydrinate, which is promoted almost exclusively for the treatment of motion sickness, is a salt of diphenhydramine. The piperazines (cyclizine and meclizine) also have significant activity in preventing motion sickness and are less sedating than diphenhydramine in most patients. Dosage is the same as that recommended for allergic disorders (Table 16-2). Both scopolamine and the Hi antagonists are more effective in preventing motion sickness when combined with ephedrine or amphetamine. 

The most popular use of scopolamine today is for the prevention of motion sickness via the Transderm-Scop patch. This device delivers about 0.5 mg of the drug over a three day period. Scopolamine and other drugs in this class can accumulate in significant quantities in the blood and some can cause CNS effects such as drowsiness, dry mouth and blurry vision. In rare cases amnesia and even psychosis can occur. The sedation and dry mouth are useful effects in that some of the compounds are used as tranquilizers and to dry up the mouth prior to anesthesia. 

Jimson weed contains the naturally occurring compounds atropine and scopolamine, which can interfere with the activity of the nervous system by blocking the action of a key chemical known as acetylcholine. This interference can produce hallucinations. Ingestion of the plant can also cause dilation of the pupils, blurred vision, rapid heart beat, reduction of salivation, as well as sedation and all of these effects are potentially useful in the practice of medicine. Consequently, by the early 1800s people the world over were buying Jimson weed from their local apothecaries. This included the citizens of Mecca. 

Atropine To prevent excess salivation and bradycardia Scopolamine hi obstetrics, to produce sedation and amnesia Cardiology Atropine ... 

Actions Scopolamine is one of the most effective anti-motion sickness drugs available (Figure 5.5). Scopolamine also has the unusual effect of blocking short-term memory. In contrast to atropine, scopolamine produces sedation, but at higher doses can instead produce excitement. 

In psychotic excitement (agitation), sedation can be achieved with scopolamine. Unlike atropine, scopolamine exerts a calming and amnesiogenic action that can also be used to advantage in anesthetic premedication. 

Scopolamine Antimotion sickness, causes sedation and short-term memory block j... 

Scopolamine (0.32 to 0.65 mg SC, IM, or IV) is indicated for producing preanesthetic sedation and obstetric amnesia in conjunction with analgesics. It may be used for calming delirium and for motion sickness. 

No special patient preparation is necessary for pelvic MRI in most cases, unless otherwise stated in the respective chapters. When making an appointment for a pelvic MRI, the patient should be informed about the most important aspects of an MR examination. This also includes questions regarding contraindications to MRI or to IV contrast agent administration. In this way,the patient maybe spared a trip to the MRI center and an effective workflow in the MRI department is ensured. Moreover, the patient should be informed beforehand that a spasmolytic agent will be given to reduce artifacts due to bowel peristalsis, which would degrade image quality. Patients who will receive butyl scopolamine should be told that vision may be transiently impaired immediately after the examination. Finally, the patient should be asked about claustrophobia. If a patient is likely to need sedation, she has to be warned about possible adverse effects. 

Common adverse events sedation, respiratory depression, pruritus, nausea/vomiting, constipation, and urinary retention, which are treated with a naloxone 40-80 pg IV bolus followed by an infusion of 50-100 pg/h. However, these adverse events are relatively less commonly observed with epidural hydromorphone than with neuraxial morphine regimens. Pruritus is treated with a naloxone infusion of 50-100 pg/h, diphenhydramine 12.5-50 mg or propofol infusion of 10 mg/h. Nausea and vomiting is best treated with either ondansetron (4-8 mg IV), low-dose droperidol (0.625-1.25 mg IV), metoclopramide (10 mg IV every 4-6 h), or transdermal scopolamine patch during the first 10 hours following administration. 

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