Scopolamine ref.: Davis's Drug Guide

Scopolamine (scoe-pol-a-meen)
Scopace, Transderm-Scop,
Transderm-V

Classification
Therapeutic: antiemetics
Pharmacologic: anticholinergics
Pregnancy Category C










Indications
Transdermal: Prevention of motion sickness. Management of nausea and vomiting associated with opioid analgesia or general anesthesia/recovery from anesthesia. IM, IV, Subcut: Preoperatively to produce amnesia and to decrease salivation and excessive respiratory secretions.
PO: Symptomatic treatment of postencephalitis parkinsonism and paralysis agitans. Treatment of spasticity. Inhibits excessive motility and hypertonus of GI tract in irritable colon syndrome, mild dysentery, diverticulitis, and pylorospasm. Prevention of motion sickness.

Action
Inhibits the muscarinic activity of acetylcholine. Corrects the imbalance of acetylcholine and norepinephrine in the CNS, which may be responsible for motion sickness.
Therapeutic Effects: Reduction of nausea and vomiting. Preoperative amnesia and decreased secretions. Reduction of spasms.

Pharmacokinetics
Absorption: Well absorbed following IM, subcut, and transdermal administration.
Distribution: Crosses the placenta and bloodbrain barrier.
Metabolism and Excretion: Mostly metabolized by the liver.

IM, IV, Subcut (Children): Antiemetic/anticholinergic— 6 mcg/kg or 0.2 mg/m2.
IM (Children 8–12 yr): Antisecretory—0.3 mg.
IM (Children 3–8 yr): Antisecretory—0.2 mg.
IM (Children 7 mo–3 yr): Antisecretory— 0.15 mg.
IM (Children 4–7 mo): Antisecretory—0.1 mg.

Availability (generic available)
Transdermal therapeutic system: Transderm- Scop—1.5 mg scopolamine/patch releases 0.5 mg scopolamine over 3 days, Transderm-V— 1.5 mg scopolamine/patch releases 1 mg scopolamine over 3 days. Tablets: 0.4 mg.
Injection: 0.3 mg/mL, 0.4 mg/mL.

NURSING IMPLICATIONS
Assessment

• Assess patient for signs of urinary retention periodically during therapy.
• Monitor heart rate periodically during parenteral therapy.
• Assess patient for pain prior to administration. Scopolamine may act as a stimulant in the presence of pain, producing delirium if used without opioid analgesics.
• Antiemetic: Assess patient for nausea and vomiting periodically during therapy.

Potential Nursing Diagnoses
Impaired oral mucous membrane (Indications, Side Effects) Risk for injury (Side Effects)

Implementation
PO: Administer at least 1 hr prior to exposure to travel for motion sickness. Tablets may be crushed or dissolved in water to decrease onset.

IV Administration

• Direct IV: Diluent: Scopolamine should be diluted with sterile water for injection prior to IV administration. Concentration: Dilute dose with an equal volume of diluent. Rate: Inject slowly over 2–3 min..
• Syringe Compatibility: atropine, butorphanol, chlorpromazine, cimetidine, diphenhydramine, droperidol, fentanyl, glycopyrrolate, hydromorphone, meperidine, metoclopramide, midazolam, morphine, nalbuphine, pentazocine, pentobarbital, perphenazine, prochlorperazine, promethazine, ranitidine, sufentanil, thiopental.

Evaluation/Desired Outcomes

• Decrease in salivation and respiratory secretion preoperatively.
• Postoperative amnesia.
• Prevention of motion sickness.
• Prevention and treatment of opioid- or anesthesia- induced nausea and vomiting.
• Reduction in spasms.
• Reduction in excessive GI motility.

Posted in: Motion Sickness