Antilirium
physostigmine
(fi-zoe-stig-meen) physostigmine,Antilirium
(trade name)Classification
Therapeutic: antidotesPharmacologic: cholinergics
See for ophthalmic use
Indications
- belladonna or other plant alkaloids,
- phenothiazines,
- tricyclic antidepressants,
- antihistamines (reverses delirium, hallucinations, coma, and some arrhythmias, but not completely effective in reversing cardiac conduction defects or tachycardia).
Action
- Miosis,
- Increased tone of intestinal and skeletal musculature,
- Bronchial and ureteral constriction,
- Bradycardia,
- Increased salivation,
- Lacrimation,
- Sweating,
- CNS stimulation.
Therapeutic effects
Pharmacokinetics
Time/action profile (systemic cholinergic effects = miosis)
ROUTE | ONSET | PEAK | DURATION |
IM, IV | 3–8 min | unknown | 45–60 min† |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- seizures (life-threatening)
- restlessness (most frequent)
- dizziness
- hallucinations
- weakness
Ear, Eye, Nose, Throat
- lacrimation
- miosis
Respiratory
- bronchospasm (most frequent)
- excess respiratory secretions
Cardiovascular
- bradycardia (most frequent)
- hypotension
Gastrointestinal
- abdominal cramps (most frequent)
- diarrhea (most frequent)
- nausea (most frequent)
- vomiting (most frequent)
- excess salivation
Dermatologic
- rash
Interactions
Drug-Drug interaction
Prolongs action of depolarizing muscle-relaxing agents (succinylcholine,decamethonium ); avoid concurrent use.Cholinergic effects may be antagonized by other drugs possessing anticholinergic properties, includingantihistamines, antidepressants, atropine, haloperidol,phenothiazines, quinidine, and disopyramide.Angel's trumpet, jimson weed, and scopolia may antagonize cholinergic effects.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Monitor pulse, respiratory rate, and BP frequently throughout parenteral administration. Monitor ECG during IV administration.
- Anticholinergic Excess: Monitor neurologic status frequently. Institute seizure precautions Protect patient from self-injury that may be caused by CNS effects of overdose. Overdose is manifested by bradycardia, respiratory distress, seizures, weakness, nausea, vomiting, stomach cramps, diarrhea, diaphoresis, and increased salivation and tearing.
- Atropine is the antidote.
- Treatment of overdose includes establishing an airway and supporting ventilation, atropine sulfate 2–4 mg (may be repeated every 3–10 min to control muscarinic effects), pralidoxime chloride 50–100 mg/min (to control neurologic and skeletal muscle effects), and supportive therapy.
Potential Nursing Diagnoses
Risk for injury (Indications)Implementation
Intravenous Administration
- Repeated doses may be needed because of short duration of action.
- Rate: May be given through Y-site at a rate of no more than 1 mg over 1 min (0.5 mg over 1 min for children). Rapid administration may cause bradycardia; increased salivation, which can lead to respiratory distress; or seizures.
Patient/Family Teaching
- Anticholinergic Excess: Explain purpose of medication and need for close monitoring.
Evaluation/Desired Outcomes
- Reversal of CNS symptoms secondary to anticholinergic excess resulting from drug overdose or ingestion of poisonous plants.