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Atropine

Mustafa Abd El-Fatah Zanata 209190 Mohamed Yasser Ahmed 209177 Mohamed Badr Sherif 209156

Definition
Atropine a naturally occurring alkaloid of "atropa belladonna", is a competitive antagonist of muscarinic cholinergic receptors. It is absorbed from the gastro-intestinal tract, and is excreted in the urine. Atropine undergoes hepatic metabolism and has a plasma half-life of 2-3 hours. Atropine ampoules should be stored away from light and never be frozen.

Characteristics
Atropine, is the derivative of Atropine (Sulphate). It is of Semi Synthetic origin and belongs to Tropane Alkaloid. It belongs to Cholinergic muscarinic antagonist pharmacological group on the basis of mechanism of action and also classified in Gastrointestinal Anticholinergics/Antispasmodics and Antidiarrhoeals pharmacological group.The Molecular Weight of Atropine (Sulphate) is 694.80. It is weakly acidic drug, 8.85% solution of the drug is isotonic and Its pKa is 9.9.

Chemical composite
Each milliliter (mL) contains atropine sulfate, monohydrate 0.1 mg (adult strength) or 0.05 mg (pediatric strength), and sodium chloride, 9 mg. May contain sodium hydroxide and/or sulfuric acid for pH adjustment 0.308 mOsmol/mL (calc.). pH 4.2 (3.0 to 6.5).

Side effects
Being a sympathetic cholinergic blocking agent, signs of parasympathetic block may occur such as dryness of the mouth, blurred vision, increased intraocular tension and urinary retention.

Contraindications
In the face of life-threatening poisonings by organophosphorous nerve agents and insecticides, there are no absolute contraindications for atropine use. Hypersensitivity to anticholinergics; narrow-angle glaucoma; primary glaucoma or tendency toward glaucoma (ophthalmic); adhesions between iris and lens; prostatic hypertrophy; obstructive uropathy; myocardial ischemia; unstable cardiac status caused by hemorrhage; tachycardia; myasthenia gravis; pyloric or intestinal obstruction; asthma; hyperthyroidism; renal disease; hepatic disease; toxic megacolon; intestinal atony or paralytic ileus.

Main effects
There is usually an increase in heart rate and sometimes a tachycardia as well as inhibition of secretions (causing a dry mouth) and relaxation of smooth muscle in the gut, urinary tract and biliary tree. Since atropine crosses the blood brain barrier CNS effects in the elderly may include amnesia, confusion and excitation. Pupillary dilatation and paralysis of accommodation occur, with an increase in intraocular pressure especially in patients with glaucoma. Occasionally small intravenous doses may be accompanied by slowing of the heart rate due to a central effect - this resolves with an extra increment of intravenous atropine.

Histopathology
The influence of dose and timing of atropine therapy on fenthion-induced organ dysfunction. Thirty-six rats were randomized into six groups. All rats in the five groups except the control group were intoxicated with fenthion. The high-dose atropine group received 2 mg/kg of atropine, whereas the low-dose group received 100 microg/kg of atropine every hour for 24 hr. One group received 2 mg/kg of atropine in the first 4 hr of intoxication while the other group received 2 mg/kg of atropine in the last 4 hr before killed, which for all rats was 24 hr after intoxication. Pseudocholinesterase and aspartate aminotransferase and alanine aminotransferase levels and histopathological markers of lung, brain and liver were studied. None of our atropine therapy strategies in this study totally prevented harm on the three organs. Although the high dose of atropine administered for 24 hr had the least harmful markers for lung, it also had the most harmful markers for brain and liver. We did not succeed in finding a unique therapy strategy in our models beneficial for all studied organs in fenthion intoxication in rats. Atropine administration strategy should be oriented for the most affected organ pathology in fenthion intoxication.

Uses
When used as premedication for anaesthesia, atropine decreases bronchial and salivary secretions, blocks the bradycardia associated with some drugs used in anaesthesia such as halothane, suxamethonium and neostigmine, and also helps prevent bradycardia from excessive vagal stimulation.

Pharmacological action
Inhibits action of acetylcholine or other cholinergic stimuli at postganglionic cholinergic receptors, including smooth muscles, secretory glands, and CNS sites.

Therapeutic Dose
Around 500-600mcg are used as a premedication in adults administered intramuscularly 30-60 minutes before surgery. Alternatively it may be given intravenously at induction of anaesthesia. Children should receive 20mcg/kg.

General Advice
Multiple concentrations are available for use. Carefully check concentration before administering medication to ensure that proper strength is being used. Inspect injection solution before administration. Do not administer if solution is discolored, cloudy, or if particulate matter noted. Use auto-injector as soon as symptoms of organophosphorous or carbamate poisoning (eg, tearing, excessive oral secretions, wheezing, muscle fasciculations) appear. Use additional autoinjectors as needed, but no more than 3 units unless under supervision of trained medical personnel, until atropinization (eg, flushing, mydriasis, tachycardia, dry mouth) is achieved. Administer as IM injection into patient's mid-lateral thigh.

Storage/Stability
Tablets Store at temperature below 86F. Ophthalmic Store at room temperature (less than 86F). Protect from heat. Injection Store vials, prefilled syringes, and auto-injector at controlled room temperature (68 to 77F). Protect from light and freezing.

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