Atropine glaucoma with

Adverse effects with atropine therapy include dry mouth, myosis, loss of visual accommodations, constipation, and urinary retention. The dmg can also produce flushing, hyperthermia, delirium, tachycardia, and exacerbate glaucoma (85). 

Preanesthetic drugs may be omitted in those 60 years or older because many of the medical disorders for which these drugsare contraindicated are seen in older individuals For example, atropine and glycopyrrolate, drugs that can be used to decrease secretions of the upper respiratory tract, are contraindicated in certain medical disorders such as prostatic hypertrophy, glaucoma, and myocardial ischemia. Other preanesthetic drugs that depress the central nervous astern (CN, such as narcotics barbiturates and antianxiety drugs with or without antiemetic properties may be contraindicated in the older individual. 

The major therapeutic uses of the cholinomimetics are for diseases of the eye (glaucoma, accommodative esotropia), the gastrointestinal and urinary tracts (postoperative atony, neurogenic bladder), the neuromuscular junction (myasthenia gravis, curare-induced neuromuscular paralysis), and very rarely, the heart (certain atrial arrhythmias). Cholinesterase inhibitors are occasionally used in the treatment of atropine overdosage. Several newer cholinesterase inhibitors are being used to treat patients with Alzheimer s disease. 

Disopyramide s atropine-like activity accounts for most of its symptomatic adverse effects urinary retention (most often, but not exclusively, in male patients with prostatic hyperplasia), dry mouth, blurred vision, constipation, and worsening of preexisting glaucoma. These effects may require discontinuation of the drug. 

These compounds have been used for many centuries and still find use today in their original forms or through synthetic analogs. Conditions which respond to muscarinic antagonists include irritable bowel syndrome, ulcers, diarrhea, glaucoma, acute rhinitis in addition to some CNS disorders. For example, Lomitil is a prescription treatment for diarrhea which is composed of atropine and diphenoxylate (an opiod with similar effects). 

Muscarinic cholinomimetics mediate contraction of the circular pupillary constrictor muscle and of the ciliary muscle. Contraction of the pupillary constrictor muscle causes miosis, a reduction in pupil size. Miosis is usually present in patients exposed to large systemic or small topical doses of cholinomimetics, especially organophosphate cholinesterase inhibitors. Ciliary muscle contraction causes accommodation of focus for near vision. Marked contraction of the ciliary muscle, which often occurs with cholinesterase inhibitor intoxication, is called cyclospasm. Ciliary muscle contraction also puts tension on the trabecular meshwork, opening its pores and facilitating outflow of the aqueous humor into the canal of Schlemm. Increased outflow reduces intraocular pressure, a very useful result in patients with glaucoma. All of these effects are prevented or reversed by muscarinic blocking drugs such as atropine. 

Standard treatment for OPP poisoning is i.v. injection with atropine sulfate to protect the muscarinic end-organs from the accumulation of excessive acetyl choline concentrations. Diagnostic testing, or treatment with atropine must be used cautiously in patients with glaucoma, in view of the risk of increased intraocular pressure from the drug. 

Tests of Cardiovascular Status. Pulse strength, regularity, heart rate, and blood pressure measurements should be evaluated. Some topically administered ocular drugs, such as atropine and p-blockers, can affect systemic blood pressure and cardiac activity. This is especially important before and during long-term treatment with P-blockers in those patients with glaucoma. 

Systemically administered atropine may also cause mydriasis and raise lOP in patients with open-angle glaucoma. After intramuscular injection of 0.6 mg atropine, three of eight patients developed 0.5- to 1.5-mm mydriasis. A mean increase of 0.8 cm in the near point of accommodation after atropine administration was also reported. 

Atropine is contraindicated for patients who are hypersensitive to the belladonna alkaloids, have open-angle or angle-closure glaucoma, or have a tendency toward lOP elevations. Manufecturers recommended dosages should not be exceeded, particularly in infants, small children, and the elderly. Children with Down s syndrome demonstrate a hyperreactive pupillary response to topical atropine. 

Topically applied cyclopentolate can increase lOP in patients with primary open-angle glaucoma, and it may precipitate an attack of acute glaucoma in patients with narrow angles. It was reported that approximately 1 of 4 eyes with open-angle glaucoma responded to topical 1% cyclopentolate with a significant elevation of lOP (6 mm Hg or more increase compared with the baseline lOP), whereas only 2 of 100 normal eyes responded in a similar manner. These two apparently normal eyes also responded with an lOP increase of 6 mm Hg or more with the application of 5% homatropine or an application of 1% atropine. 

You have been asked to consult in the treatment of an 8()-year-old patient. An antimuscaiinic drug is being considered. Atropine therapy in the elderly may be hazardous becau.se (A) Atropine can elevate intraocular pressure in patients with glaucoma Atropine frequently causes ventricular arrhythmias Urinary retention is often precipitated by atiopine in women... 

CiiHi NjOa, Mr 208.26, oily liquid or crystals, mp. 34 °C (as hydrochloride 193-205 °C, nitrate I74°C), bp. 260°C (0.7 kPa), [a] > +106° (HjO), soluble in water, ethanol, chloroform forms well crystallizing salts with acids. P. is the main alkaloid of the South American jaborandi tree (Pilocarpus jaborandi). It is isolated from the leaves. P. is also easily accessible by synthesis and is used as its salts in medicine as a cholinergic parasympathicomimetic, miotic (for glaucoma) agent and as an atropine antagonist it is also used in veterinary medicine for colics and constipation. Detection by means of Helch s reaction. Pilocarpus species contain further imidazole alkaloids (see table). 

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