Атропин — Википедия

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Атропин — Википедия

Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. Common side effects include a dry mouth, large pupils , urinary retention , constipation , and a fast heart rate. Atropine occurs naturally in a number of plants of the nightshade family including deadly nightshade , Jimson weed , and mandrake. Topical atropine is used as a cycloplegic , to temporarily paralyze the accommodation reflex , and as a mydriatic , to dilate the pupils. In refractive and accommodative amblyopia , when occlusion is not appropriate sometimes atropine is given to induce blur in the good eye. While atropine eye drops have been shown to be effective in slowing the progression of myopia in children in several studies, side effects such as blurred vision and sensitivity to light occur. Atropine was previously included in international resuscitation guidelines for use in cardiac arrest associated with asystole and PEA , but was removed from these guidelines in due to a lack of evidence for its effectiveness. Atropine is also useful in treating second-degree heart block Mobitz type 1 Wenckebach block , and also third-degree heart block with a high purkinje or AV-nodal escape rhythm. It is usually not effective in second-degree heart block Mobitz type 2 , and in third-degree heart block with a low Purkinje or ventricular escape rhythm. Atropine has also been used in an effort to prevent a low heart rate during intubation of children; however, evidence does not support this use. The drug may also inhibit sweating via the sympathetic nervous system. This can be useful in treating hyperhidrosis , and can prevent the death rattle of dying patients. Even though atropine has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes. Atropine is not an actual antidote for organophosphate poisoning. However, by blocking the action of acetylcholine at muscarinic receptors, atropine also serves as a treatment for poisoning by organophosphate insecticides and nerve agents , such as tabun GA , sarin GB , soman GD , and VX. Troops who are likely to be attacked with chemical weapons often carry autoinjectors with atropine and an oxime , for rapid injection into the muscles of the thigh. In a developed case of nerve-gas poisoning, maximum atropinization is desirable. Atropine is often used in conjunction with the oxime pralidoxime chloride. Some of the nerve agents attack and destroy acetylcholinesterase by phosphorylation , so the action of acetylcholine becomes excessive and prolonged. Pralidoxime 2-PAM can be effective against organophosphate poisoning because it can re-cleave this phosphorylation. Atropine can be used to reduce the effect of the poisoning by blocking muscarinic acetylcholine receptors, which would otherwise be overstimulated, by excessive acetylcholine accumulation. Adverse reactions to atropine include ventricular fibrillation , supraventricular or ventricular tachycardia , dizziness , nausea , blurred vision, loss of balance, dilated pupils, photophobia , dry mouth and potentially extreme confusion , deliriant hallucinations , and excitation especially among the elderly. Most of available ampules are carried on sulfate which can cause histamine release and anaphylaxis to susceptible patients or patients with allergy to sulfa products. These latter effects are because atropine is able to cross the blood—brain barrier. Because of the hallucinogenic properties, some have used the drug recreationally , though this is potentially dangerous and often unpleasant. In overdoses, atropine is poisonous. Atropine is sometimes added to potentially addictive drugs, particularly antidiarrhea opioid drugs such as diphenoxylate or difenoxin , wherein the secretion-reducing effects of the atropine can also aid the antidiarrhea effects. Although atropine treats bradycardia slow heart rate in emergency settings, it can cause paradoxical heart rate slowing when given at very low doses i. A common mnemonic used to describe the physiologic manifestations of atropine overdose is: 'hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter'. This set of symptoms is known as anticholinergic toxidrome , and may also be caused by other drugs with anticholinergic effects, such as hyoscine hydrobromide scopolamine , diphenhydramine , phenothiazine antipsychotics and benztropine. It is generally contraindicated in people with glaucoma , pyloric stenosis , or prostatic hypertrophy , except in doses ordinarily used for preanesthetia. Atropine is an enantiomeric mixture of d - hyoscyamine and l -hyoscyamine, with most of its physiological effects due to l -hyoscyamine. Its pharmacological effects are due to binding to muscarinic acetylcholine receptors. It is an antimuscarinic agent. Significant levels are achieved in the CNS within 30 minutes to 1 hour and disappears rapidly from the blood with a half-life of 2 hours. No conjugates were detectable. In general, atropine counters the 'rest and digest' activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive, reversible antagonist of the muscarinic acetylcholine receptors acetylcholine being the main neurotransmitter used by the parasympathetic nervous system. Atropine is a competitive antagonist of the muscarinic acetylcholine receptor types M1 , M2 , M3 , M4 and M5. In cardiac uses, it works as a nonselective muscarinic acetylcholinergic antagonist, increasing firing of the sinoatrial node SA and conduction through the atrioventricular node AV of the heart , opposes the actions of the vagus nerve , blocks acetylcholine receptor sites, and decreases bronchial secretions. In the eye, atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial iris dilator muscle to contract and dilate the pupil. Atropine induces cycloplegia by paralyzing the ciliary muscles , whose action inhibits accommodation to allow accurate refraction in children, helps to relieve pain associated with iridocyclitis , and treats ciliary block malignant glaucoma. The vagus parasympathetic nerves that innervate the heart release acetylcholine ACh as their primary neurotransmitter. ACh binds to muscarinic receptors M2 that are found principally on cells comprising the sinoatrial SA and atrioventricular AV nodes. Muscarinic receptors are coupled to the Gi-protein ; therefore, vagal activation decreases cAMP. Gi-protein activation also leads to the activation of KACh channels that increase potassium efflux and hyperpolarizes the cells. Increases in vagal activities to the SA node decreases the firing rate of the pacemaker cells by decreasing the slope of the pacemaker potential phase 4 of the action potential ; this decreases heart rate negative chronotropy. The change in phase 4 slope results from alterations in potassium and calcium currents, as well as the slow-inward sodium current that is thought to be responsible for the pacemaker current If. Similar electrophysiological effects also occur at the AV node; however, in this tissue, these changes are manifested as a reduction in impulse conduction velocity through the AV node negative dromotropy. In the resting state, there is a large degree of vagal tone on the heart, which is responsible for low resting heart rates. There is also some vagal innervation of the atrial muscle, and to a much lesser extent, the ventricular muscle. Vagus activation, therefore, results in modest reductions in atrial contractility inotropy and even smaller decreases in ventricular contractility. Muscarinic receptor antagonists bind to muscarinic receptors thereby preventing ACh from binding to and activating the receptor. By blocking the actions of ACh, muscarinic receptor antagonists very effectively block the effects of vagal nerve activity on the heart. By doing so, they increase heart rate and conduction velocity. The name atropine was coined in the 19th century, when pure extracts from the belladonna plant Atropa belladonna were first made. Mandragora mandrake was described by Theophrastus in the fourth century B. By the first century A. Dioscorides recognized wine of mandrake as an anaesthetic for treatment of pain or sleeplessness, to be given prior to surgery or cautery. Atropine-rich extracts from the Egyptian henbane plant another nightshade were used by Cleopatra in the last century B. Likewise in the Renaissance , women used the juice of the berries of the nightshade Atropa belladonna to enlarge their pupils for cosmetic reasons. This practice resumed briefly in the late nineteenth and early twentieth century in Paris. The pharmacological study of belladonna extracts was begun by the German chemist Friedlieb Ferdinand Runge — In , the German pharmacist Heinrich F. Mein \\\\\\\\\\\\[31\\\\\\\\\\\\] succeeded in preparing a pure crystalline form of the active substance, baptized atropine. Atropine is found in many members of the family Solanaceae. The most commonly found sources are Atropa belladonna the deadly nightshade , Datura innoxia , D. Atropine can be synthesized by the reaction of tropine with tropic acid in the presence of hydrochloric acid. The biosynthesis of atropine starting from l -phenylalanine first undergoes a transamination forming phenylpyruvic acid which is then reduced to phenyl-lactic acid. Both atropine and the genus name for deadly nightshade derive from Atropos , one of the three Fates who, according to Greek mythology, chose how a person was to die. From Wikipedia, the free encyclopedia. IUPAC name. Interactive image. This article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. Retrieved Clinical anesthesia 6th ed. Archived from the original on Retrieved Aug 13, Tarascon pharmacopoeia 15 ed. National Eye Institute. Putting special eye drops in the stronger eye. A once-a-day drop of the drug atropine can temporarily blur near vision, which forces the brain to use the other eye. For some kids, this treatment works as well as an eye patch, and some parents find it easier to use for example, because young children may try to pull off eye patches. Archived from the original on 6 September Retrieved 14 August Neurological aspects of substance abuse 2 ed. Philadelphia: Elsevier. World Health Organization model list of essential medicines: 21st list Geneva: World Health Organization. International Drug Price Indicator Guide. Retrieved 13 August Clinical and Experimental Ophthalmology. The Cochrane Database of Systematic Reviews. JAMA Ophthalmology. Community Eye Health. November Porter; Richard A. Cherry Intermediate Emergency Care. Elsevier Churchill Livingstone. Ketchum J, Kirby R eds. Historical Contributions to the Human Toxicology of Atropine. Holzman, MD July Arena, Poisoning: Toxicology-Symptoms-Treatments, 3rd edition. Springfield, Charles C. Archived from the original on 2 July National Library of Medicine. Retrieved 30 October The Journal of Pharmacy and Pharmacology. Annalen der Pharmacie in German. Geiger; Hesse Ancient anaesthesia. Drugs for functional gastrointestinal disorders A Papaverine Drotaverine Moxaverine. Tertiary amines: Atropine Hyoscyamine Quaternary ammonium compounds: Scopolamine Butylscopolamine Methylscopolamine Methylatropine Fentonium bromide Cimetropium bromide. Emergency medicine. Emergency department Emergency medical services Emergency nursing Emergency psychiatry Golden hour Medical emergency International emergency medicine Pediatric emergency medicine Pre-hospital emergency medicine Major trauma Trauma center Triage. Book Category Outline. Diphenidine Ephenidine Fluorolintane Methoxphenidine. Dextrallorphan Dextromethorphan Dextrorphan Racemethorphan Racemorphan. Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D 2 agonists, such as dopamine reuptake inhibitors cocaine , methylphenidate , releasing agents amphetamine , methamphetamine , and precursors levodopa. Glaucine Isoaminile Noscapine Pukateine. Ophthalmologicals : mydriasis and cycloplegia S01F. Phenylephrine Ephedrine Ibopamine. Drugs used for glaucoma preparations and miosis S01E. Aceclidine Pilocarpine. Acetylcholine Carbachol. Dapiprazole Guanethidine Ripasudil. Muscarinic acetylcholine receptor modulators. Medicine portal. Categories : Antidotes Deliriants Entheogens Pfizer brands Muscarinic antagonists Tropane alkaloids Tropane alkaloids found in Solanaceae World Health Organization essential medicines Esters Primary alcohols Oneirogens Glycine receptor agonists Secondary metabolites Chemical substances for emergency medicine Medical mnemonics Anticholinergics. Namespaces Article Talk. Views Read Edit View history. In other projects Wikimedia Commons. By using this site, you agree to the Terms of Use and Privacy Policy.

Атропин — Википедия

Как действует атропин

Atropine is a medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate and to decrease saliva production during surgery. Common side effects include a dry mouth, large pupils , urinary retention , constipation , and a fast heart rate. Atropine occurs naturally in a number of plants of the nightshade family including deadly nightshade , Jimson weed , and mandrake. Topical atropine is used as a cycloplegic , to temporarily paralyze the accommodation reflex , and as a mydriatic , to dilate the pupils. In refractive and accommodative amblyopia , when occlusion is not appropriate sometimes atropine is given to induce blur in the good eye. While atropine eye drops have been shown to be effective in slowing the progression of myopia in children in several studies, side effects such as blurred vision and sensitivity to light occur. Atropine was previously included in international resuscitation guidelines for use in cardiac arrest associated with asystole and PEA , but was removed from these guidelines in due to a lack of evidence for its effectiveness. Atropine is also useful in treating second-degree heart block Mobitz type 1 Wenckebach block , and also third-degree heart block with a high purkinje or AV-nodal escape rhythm. It is usually not effective in second-degree heart block Mobitz type 2 , and in third-degree heart block with a low Purkinje or ventricular escape rhythm. Atropine has also been used in an effort to prevent a low heart rate during intubation of children; however, evidence does not support this use. The drug may also inhibit sweating via the sympathetic nervous system. This can be useful in treating hyperhidrosis , and can prevent the death rattle of dying patients. Even though atropine has not been officially indicated for either of these purposes by the FDA, it has been used by physicians for these purposes. Atropine is not an actual antidote for organophosphate poisoning. However, by blocking the action of acetylcholine at muscarinic receptors, atropine also serves as a treatment for poisoning by organophosphate insecticides and nerve agents , such as tabun GA , sarin GB , soman GD , and VX. Troops who are likely to be attacked with chemical weapons often carry autoinjectors with atropine and an oxime , for rapid injection into the muscles of the thigh. In a developed case of nerve-gas poisoning, maximum atropinization is desirable. Atropine is often used in conjunction with the oxime pralidoxime chloride. Some of the nerve agents attack and destroy acetylcholinesterase by phosphorylation , so the action of acetylcholine becomes excessive and prolonged. Pralidoxime 2-PAM can be effective against organophosphate poisoning because it can re-cleave this phosphorylation. Atropine can be used to reduce the effect of the poisoning by blocking muscarinic acetylcholine receptors, which would otherwise be overstimulated, by excessive acetylcholine accumulation. Adverse reactions to atropine include ventricular fibrillation , supraventricular or ventricular tachycardia , dizziness , nausea , blurred vision, loss of balance, dilated pupils, photophobia , dry mouth and potentially extreme confusion , deliriant hallucinations , and excitation especially among the elderly. Most of available ampules are carried on sulfate which can cause histamine release and anaphylaxis to susceptible patients or patients with allergy to sulfa products. These latter effects are because atropine is able to cross the blood—brain barrier. Because of the hallucinogenic properties, some have used the drug recreationally , though this is potentially dangerous and often unpleasant. In overdoses, atropine is poisonous. Atropine is sometimes added to potentially addictive drugs, particularly antidiarrhea opioid drugs such as diphenoxylate or difenoxin , wherein the secretion-reducing effects of the atropine can also aid the antidiarrhea effects. Although atropine treats bradycardia slow heart rate in emergency settings, it can cause paradoxical heart rate slowing when given at very low doses i. A common mnemonic used to describe the physiologic manifestations of atropine overdose is: 'hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter'. This set of symptoms is known as anticholinergic toxidrome , and may also be caused by other drugs with anticholinergic effects, such as hyoscine hydrobromide scopolamine , diphenhydramine , phenothiazine antipsychotics and benztropine. It is generally contraindicated in people with glaucoma , pyloric stenosis , or prostatic hypertrophy , except in doses ordinarily used for preanesthetia. Atropine is an enantiomeric mixture of d - hyoscyamine and l -hyoscyamine, with most of its physiological effects due to l -hyoscyamine. Its pharmacological effects are due to binding to muscarinic acetylcholine receptors. It is an antimuscarinic agent. Significant levels are achieved in the CNS within 30 minutes to 1 hour and disappears rapidly from the blood with a half-life of 2 hours. No conjugates were detectable. In general, atropine counters the 'rest and digest' activity of glands regulated by the parasympathetic nervous system. This occurs because atropine is a competitive, reversible antagonist of the muscarinic acetylcholine receptors acetylcholine being the main neurotransmitter used by the parasympathetic nervous system. Atropine is a competitive antagonist of the muscarinic acetylcholine receptor types M1 , M2 , M3 , M4 and M5. In cardiac uses, it works as a nonselective muscarinic acetylcholinergic antagonist, increasing firing of the sinoatrial node SA and conduction through the atrioventricular node AV of the heart , opposes the actions of the vagus nerve , blocks acetylcholine receptor sites, and decreases bronchial secretions. In the eye, atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial iris dilator muscle to contract and dilate the pupil. Atropine induces cycloplegia by paralyzing the ciliary muscles , whose action inhibits accommodation to allow accurate refraction in children, helps to relieve pain associated with iridocyclitis , and treats ciliary block malignant glaucoma. The vagus parasympathetic nerves that innervate the heart release acetylcholine ACh as their primary neurotransmitter. ACh binds to muscarinic receptors M2 that are found principally on cells comprising the sinoatrial SA and atrioventricular AV nodes. Muscarinic receptors are coupled to the Gi-protein ; therefore, vagal activation decreases cAMP. Gi-protein activation also leads to the activation of KACh channels that increase potassium efflux and hyperpolarizes the cells. Increases in vagal activities to the SA node decreases the firing rate of the pacemaker cells by decreasing the slope of the pacemaker potential phase 4 of the action potential ; this decreases heart rate negative chronotropy. The change in phase 4 slope results from alterations in potassium and calcium currents, as well as the slow-inward sodium current that is thought to be responsible for the pacemaker current If. Similar electrophysiological effects also occur at the AV node; however, in this tissue, these changes are manifested as a reduction in impulse conduction velocity through the AV node negative dromotropy. In the resting state, there is a large degree of vagal tone on the heart, which is responsible for low resting heart rates. There is also some vagal innervation of the atrial muscle, and to a much lesser extent, the ventricular muscle. Vagus activation, therefore, results in modest reductions in atrial contractility inotropy and even smaller decreases in ventricular contractility. Muscarinic receptor antagonists bind to muscarinic receptors thereby preventing ACh from binding to and activating the receptor. By blocking the actions of ACh, muscarinic receptor antagonists very effectively block the effects of vagal nerve activity on the heart. By doing so, they increase heart rate and conduction velocity. The name atropine was coined in the 19th century, when pure extracts from the belladonna plant Atropa belladonna were first made. Mandragora mandrake was described by Theophrastus in the fourth century B. By the first century A. Dioscorides recognized wine of mandrake as an anaesthetic for treatment of pain or sleeplessness, to be given prior to surgery or cautery. Atropine-rich extracts from the Egyptian henbane plant another nightshade were used by Cleopatra in the last century B. Likewise in the Renaissance , women used the juice of the berries of the nightshade Atropa belladonna to enlarge their pupils for cosmetic reasons. This practice resumed briefly in the late nineteenth and early twentieth century in Paris. The pharmacological study of belladonna extracts was begun by the German chemist Friedlieb Ferdinand Runge — In , the German pharmacist Heinrich F. Mein \\\\\\\\\\\\\\[31\\\\\\\\\\\\\\] succeeded in preparing a pure crystalline form of the active substance, baptized atropine. Atropine is found in many members of the family Solanaceae. The most commonly found sources are Atropa belladonna the deadly nightshade , Datura innoxia , D. Atropine can be synthesized by the reaction of tropine with tropic acid in the presence of hydrochloric acid. The biosynthesis of atropine starting from l -phenylalanine first undergoes a transamination forming phenylpyruvic acid which is then reduced to phenyl-lactic acid. Both atropine and the genus name for deadly nightshade derive from Atropos , one of the three Fates who, according to Greek mythology, chose how a person was to die. From Wikipedia, the free encyclopedia. IUPAC name. Interactive image. This article needs more medical references for verification or relies too heavily on primary sources. Please review the contents of the article and add the appropriate references if you can. Unsourced or poorly sourced material may be challenged and removed. Retrieved Clinical anesthesia 6th ed. Archived from the original on Retrieved Aug 13, Tarascon pharmacopoeia 15 ed. National Eye Institute. Putting special eye drops in the stronger eye. A once-a-day drop of the drug atropine can temporarily blur near vision, which forces the brain to use the other eye. For some kids, this treatment works as well as an eye patch, and some parents find it easier to use for example, because young children may try to pull off eye patches. Archived from the original on 6 September Retrieved 14 August Neurological aspects of substance abuse 2 ed. Philadelphia: Elsevier. World Health Organization model list of essential medicines: 21st list Geneva: World Health Organization. International Drug Price Indicator Guide. Retrieved 13 August Clinical and Experimental Ophthalmology. The Cochrane Database of Systematic Reviews. JAMA Ophthalmology. Community Eye Health. November Porter; Richard A. Cherry Intermediate Emergency Care. Elsevier Churchill Livingstone. Ketchum J, Kirby R eds. Historical Contributions to the Human Toxicology of Atropine. Holzman, MD July Arena, Poisoning: Toxicology-Symptoms-Treatments, 3rd edition. Springfield, Charles C. Archived from the original on 2 July National Library of Medicine. Retrieved 30 October The Journal of Pharmacy and Pharmacology. Annalen der Pharmacie in German. Geiger; Hesse Ancient anaesthesia. Drugs for functional gastrointestinal disorders A Papaverine Drotaverine Moxaverine. Tertiary amines: Atropine Hyoscyamine Quaternary ammonium compounds: Scopolamine Butylscopolamine Methylscopolamine Methylatropine Fentonium bromide Cimetropium bromide. Emergency medicine. Emergency department Emergency medical services Emergency nursing Emergency psychiatry Golden hour Medical emergency International emergency medicine Pediatric emergency medicine Pre-hospital emergency medicine Major trauma Trauma center Triage. Book Category Outline. Diphenidine Ephenidine Fluorolintane Methoxphenidine. Dextrallorphan Dextromethorphan Dextrorphan Racemethorphan Racemorphan. Apomorphine Aporphine Bromocriptine Cabergoline Lisuride Memantine Nuciferine Pergolide Phenethylamine Piribedil Pramipexole Ropinirole Rotigotine Salvinorin A Also indirect D 2 agonists, such as dopamine reuptake inhibitors cocaine , methylphenidate , releasing agents amphetamine , methamphetamine , and precursors levodopa. Glaucine Isoaminile Noscapine Pukateine. Ophthalmologicals : mydriasis and cycloplegia S01F. Phenylephrine Ephedrine Ibopamine. Drugs used for glaucoma preparations and miosis S01E. Aceclidine Pilocarpine. Acetylcholine Carbachol. Dapiprazole Guanethidine Ripasudil. Muscarinic acetylcholine receptor modulators. Medicine portal. Categories : Antidotes Deliriants Entheogens Pfizer brands Muscarinic antagonists Tropane alkaloids Tropane alkaloids found in Solanaceae World Health Organization essential medicines Esters Primary alcohols Oneirogens Glycine receptor agonists Secondary metabolites Chemical substances for emergency medicine Medical mnemonics Anticholinergics. Namespaces Article Talk. Views Read Edit View history. In other projects Wikimedia Commons. By using this site, you agree to the Terms of Use and Privacy Policy.

Атропин (Atropine)

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Атропин — Википедия

Как действует атропин

Атропин (Atropine)

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