Although atropine is used in a large variety of clinical settings, this drug can also be a poison, causing severe toxicity. Because it is found in many natural products, including the belladonna plant, and may be present in herbal or alternative therapy products, atropine toxicity can occur inadvertently. Atropine toxicity should be considered whenever a patient receiving an anticholinergic drug presents with a sudden onset of bizarre mental and neurological symptoms. Toxicity is dose related and usually progresses as follows:
0.5 mg atropine: Slight cardiac slowing, dryness of mouth, inhibition of sweating 0.5 mg阿托品：心脏略微变慢，口干，出汗受抑 1.0 mg atropine: Definite mouth and throat dryness, thirst, rapid heart rate, pupil dilation 1.0 mg阿托品：明显口干和喉头干燥，渴，快速心率，瞳孔扩大 2.0 mg atropine: Rapid heart rate, palpitations; marked mouth dryness; dilated pupils; some blurring of vision 2.0 mg阿托品：快速心率，心悸，显著性口干，瞳孔扩大，视力模糊 5.0 mg atropine: All of the foregoing and marked speech disturbances; difficulty swallowing; restlessness, fatigue, and headache; dry and hot skin; difficulty voiding; reduced intestinal peristalsis 5.0 mg阿托品：上述情形+显著性言语错乱；吞咽困难；不安，疲劳，头痛；皮肤干、热；排便困难；肠蠕动减少 10.0 mg atropine: All of the foregoing symptoms, more marked; pulse rapid and weak; iris nearly gone; vision blurred; skin flushed, hot, dry, and scarlet; ataxia; restlessness and excitement; hallucinations; delirium; and coma 10.0 mg阿托品：上述情形，更加明显；脉搏快、弱；几无虹膜；视力模糊；皮肤潮红、热、干燥、猩红；共济失调；不安、兴奋；幻觉；谵妄；昏迷
Treatment is as follows. If the poison was taken orally, immediate gastric lavage should be done to limit absorption. Physostigmine can be used as an antidote. A slow intravenous injection of 0.5 to 4 mg (depending on the size of the patient and the severity of the symptoms) usually reverses the delirium and coma of atropine toxicity. Physostigmine is metabolized rapidly, so the injection may need to be repeated every 1 to 2 hours until the atropine has been cleared from the system. A barbiturate can be used if an anticonvulsant is needed. Cool baths and alcohol sponging may relieve the fever and hot skin. In extreme cases, respiratory support may be needed. It is important to remember that the half-life of atropine is 2.5 hours; at extremely high doses, several hours may be needed to clear the atropine from the body.
poison – n. 毒药
toxicity – n. 毒性
inadvertently – ad. 不注意地
bizarre – a. 稀奇古怪的
throat dryness -- 喉头干燥
foregoing – a. 前述的，上述的
speech disturbances -- 言语错乱
ataxia – n. 共济失调
physostigmine – n. 毒扁豆碱 Sanctura – n. 【奥】圣图拉
muscarinic – a. 毒蕈碱的
carotid sinus reflex – 颈动脉窦反射
pylorospasm – n. 幽门痉挛
motion sickness – 晕动病
colic – n. 绞痛，疝痛
detrusor – n. 逼肌
detrusor muscle – 逼尿肌
hypertonicity – n. 高张性，紧张过度
mydriasis – n. 瞳孔散大，散瞳症
cycloplegia – n. 睫状肌麻痹
belladonna – n. 颠茄
alluring – a. 迷人的，诱惑的
注：标记【奥】者为本站临时用名，只为方便会员学习记忆，不得作为临床用药依据。
Atropine
1. The female client tells the clinic nurse that she gets car sick every time the family goes on a vacation and the HCP prescribed scopolamine for motion sickness. Which statement indicates the client understands the medication teaching? Select all that apply.
A. “I will put the transdermal scopolamine patch behind my ear.”
B. “I will put the patch on for 12 hours and take it off at night.”
C. “If my car sickness does not go away, I will wear two patches.”
D. “I should leave the patch on for 3 days before changing it.”
E. “I should take the medication with one glass of water.”
2. Atropine and scopolamine work by blocking what receptor(s) in the parasympathetic nervous system?
A. Nicotinic receptors only
B. Muscarinic and nicotinic receptors
C. Muscarinic receptors only
D. Adrenergic receptors to allow cholinergic receptors to dominate
答案 Answers
1. A, D Rationale: Scopolamine (Transderm Scop) is a topical anticholinergic. The Transderm Scop patch is applied behind the ears. It is effective up to 3 days; therefore, this indicates the client understands the medication teaching. 2. C. Muscarinic receptors only Rationale: Atropine and scopolamine work by blocking only the muscarinic effectors in the parasympathetic nervous system and the few cholinergic receptors in the SNS.
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