13. PASSIVE MYDRIASIS – due to unopposed
action of sympathetic dilator activity
Loss of light reflex .
Active
mydriasis?
14. ons 1 & 2
CYCLOPLEGIA
(Paralysis of accomodation)
-eyes set for distant vision
15. EYE
• Topical instillation of atropine (0.1%) causes
–Passive mydriasis
–abolition of light reflex
–Cycloplegia
• Last 7–10 days
• Photophobia & blurring of near vision.
The IOP ↑specially in narrow angle
glaucoma-contraindicated in GLAUCOMA
16. SMOOTH MUSCLES
visceral smooth muscles-
relaxed (M3-block).
Tone & amplitude of
contractions - GIT ↓
Spasm
reduced,
constipation
18. Relaxant - ureter & urinary bladder.
Beneficial neurogenic bladder/enuresis
More chance of Urinary retention -
older man with prostatic hyperplasia.
19. GLANDS
↓sweat, salivary,
tracheobrochial &
lacrimal secretion
(M3-block).
Skin & eyes becomes
dry
↓ the secretion of
acid, pepsin & mucus
in the stomach
Bile & milk secretion
not under cholinergic
control, so not affected
by atropine
20. BODY TEMPERATURE
Rise in body temp occurs
LOCAL ANAESTHETIC ACTION
Mild anaesthetic action on the cornea
24. Bronchodilator-Large airways
No alteration of volume or
consistency of resp secretion
No depression of mucociliary
clearance -bronchial epithelium
SE : Dryness of mouth, scratching
in trachea, Cough , Bad taste
Use-prophylatic-COPD, perennial
rhinitis, common cold
*******IPRATROPIUM BROMIDE*****
25. *****TIOTROPIUM BROMIDE*****
• Long lasting bronchodilator
• Binds tightly to M1/M3
• High bronchial selectivity
*****OXITROPIUM BROMIDE*****
32. MYDRIATICS
• Atropine – potent mydriatic
• Slow & Long lasting action - undesirable for
Refraction testing
• Pupil dilates in 30- 40 mins; Cycloplegia – 1-3 hrs
• Visually handicapped x 1 week
HOMATROPINE
• 10 times less potent
• Acts in 45-60 mn,lasts 1- 3days
• Accomodation recover 1-2 days
33. CYCLOPENTOLATE
• Potent & Rapidly acting
• Mydriasis & Cycloplegia – occur in 30-60 min & lasts
1 day
– Preferred for cycloplegic refraction
Children – Transient behavioural abnormalities
******TROPICAMIDE*****
• Quickest (20-40 min) & Briefest action(3-6hrs)
• Unreliable cycloplegic
• Refraction testing in adults
• Short acting mydriatic for fundoscopy
34. USES
PRE ANAESTHETIC MEDICATION-
Glycopyrrolate
↓ salivary & Tracheobronchial secretion
↓secretion which predispose to reflex
larnyngospasm
Prevent vasovagal attack during
anaesthesia
keeps in check arryhthmias- NA mediated
ventricular arrhythmia
39. 1. DIAGNOSTIC
• Testing error of refraction – Tropicamide
• Atropine– in children
• Fundoscopy
2. THERAPEUTIC
• Iritis, iridocyclitis, Choroiditis, Keratitis &
Corneal ulcer-rest and relieve spasm
• Prevent /break adhesions between Iris and Lens
or Iris and Cornea alternating with Miotic
45. Treatment:
• Gastric lavage with tannic acid
(KMnO4 is ineffective in oxidation
of atropine).
• The patient must be kept in a
dark quiet room.
• Cold sponging / Ice bags applied
• Assisted respiration, maintain
circulation, diazepam for
46. INTERACTIONS
• Absorption of most drugs is slowed because
atropine delays gastric empting.
•Antihistaminics, tricyclic
antidepressants, phenothiazines,
pethidine have anticholinergic
property- additive SE.
50. Nicotine
• Important in the context of
smoking and tobacco chewing
• Its only clinical indication is short-
term nicotine replacement in
tobacco abstinent subjects
51. Nicotine transdermal
• once daily on the hip/ abdomen/ chest/
upper arm - aid smoking cessation.
• Ameliorates the symptoms of
withdrawal
• Only partially suppresses craving -
intermittent peak nicotine blood levels -
smoking are not reproduced by the
patch.
52. Varenicline
• Partial agonist of Nicotinic receptor
• Oral tablets - help smoking cessation.
• Reduce craving as well as nicotine
withdrawal symptoms
• Side effects - mood changes, appetite &
taste disturbances
53. GANGLION BLOCKING AGENTS
A. Competitive blockers
Hexamethonium
Mecamylamine, Pempidine
Trimethaphan
B. Persistent depolarising blockers
Nicotine
Anticholinesterases
54. Re-Cap
1. The 2 natural anticholinergics are……………..
2. The drug of choice for motion sickness
is…………………………
3. The drug of choice for drug induced
parkinsonism is…………………………..
4. The other name of hyoscine is……………………
5. The antisecretory agent used as
preanaesthetic medication is…………………….
55. 6. Advantages of glycopyrrolate over atropine
are that it is…………………,…………………………..
and……………………………………………………………
7. The anticholinergics preferred for COPD
are……………………………and…………………………….
8. Advantages of Ipratropium over atropine are
that…………………………………………………………and
………………………………………………………………….
9. Anticholinergics
produce……………………….,…………………….and
………………………………………in the eye
56. 10.The anticholinergics that cause mydriasis
are………………………………….,……………………………
,……………………………………….,…………………………
11.…………………………….is the quickest and
shortest acting mydriatic
12.The vasicoselective anticholinergics
are………………………….,…………………………….and
……………………………
13.…………………..is an anticholinergic with direct
smooth muscle relaxant and antiemetic
property
57. 14. …………………………….is a non anticholinergic which
inhibits PDE4
15. ………………………………and …………………………are the
anticholinergics used to treat peptic ulcer
16. The mydriatic of choice
in elderly, children, adults
17.Give rationale
a. Atropine along with neostigmine in cobra bite
poisoning
b. Neostigmine/Physostigmine for treatment of
Atropine poisoning
c.Levodopa/Benzhexol for treatment of Drug Induced
Parkinsonism
58. What are the uses of atropine?
1. Doc in organophosphate poisoning
2. Sinus bradycadia and first degree AV block
3. As preanesthetic-to decrease the
senisitisation of heart to NA by halothane
4. For refraction testing in children-mydriasis
with cycloplegia.
5. To break adhesions in iritis ,iridocyclitis
6. In mushroom poisoning
