Treatment of cardiac rhythm is a complicated problem, which has to be solved in order of emergency case. Nowadays, there are two methods of the treatment medication: the drug therapy and the electro pulse treatment. Atropine (Lat. Antropinum) is anticholinergic action. Chemically it is racemic mixture of tropinic ether D-and-L tropic acid. The atropine is contained in various plants of the nightshade family: belladonna, henbane, different types of intoxication, etc. In general, chemical basis of their actions is clear.
The ability of these plants to cause mental changes have been known for thousands of years, at least since the time of ancient Greece and Rome. In antiquity and the middle Ages, it was used for the religious ceremonies, witchcraft, to prove the enemy has a mental illness, etc. It was believed, for example, that the famous Pythia – prophetess of the temple of Apollo at Delphi – prophesied under the influence of belladonna. The prophecy pythonesses differed their inscrutability and incomprehensibility. In the Middle Age a number of self-incriminations – the recognition in dealing with the devil, participation in Sabbath – were often the result of poisoning by atropine. The idea of atropine, as the mysterious agents affecting the human soul, reflected in the names of plants containing dope, – witch grass and devil’s weed. The title atropine, – is derived from the name of Atropos – the ancient Greek goddess of fate, who cut the threat of human life. The descriptions of mental disorders, – caused buy the dope and other plants, not belonging to doctors, are also known for a long time. It was described the state of the excitation of soldiers of the Roman general Antony, who overturned every stone in the field. In 1676 Beverly described the daturism of a group of soldiers, – who were excited, rolled on the ground, produced mindless actions, grimaced, barked, laughed, some of them fell into a coma. Nowadays, the atropines psychoses are relatively often – in the experience they are observed more than other drug psychoses. The cause of psychoses can be as accidental poisoning by henbane, dope and atropine, as the drug poisoning – when atropine is used for medical purposes. In the foreign literature there are references to the use of scopolamine for criminal purposes to cause the picture of mental illness or cause the victim in a helpless state, for example, to rape. In this case a woman could not resist and performing all demands to her “with open eyes, but with the associated spirit”, and later she did not remember what happened. The psychosis develops after a single or short-term high-dose atropine, much less with prolonged course of treatment.
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Atropine in the body associated with reduction the secretion of salivary, gastric, bronchial, sweat glands (the latter receive cholinergic sympathetic innervation), pancreas, rapid heart rate (due to the inhibitory effect on the heart of the vagus nerve), lowering the tone of smooth muscle organs (bronchi, abdominal cavity and others). Atropine effect is more pronounced with increased vagal tone. Under the influence of the atropine eyes of pupils widen. It is connected with relaxation of orbicular muscle of the iris, which is innervated by parasympathetic fibers. At the same time, with the expansion to pupils, the intraocular pressure can increase due to the violation of the efflux of fluid. The atropine is used for gastric ulcer and dodecadactylon, pylorospasm, cholecystitis, cholelithiasis, enterospasm, urinary tracks, bronchial allergy, to reduce the secretion of saliva, gastral and bronchial glands, brachycardia, developed by the increasing vagal tone. Atropine is often administered with analgesics (analgin, promedol, morphine), – in case of the pain associated with spasms of smooth muscle.
The atropine is also used before anesthesia and surgery and during the operation to prevent bronchiolospasm and laryngospasm, and limits the secretion of salivary and bronchial glands reducing the reaction and other effects associated with the excitation of the vagus nerve.
The atropine is also used for X-ray examination of the gastrointestinal tract with the need to reduce the tone and motility of the stomach and intestines.
The atropine is used with excessive sweating to reduce the secretion of sweat glands.
The atropine has complex effects on the central nervous system. It has a central effect and causes a decrease in patients with Parkinson’s tremor and muscle tension, however, it is not effective enough; its strong influence on the peripheral M-cholinergic receptors leads to several complications (dry mouth, heart palpitations), complicating its long-term use for these purposes. In large doses the atropine stimulates the cortex of the brain and can cause motor and mental agitation, extreme restlessness, seizures, hallucinatory phenomena. It also can excite breathing in large doses, but with it the medicine can excite respiratory paralysis.
The atropine blocks the inhibitory effect on the heart by the vagus nerve, so it causes a rapid heart rate. This effect of atropine is used in the deceleration of the heart rate (brachycardia). If it is irritated by some nerves accelerate, the heart cannot decline in the rhythm for a long time, imposed by the stimulation of the accelerating fibers. Soon the phenomenon of discord between the activity of the atrium and ventricles was discovered – the first store, the frequent rhythm, the ventricles give only one reduction of two (or three), atrial contraction (partial heart block).
The caution in dose and consider the possibility of individual sensitivity patients should be taken in the application of the atropine. A small overdose can cause dry mouth, dilated pupils, accommodation disturbances, tachycardia, difficulty urination, intestinal atony, and dizziness. Atropine is contraindicated in glaucoma.
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