Atropine

Atropine

Q. 1 Atropine is used in all EXCEPT: 
 A

Glaucoma

 B

Mydriatic

 C

Cyclopegic

 D Preanaesthetic medication
Q. 1 Atropine is used in all EXCEPT: 
 A

Glaucoma

 B

Mydriatic

 C

Cyclopegic

 D Preanaesthetic medication
Ans. A

Explanation:

Glaucoma REF: KDT 5′ edition p. 98

Uses of atropine

  • Preanaesthetic medication
  • Antispasmodic
  • Mydriatic
  • Cycloplegic
  • Vagolytic
  • Belladonna poisoning 

Contraindications of atropine:

  • Narrow angle glaucoma
  • BPH

Q. 2

Atropine is not an antidote for? 

 A Mushroom poisoning
 B

Dhatura poisoning

 C

Organophosphates poisoning

 D Carbamates poisoning
Q. 2

Atropine is not an antidote for? 

 A Mushroom poisoning
 B

Dhatura poisoning

 C

Organophosphates poisoning

 D Carbamates poisoning
Ans. B

Explanation:

Dhatura poisoning REF: Poisoning in Children by Utpal Kant Singh – page 158 See APPENDIX-42 for list of Antidotes

“The specific antidote of Datura poisoning is physostigmine not atropine” Atropine is used as antidote in:

  1. Alpha2 agonists (e.g., clonidine)
  2. Alzheimer drugs (e.g., donepezil, galantamine, rivastigmine, tacrine)
  3. Antimyesthenic agents (e.g., pyridostigmine)
  4. Bradyarrhythmia-producing agents (e.g., beta blockers, calcium channel blockers and digitalis glycosides)
  5. Cholinergic agonists (e.g., bethanechol)
  6. Muscarine-containing mushrooms Nerve agents (sarin, soman, tabun and VX)
  7. Organophosphate and carbamate insecticides

Q. 3

Atropine is most sensitive to:

 A

Mucous and pharyngeal secretions

 B

Heart

 C

Pupil

 D

GI tract motility

Q. 3

Atropine is most sensitive to:

 A

Mucous and pharyngeal secretions

 B

Heart

 C

Pupil

 D

GI tract motility

Ans. A

Explanation:

Tissues most sensitive to atropine are the salivary, bronchial, and sweat glands. Secretion of acid by the gastric parietal cells is the least sensitive.

Sensitivity of atropine to various organ systems:
Saliva, sweat, bronchial secretions > eyes, bronchial muscles, heart > smooth muscle of
intestine and bladder > gastric glands and smooth muscle. This probably is
due to:
  • Other factors that influence the cholinergic tone of various organs.
  • Variations in synaptic gaps

Q. 4

Atropine is derived from which of the following plant?

 A

Atropa belladonna

 B

Hyoscyamus niger

 C

Datura stramonium

 D

Argemone mexicana

Q. 4

Atropine is derived from which of the following plant?

 A

Atropa belladonna

 B

Hyoscyamus niger

 C

Datura stramonium

 D

Argemone mexicana

Ans. A

Explanation:

  • Plants and mushrooms containing anticholinergic alkaloids include
    • Jimsonweed (Datura stramonium)
    • Deadly nightshade (Atropa belladonna)
    • Fly agaric (Amanita muscaria)
  • The root of Atropa belladonna contains 82-97% of hyoscyamine, 3-15% atropine, and up to 2.5% scopolamine.
  • Anticholinergic agents competitively antagonize the effects of acetylcholine at peripheral muscarinic and central receptors.
Ref: Manning B.H. (2012). Chapter 13. Anticholinergics. In K.R. Olson (Ed), Poisoning & Drug Overdose, 6e.

Q. 5

Which of the following drugs cause relaxation of LES?

1. Nitrates
2. Histamine blockers
3. Morphine
4. Atropine
5. Calcium channel blockers

 

 A

1,2 & 3

 B

1,4 & 5

 C

1,2 & 5

 D

All

Q. 5

Which of the following drugs cause relaxation of LES?

1. Nitrates
2. Histamine blockers
3. Morphine
4. Atropine
5. Calcium channel blockers

 

 A

1,2 & 3

 B

1,4 & 5

 C

1,2 & 5

 D

All

Ans. B

Explanation:

Factor causing relaxation of LES Factor increasing LES pressure
  • Pharmacological agents:nitrates, anticholinergics, barbiturates, calcium channel blockers, caffeine, theophylline, diazepam, dopamine, prostaglandin E1 and E2 and meperidine
  • Pepperdine
  • Chocolate
  • Coffee
  • Alcohol
  • Smoking
  • Fat
  • Antacids
  • Cholinergics
  • Domperidone
  • Metoclopramide
  • Prostaglandin F2

Also know: LES pressure is higher in the supine position than in the upright position.

Ref: Schwarz 9/e, Page 812; Harrison 17/e, Page 1741.

Q. 6

All of the following are the effects of atropine in anterior uveitis, EXCEPT:

 A

Rest to the ciliary muscle

 B

Increase supply of antibody

 C

Decreases blood flow

 D

Prevents posterior synechia formation

Q. 6

All of the following are the effects of atropine in anterior uveitis, EXCEPT:

 A

Rest to the ciliary muscle

 B

Increase supply of antibody

 C

Decreases blood flow

 D

Prevents posterior synechia formation

Ans. C

Explanation:

Ans:C.)Decreases Blood Flow.

Mode of action of Atropine in iridocyclitis :

(i) gives comfort and rest to the eye by relieving spasm of iris sphincter and ciliary muscle,

(ii) prevents the formation of synechiae and may break the already formed synechiae,

(iii) reduces exudation by decreasing hyperaemia and vascular permeability and
(iv) increases the blood supply to anterior uvea by relieving pressure on the anterior ciliary arteries. As a result more antibodies reach the target tissues and more toxins are absorbed.



Q. 7

You have been asked to consult in the treatment of an 80-year-old patient. An antimuscarinic drug is being considered. Atropine therapy in the elderly may be hazardous because:

 A

Atropine can elevate intraocular pressure in patients with glaucoma

 B

Atropine frequently causes ventricular tachycardia

 C

Urinary retention may be precipitated by atropine in women

 D

The elderly are particularly prone to develop dangerous hyperthermia when given Atropine

Q. 7

You have been asked to consult in the treatment of an 80-year-old patient. An antimuscarinic drug is being considered. Atropine therapy in the elderly may be hazardous because:

 A

Atropine can elevate intraocular pressure in patients with glaucoma

 B

Atropine frequently causes ventricular tachycardia

 C

Urinary retention may be precipitated by atropine in women

 D

The elderly are particularly prone to develop dangerous hyperthermia when given Atropine

Ans. A

Explanation:

The elderly have a much higher incidence of glaucoma than younger people (and may be unaware of the disease until late in its course). Antimuscarinic agents may increase intraocular pressure in individuals with glaucoma. Elderly men (not women) have a much higher probability of developing urinary retention because they have high incidence of prostatic hyperplasia. Cardiac and hyperthermic reactions to atropine are not common in the elderly.
 
Ref: Chong N. (2011). Chapter 23. Lasers in Ophthalmology. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e. 

Q. 8

What is the percentage of atropine present in atropine drops?

 A

1 %

 B

2 %

 C

3 %

 D

4 %

Q. 8

What is the percentage of atropine present in atropine drops?

 A

1 %

 B

2 %

 C

3 %

 D

4 %

Ans. A

Explanation:

Atropine is an alkaloid and is used in its water soluble form and it is available as both drops and ointment at 0.5% and 1% strength.
 
Ophthalmologic indications of atropine:
Atropine is an effective and long acting cycloplegic drug. In addition to this, it can used in the treatment of iritis. It is also used to maintain a dilated pupil after intraocular surgical procedures.
 
Toxicity: The prominent toxic symptoms especially in children are:
  • Restlessness and excited behavior with 
  • Dryness and flushing of the skin of the face
  • Dry mouth
  • Fever
  • Inhibition of sweating
  • Tachycardia 
Ref: Flach A.J., Fraunfelder F.W. (2011). Chapter 22. Ophthalmic Therapeutics. In P. Riordan-Eva, E.T. Cunningham, Jr. (Eds), Vaughan & Asbury’s General Ophthalmology, 18e. A Textbook of Clinical Ophthalmology: A Practical Guide to Disorders of the …  By R. Pitts Crick page 588.

 


Q. 9

Atropine is used for following except:

 A

Organophosphorus posioning

 B

Mushroom poisoning

 C

Physostigmine overdose

 D

Glaucoma

Q. 9

Atropine is used for following except:

 A

Organophosphorus posioning

 B

Mushroom poisoning

 C

Physostigmine overdose

 D

Glaucoma

Ans. D

Explanation:

D i.e. Glucoma

Atropine is contraindicated in narrow angle glucomaQ.

Atropine is used as antidote for various poisons with cholinergic symptoms as – Anticholine Esterase (Organophosphorus) poisoning, Neostigmine / Pyridostigmine / Plzysostigmine overdose, Mushroom poisoningQ


Q. 10

Atropine should never be started when the patient is cyanosed due to danger of :

 A

Cerbral edema

 B

Respiratory arrest

 C

Ventricular fibrillation

 D

None of the above

Q. 10

Atropine should never be started when the patient is cyanosed due to danger of :

 A

Cerbral edema

 B

Respiratory arrest

 C

Ventricular fibrillation

 D

None of the above

Ans. B

Explanation:

B i.e. Respiratory arrest


Q. 11

Atropine is useful in organophosphate poisoning because it –

 A

Reactivates acetylcholinesterase

 B

Competes with acetylcholine release

 C

Binds with both nicotinic and muscarinic acetylcholine receptors

 D

Is a competitive antagonist of acetylcholine

Q. 11

Atropine is useful in organophosphate poisoning because it –

 A

Reactivates acetylcholinesterase

 B

Competes with acetylcholine release

 C

Binds with both nicotinic and muscarinic acetylcholine receptors

 D

Is a competitive antagonist of acetylcholine

Ans. D

Explanation:

Ans. is ‘d’ i.e., Is a competitive antagonist of acetylcholine

o Atropine acts as competitive antagonist at muscarinic receptors. It has no activity on nicotinic receptors and has nothing to do with Ach release.


Q. 12

Which is not an effect of atropine?

 A

Rise of body temperature

 B

Decreased salivary secretion

 C

B radycardi a

 D

Increased A-V conduction

Q. 12

Which is not an effect of atropine?

 A

Rise of body temperature

 B

Decreased salivary secretion

 C

B radycardi a

 D

Increased A-V conduction

Ans. C

Explanation:

Ans. is ‘c’ i.e., Bradycardia

o Atropine is an anticholinergic drug and thus causes tachycardia (not bradycardia)


Q. 13

Atropine does not cause –

 A

Increase bowel sound

 B

Decrease bowel sound

 C

Hypotension

 D

a and c

Q. 13

Atropine does not cause –

 A

Increase bowel sound

 B

Decrease bowel sound

 C

Hypotension

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Increase bowel sound; ‘c’ i.e., Hypotension

o Whenever there is peristalatic activity, there will be bowel sound —) Peristalasis causes movement of gases (that are present in the bowel) which results in bowel sound.

o When there is paralysis of bowel smooth muscles (paralytic ileus), bowel sound will be absent.

o Now you can easily understand that

i) Drugs that increase peristalasis (e.g. cholinergic drugs) will increase bowel sound.

ii) Drugs that decrease peristalasis (e.g. anticholinergic drugs —) atropine) will decrease bowel sound. About other options

There are no changes in blood pressure or cardiac output — Goodman & Gilman Atropine causes tachycardia.


Q. 14

Atropine when used as a pre-medication causes all of the following symptoms except –

 A

Skin flush

 B

Bronchoconstriction

 C

Prevents bradycardia

 D

Dryness of mouth

Q. 14

Atropine when used as a pre-medication causes all of the following symptoms except –

 A

Skin flush

 B

Bronchoconstriction

 C

Prevents bradycardia

 D

Dryness of mouth

Ans. B

Explanation:

Ans. is ‘b’ i.e., Bronchoconstriction

Atropine causes bronchodilation.


Q. 15

Uses of atropine are AJE –

 A

Organophoshorus poisoning

 B

Mushroom poisoning

 C

Arrhythmia

 D

Miotic

Q. 15

Uses of atropine are AJE –

 A

Organophoshorus poisoning

 B

Mushroom poisoning

 C

Arrhythmia

 D

Miotic

Ans. D

Explanation:

Ans. is ‘d’ i.e., Miotic

CLINICAL USES OFATROPINE

Remember – ATROPA

A As mydriatic – cycloplegic

T —> ‘Traveller’s diarrhoea

R —> Rapid (early) onset mushroom poisoning

0 —> Organophosphate poisoning

P —> Preanaesthetic medication

A Arrhythmias (brady-arrhythmias)

Atropine is also used with neostigmine in mysthenia gravis to decrease anti,nuscarinic side effects of neostigmine —› As atropine blocks muscarinic receptors, use of atropine prevents muscarinic side effects of neostigmine, while neostigmine retains its benficial effects in mysthenics which are due to nicotinic receptors.


Q. 16

Atropine-mechanism of action in organophosphate poisoning-

 A

Reactivation of choline-esterase

 B

Acts on central and peripheral post.ganglionic receptors

 C

Acts on central and peripheral cholinergic receptors

 D

Acts on peripheral cholinergic receptors only

Q. 16

Atropine-mechanism of action in organophosphate poisoning-

 A

Reactivation of choline-esterase

 B

Acts on central and peripheral post.ganglionic receptors

 C

Acts on central and peripheral cholinergic receptors

 D

Acts on peripheral cholinergic receptors only

Ans. C

Explanation:

Ans. is ‘c’ i.e., Acts on central and peripheral cholinergic receptors

o In organophosphate poisoning, atropine counteracts the peripheral muscarinic symptoms and at higher doses central effects as well.

o Atropine does not reverse nicotinic action i.e., peripheral muscular paralysis.


Q. 17

Treatment of atropine toxicity

 A

2-pralidoxime

 B

Naloxone

 C

Flumazenil

 D

Physostigmine

Q. 17

Treatment of atropine toxicity

 A

2-pralidoxime

 B

Naloxone

 C

Flumazenil

 D

Physostigmine

Ans. D

Explanation:

Ans. is ‘d’ i.e., Physostigmine

o Atropine blocks cholinergic receptors.

  • So, for atropine overdose, we require a drug that increases cholinergic action.

o Physostigmine increases the concentration of Ach.

  • Physostigmine counteracts central (because it crosses BBB) as well as peripheral symptoms of atropine toxicity (other anticholinesterases like neostigmine and pyridostigmine counteract only peripheral symptoms as they cannot cross BBB) –> Physostigmine is the DOC.

Q. 18

Atropine as preanesthesia has all effects except 

 A

Decrease secretion

 B

Bronchoconstriction

 C

Prevent bradycardia

 D

Prevent hypotension

Q. 18

Atropine as preanesthesia has all effects except 

 A

Decrease secretion

 B

Bronchoconstriction

 C

Prevent bradycardia

 D

Prevent hypotension

Ans. B

Explanation:

B i.e. Bronchoconstrictor 


Q. 19

Drug required for dilatation of eye in patient of children with squint

 A

Tropicamide

 B

1% Atropine drop

 C

Homatropine

 D

1% Atropine ointment

Q. 19

Drug required for dilatation of eye in patient of children with squint

 A

Tropicamide

 B

1% Atropine drop

 C

Homatropine

 D

1% Atropine ointment

Ans. D

Explanation:

D i.e. 1% Atropine ointment


Q. 20

For refraction in a hypermetropic child, which is the best drug?

 A

Phenylephrine

 B

Atropine ointment

 C

Atropine drops

 D

Homatropine

Q. 20

For refraction in a hypermetropic child, which is the best drug?

 A

Phenylephrine

 B

Atropine ointment

 C

Atropine drops

 D

Homatropine

Ans. B

Explanation:

B i.e. Atropine ointment.

 

  • Atropine (1%) eye ointment is the strongest cycloplegic agent, which is instilled twice a day for three days prior to the refraction (retinoscopy).
  • The parents should be warned that the child will experience blurred vision and photophobia for a period of 10 to 14 days.
  • Also, some children may experience flushing of the face, confusion, tachycardia or an allergic reaction.
  • Atropine eye drops have a higher chance of being absorbed systemically via the nasolacrimal passage, and thus, atropine eye ointment and punctal pressure is preferred, especially in infants.
  • The more commonly used regimen for cycloplegia includes cyclopentolate (1%) eye drops instilled twice followed by tropicamide (0.8%) with phenylephrine (5%), commercially available combination eye drops, once, at 5 minute intervals

Q. 21

Which of the following will be the most important adjuvant therapy in a case of fungal corneal ulcer :

 A

Atropine sulphate eye ointment

 B

Dexamethasone eye drops

 C

Pilocarpine eye drops

 D

Lignocaine eye drops

Q. 21

Which of the following will be the most important adjuvant therapy in a case of fungal corneal ulcer :

 A

Atropine sulphate eye ointment

 B

Dexamethasone eye drops

 C

Pilocarpine eye drops

 D

Lignocaine eye drops

Ans. A

Explanation:

A i.e. Atropine sulphate ointment


Q. 22

Drug of choice for increased IOT in acute anterior uveitis

 A

Atropine

 B

Timolol

 C

5% Epinephrine

 D

2% Pilocarpine

Q. 22

Drug of choice for increased IOT in acute anterior uveitis

 A

Atropine

 B

Timolol

 C

5% Epinephrine

 D

2% Pilocarpine

Ans. A

Explanation:

A i.e. Atropine

  • Treatment of hypertensive uveitis is treatment of acute iridocyclitis (Mydriatic-cycloplegic-steroid­antibiotics), topical (3 blocker (e.g. timolol), carbonic anhydrase inhibitor (acetazolamide) dipivefrine.
  • Secondary glaucoma Q (due to posterior synechiae formation) is the m.c. complication of recurrent anterior uveitis.
  • Miotics eg pilocarpine or other cholinergics are contraindicated in treatment of anterior uveitis Q as these increase chances of synechiae formation. It is also contraindicated in malignant glaucoma Q & post inflammatory glaucoma Q.

Q. 23

Atropine is drug of choice in

 A

Chorioretinitis

 B

Lens induced glaucoma

 C

Iridocyclitis

 D

Close angle glaucoma

Q. 23

Atropine is drug of choice in

 A

Chorioretinitis

 B

Lens induced glaucoma

 C

Iridocyclitis

 D

Close angle glaucoma

Ans. C

Explanation:

C i.e. Iridocyclitis

  • Steroid > Atropine is drug of choice for acute iridocyclitis (anterior uveitis).Q

Atropine is contraindicated in glucomas where as pilocarpine is contraindicated in anterior uveitis. Q


Q. 24

Primary objective of use of atropine in anterior uveitis

 A

Rest to the ciliary muscle

 B

Increase supply of antibody

 C

Increase blood flow

 D

Prevents posterior synechia formation

Q. 24

Primary objective of use of atropine in anterior uveitis

 A

Rest to the ciliary muscle

 B

Increase supply of antibody

 C

Increase blood flow

 D

Prevents posterior synechia formation

Ans. A

Explanation:

A i.e. Rest to the ciliary muscle

In inflamatory glaucoma (glaucoma with uveitis) pilocarpine (miotic) & prostaglandin analogue e.g. latanoprost are contraindicated Q because

–           Pilocarpine 1/t development of posterior synechiae

–           Prostaglandin analogue enhance breakdown of aqueous barrier and exacerbate cystoid macular edema.


Q. 25

In the treatment of severe bradycardia, all of the following can be the best modality of treatment except:

 A

Atropine

 B

Pacing

 C

Isoproterenol

 D

Diltiazem

Q. 25

In the treatment of severe bradycardia, all of the following can be the best modality of treatment except:

 A

Atropine

 B

Pacing

 C

Isoproterenol

 D

Diltiazem

Ans. D

Explanation:

Answer is D (Diltiazem)

Diltiazem is used in the treatment of tachvarhythmias and not in the treatment of bradvarrhEthmias.

Diltiazem is a class IV antiarrhythmogenic drug, used in atrial fibrillation/flutter and supraventricular tachycardias (tachycardias) to slow the ventricular rate, by decreasing conduction velocity and increasing refractoriness in the AV nodal tissue. Atropine, lsoproterenol and pacemakers are all useful in the management of bradycardia.

  • Atropine and isoproterenol are useful in increasing heart rate and decreasing symptoms in patients with sinus bradycardia or AV block localized to AV node.’ – Harrison 16th/1339
  • Long term therapy of brady arrhythmias is best accomplished by pacemakers.

Q. 26

Festooned pupil results from:

 A

Irregular dilatation of pupil with atropine in the presence of segmental posterior synechiae

 B

Annular synechiae

 C

Occlusion pupillae

 D

All of the above

Q. 26

Festooned pupil results from:

 A

Irregular dilatation of pupil with atropine in the presence of segmental posterior synechiae

 B

Annular synechiae

 C

Occlusion pupillae

 D

All of the above

Ans. A

Explanation:

Ans. Irregular dilatation of pupil with atropine in the presence of segmental posterior synechiae


Q. 27

In atropine instillation, all are seen except:

 A

Dilated pupil

 B

Paralysis of accommodation

 C

Increased water content to tear

 D

Decreased water content to tear

Q. 27

In atropine instillation, all are seen except:

 A

Dilated pupil

 B

Paralysis of accommodation

 C

Increased water content to tear

 D

Decreased water content to tear

Ans. C

Explanation:

Ans. C.)Increased water content to tear.

Causes of decreased tear formation:

  • Idiopathic, congenital alacrima, xerophthalmia, lacrimal gland ablation, and sensory denervation.
  • Collagen vascular diseases, including relapsing polychondritis, rheumatoid arthritis, granulomatosis with polyangiitis, and systemic lupus erythematosus.
  • Sjögren’s syndrome and other autoimmune diseases are associated with aqueous tear deficiency.
  • Drugs such as isotretinoin, sedatives, diuretics, tricyclic antidepressants, antihypertensives, oral contraceptives, antihistamines, nasal decongestants, beta-blockers, phenothiazines, atropine, and pain relieving opiates such as morphine can cause or worsen this condition.
  • Infiltration of the lacrimal glands by sarcoidosis or tumors, or postradiation fibrosis of the lacrimal glands

 

Mode of action of Atropine

(i) gives comfort and rest to the eye by relieving spasm of iris sphincter and ciliary muscle,

(ii) prevents the formation of synechiae and may break the already formed synechiae,

(iii) reduces exudation by decreasing hyperaemia and vascular permeability and
(iv) increases the blood supply to anterior uvea by relieving pressure on the anterior ciliary arteries. As a result more antibodies reach the target tissues and more toxins are absorbed.


Q. 28

Features of atropine poisoning are all of the following except: 

March 2011

 A

Mydriasis

 B

Hypothermia

 C

Confusion

 D

Hallucinations

Q. 28

Features of atropine poisoning are all of the following except: 

March 2011

 A

Mydriasis

 B

Hypothermia

 C

Confusion

 D

Hallucinations

Ans. B

Explanation:

Ans. B: Hypothermia

Sign and symptoms of atropine poisoning are due to peripheral muscarinic blockade (dilatation of pupils, hyperpyrexia due to inhibition of sweating) and central effects (initial stimulation and subsequent depresion of CNS; confusion and hallucination)

Atropine

  • It is a naturally occurring tropane alkaloid extracted from deadly nightshade (Atropa belladonna), Jimson weed (Datura stramonium), mandrake (Mandragora officinarum) and other plants of the family Solanaceae.
  • Atropine increases 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.
  • Atropine lowers the parasympathetic activity of all muscles and glands regulated by the parasympathetic nervous system.
  • This occurs because atropine is a competitive antagonist of the muscarinic acetylcholine receptors (acetylcholine being the main neurotransmitter used by the parasympathetic nervous system).
  • Therefore, it may cause swallowing difficulties and reduced secretions
  • Adverse reactions to atropine include ventricular fibrillation, supraventricular or ventricular tachycardia, dizziness, nausea, blurred vision, loss of balance, dilated pupils (mydriasis), photophobia, dry mouth and potentially extreme confusion, dissociative hallucinations and excitation especially amongst the elderly.
  • These latter effects are because atropine is able to cross the blood-brain barrier
  • The antidote to atropine is physostigmine or pilocarpine.
  • A common mnemonic used to describe the physiologic manifestations of atropine overdose is: as per Jon Blinkey “hot as a hare, blind as a bat, dry as a bone, red as a beet, and mad as a hatter”.
  • These associations reflect the specific changes of warm, dry skin from decreased sweating, blurry vision, decreased sweating/ lacrimation, vasodilation, and central nervous system effects on muscarinic receptors, type 4 and 5.
  • This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as diphenhydramine, phenothiazine antipsychotics and benztropine

Q. 29

Atropine causes all except:          

March 2012

 A

Bronchoconstriction

 B

Tachycardia

 C

Dry mouth

 D

Mydriasis

Q. 29

Atropine causes all except:          

March 2012

 A

Bronchoconstriction

 B

Tachycardia

 C

Dry mouth

 D

Mydriasis

Ans. A

Explanation:

Ans: A i.e. Bronchoconstriction

Effects of atropine

  • Atropine causes bronchodilatation and reduced airway resistance, especially in COPD and asthma patients
  • The most prominent effect of atropine is to cause tachycardia
  • Atropine markedly decreases sweat, salivary (dry mouth), tracheobronchial and lacrimal secretion (M3 blockade)
  • Topical instillation of atropine causes mydriasis, abolition of light reflex and cycloplegia lasting 7-10 days

Q. 30

Which one of the following is FALSE regarding atropine:

March 2013

 A

Used to prevent adhesions in inflammatory conditions of eye

 B

Used in concentration of 1%

 C

Can be given in sinus bradycardia patients

 D

Long acting miotic

Q. 30

Which one of the following is FALSE regarding atropine:

March 2013

 A

Used to prevent adhesions in inflammatory conditions of eye

 B

Used in concentration of 1%

 C

Can be given in sinus bradycardia patients

 D

Long acting miotic

Ans. D

Explanation:

Ans. D i.e. Long acting miotic

Atropine in ophthalmology

  • Topical atropine is used as a cycloplegic, to temporarily paralyze the accommodation reflex, and as a mydriatic, to dilate the pupils.
  • Atropine degrades slowly, typically wearing off in 7 to 14 days, so it is generally used as a therapeutic mydriatic, whereas tropicamide (a shorter-acting cholinergic antagonist) or phenylephrine (an alpha-adrenergic agonist) is preferred as an aid to ophthalmic examination.
  • Atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillary 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.
  • Atropine is contraindicated in patients pre-disposed to narrow angle glaucoma.

Q. 31

Which of the following drug is contraindicated in glaucoma:

September 2009

 A

Adrenaline

 B

Timolol

 C

Atropine

 D

Pilocarpine

Q. 31

Which of the following drug is contraindicated in glaucoma:

September 2009

 A

Adrenaline

 B

Timolol

 C

Atropine

 D

Pilocarpine

Ans. C

Explanation:

Ans. C: Atropine

Most categories of drugs that list glaucoma as a contraindication or adverse effect are concerned with inducing acute angle-closure glaucoma. These medications will incite an attack only in those individuals with occludable angles (ie, very narrow anterior chamber angles).

The classes of medications that have the potential to induce angle closure are:

–        Topical anticholinergic (Atropine) or sympathomimetic dilating drops

–        Tricyclic antidepressants

–        Monoamine oxidase inhibitors

Antihistamines

–        Antiparkinsonian drugs

–        Antipsychotic medications

–        Antispasmolytic agents.

Sulfa containing medications may induce angle-closure glaucoma by a different angle-closure mechanism, involving anterior rotation of the ciliary body. Typically, the angle closure is bilateral and occurs within the first several doses of the sulfonamide-containing medication. Patients with narrow or wide open angles are potentially susceptible to this rare and idiosyncratic reaction.

• Drug-induced elevation of IOP is more common by an open-angle mechanism:

—  Corticosteroids are a class of drugs that may produce IOP elevation by this mechanism

Atropine:

Topical atropine is used as a cycloplegic, to temporarily paralyze the accommodation reflex, and as a mydriatic, to dilate the pupils. Atropine degrades slowly, typically wearing off in 7 to 14 days, so it is generally used as a therapeutic mydriatic, whereas tropicamide (a shorter-acting cholinergic antagonist) or phenylephrine (an alpha-adrenergic agonist) is preferred as an aid to ophthalmic examination.

Atropine induces mydriasis by blocking contraction of the circular pupillary sphincter muscle, which is normally stimulated by acetylcholine release, thereby allowing the radial pupillar 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.

Atropine is contraindicated in patients pre-disposed to narrow angle glaucoma.

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, dissociative hallucinations and excitation especially amongst the elderly. These latter effects are because atropine is able to cross the blood-brain barrier.

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”.

These associations reflect the specific changes of warm, dry skin from decreased sweating, blurry vision, decreased sweating/ lacrimation, vasodilation, and central nervous system effects on muscarinic receptors, type 4 and 5. This set of symptoms is known as anticholinergic toxidrome, and may also be caused by other drugs with anticholinergic effects, such as diphenhydramine, phenothiazine antipsychotics and benztropine.

The antidote to atropine is physostigmine or pilocarpine.


Q. 32

Best indicator for beneficial effect of atropine in a patient with organophosphorous poisoning is:

March 2012

 A

Heart rate

 B

Pupil

 C

Blood pressure

 D

Ventilation

Q. 32

Best indicator for beneficial effect of atropine in a patient with organophosphorous poisoning is:

March 2012

 A

Heart rate

 B

Pupil

 C

Blood pressure

 D

Ventilation

Ans. A

Explanation:

Ans: A i.e. Heart rate

In organophosphate poisoning, atropine should be administered in doses of 0.6-2 mg i.v., repeated every 10-25 minutes until secretions are controlled, the skin is dr./ and there is sinus tachycardia.


Q. 33

All are true about atropine poisoning, except

FMGE 11

 A

Dilated pupils

 B

Decreased temperature

 C

Dysarthria

 D

Dysphagia

Q. 33

All are true about atropine poisoning, except

FMGE 11

 A

Dilated pupils

 B

Decreased temperature

 C

Dysarthria

 D

Dysphagia

Ans. B

Explanation:

Ans. Decreased temperature


Q. 34

Ramesh presented with bronchodilatation, increased temperature, constipation and tachycardia. Probable diagnosis is poisoning with:           

AIIMS 10

 A

Mushroom

 B

Atropine

 C

Arsenic

 D

Organophosphorus

Q. 34

Ramesh presented with bronchodilatation, increased temperature, constipation and tachycardia. Probable diagnosis is poisoning with:           

AIIMS 10

 A

Mushroom

 B

Atropine

 C

Arsenic

 D

Organophosphorus

Ans. B

Explanation:

Ans. Atropine


Q. 35

A farmer visiting an orchard gets unconscious, excessive salivation, constricted pupils and fasciculation of muscles. Treatment is started with:   

AIIMS 07

 A

Atropine

 B

Neostigmine

 C

Physostigmine

 D

Adrenaline

Q. 35

A farmer visiting an orchard gets unconscious, excessive salivation, constricted pupils and fasciculation of muscles. Treatment is started with:   

AIIMS 07

 A

Atropine

 B

Neostigmine

 C

Physostigmine

 D

Adrenaline

Ans. A

Explanation:

Ans. Atropine


Q. 36

The drug of choice for mushroom poisoning is:

Al 07

 A

Atropine

 B

Physostigmine

 C

Adrenaline

 D

Carbachol

Q. 36

The drug of choice for mushroom poisoning is:

Al 07

 A

Atropine

 B

Physostigmine

 C

Adrenaline

 D

Carbachol

Ans. A

Explanation:

Ans. Atropine


Q. 37

Atropine and acetylcholine show the following type of antagonism‑

 A

Competitive

 B

Non competetive

 C

Both of the above

 D

None of the above

Q. 37

Atropine and acetylcholine show the following type of antagonism‑

 A

Competitive

 B

Non competetive

 C

Both of the above

 D

None of the above

Ans. A

Explanation:

Ans. is ‘a’ i.e., Competetive


Q. 38

Antidote in Atropine poisoning is ‑

 A

Flumazenil

 B

Physostigmine

 C

Naloxone

 D

NaHCO3

Q. 38

Antidote in Atropine poisoning is ‑

 A

Flumazenil

 B

Physostigmine

 C

Naloxone

 D

NaHCO3

Ans. B

Explanation:

Ans. is ‘b’ i.e., Physostigmine

Atropine blocks cholinergic receptors.

So, for atropine overdose, we require a drug that increases cholinergic action.

Physostigmine increases the concentration of Ach.

Physostigmine counteracts central (because it crosses BBB) as well as peripheral symptoms of atropine toxicity (other anticholinesterases like neostigmine and pyridostigmine counteract only peripheral symptoms as they cannot cross BBB) Physostigmine is the DOC.


Q. 39

The drug of choice in a patient suffering from muscular cramps, salivation, frothing from mouth, sweating, lacrimation, blurring of vision, miosis,bronchorrhea etc after consuming the food item shown in the picture below is which among the following? 

 A

Atropine.

 B

Carbachol.

 C

Adrenaline.

 D

Physostigmine.

Q. 39

The drug of choice in a patient suffering from muscular cramps, salivation, frothing from mouth, sweating, lacrimation, blurring of vision, miosis,bronchorrhea etc after consuming the food item shown in the picture below is which among the following? 

 A

Atropine.

 B

Carbachol.

 C

Adrenaline.

 D

Physostigmine.

Ans. A

Explanation:

Ans:A.) Atropine.

Patient is suffering from Mushroom poisoning with Muscarinic effects.

  • There are different type of Mushroom toxins:
  • GI poisons are the most frequently encountered mushroom toxins like Amatoxins, hepatotoxins, Epileptogenic toxins,Nephrotoxins,CNS poisons like Muscarine, psilocybin, etc.
  • In mushroom poisoning that primarily contain Muscarinic effect, the following manifestations may be seen:
  • Exhaustion, irritability, muscular cramps, salivation, frothing from mouth, sweating, lacrimation, blurring of vision, miosis, ptosis, bronchorrhea, cough, wheeze, tachypnea, rhonchi, bradycardia, hypotension, abdominal cramps, vomiting, and diarrhea were observed.
  • The drug of choice for mushroom poisoning manifesting with muscarinic effects is Atropine.



Q. 40

All of the following may be used in the treatment of cardiac arrest following the condition as represented in the picture below, Except? 

 A

Atropine.

 B

External cardiac pacing.

 C

Epinephrine.

 D

a and b.

Q. 40

All of the following may be used in the treatment of cardiac arrest following the condition as represented in the picture below, Except? 

 A

Atropine.

 B

External cardiac pacing.

 C

Epinephrine.

 D

a and b.

Ans. D

Explanation:

Ans:D.)Atropine and External cardiac pacing

The condition shown in the picture above represents ventricular fibrillation.

Atropine and External cardiac pacing may be used in cardiac arrest following non shockable rhythms like Asystole but they have no role in the management of cardiac arrest with shockable rhythms like VF

Ventricular fibrillation (VF)

  • It is a life-threatening cardiac arrhythmia in which the coordinated contraction of the ventricular myocardium is replaced by high-frequency, disorganized excitation, resulting in failure of the heart to pump blood.
  • VF is the most commonly identified arrhythmia in cardiac arrest patients.
  • Treatment:
    • Initiate CPR by giving 30 chest compressions, then open the airway and deliver 2 breaths. Continue CPR in this compression-to-ventilation ratio (30:2) until the AED/defibrillator arrives and is set up.
    • External electrical defibrillation remains the most successful treatment for VF.
    • Vasopressors (epinephrine or vasopressin) are given per the asystole/pulseless electrical activity ACLS algorithm:
    • Antiarrhythmic agents can be given before or after the shock.
      • Amiodarone or  lidocaine
      • If torsade de pointes is present, consider magnesium sulfate

Q. 41

Drug which should be avoided in this condition


 A

Acetazolamide


 B

Atropine


 C

Timolol

 D

Mannitol


Q. 41

Drug which should be avoided in this condition


 A

Acetazolamide


 B

Atropine


 C

Timolol

 D

Mannitol


Ans. B

Explanation:

This condition is angle closure glaucoma

Ans. B: Atropine

Anticholinergic drugs (atropine 1%, homatropine2%) dilates the pupil

In a patient above 60 years of age having hypermetropia and a shallow anterior chamber, mydriasis may precipitate acute angle closure glaucoma


Q. 42

A patient presented with blurring of vision.He is diagnosed to be suffering from an eye condition with angle of Anterior chamber as shown in the image(marked by green arrow). On examination IOP was found to be more than 21 mmHg.Drug which is not used in this condition:

 A

Timolol

 B

Physostigmine

 C

Pilocarpine

 D

Atropine

Q. 42

A patient presented with blurring of vision.He is diagnosed to be suffering from an eye condition with angle of Anterior chamber as shown in the image(marked by green arrow). On examination IOP was found to be more than 21 mmHg.Drug which is not used in this condition:

 A

Timolol

 B

Physostigmine

 C

Pilocarpine

 D

Atropine

Ans. D

Explanation:

Ans:D.)Atropine.

The patient is suffering from Angle Closure Glaucoma 

Angle Closure Glaucoma 

Causes

  • The most common reason is relative pupillary block, but other reasons include plateau iris syndrome, Shallower anterior chambers;  enlarged or anteriorly displaced lens; shorter axial eye length; thick iris; overdeveloped iris dilator muscles, a narrow angle , mechanisms that pull the iris into contact with the TM e.g: contraction of inflammatory membrane as in uveitis, fibrovascular tissue as in iris neovascularization .
  • Medications to be avoided:
    • Medications prescribed for a variety of systemic conditions (eg, depression, allergies, Parkinson disease) can produce pupillary dilation and precipitate an attack of acute angle-closure glaucoma in anatomically predisposed eyes that have narrow angles.
    • The classes of medications that have the potential to induce angle closure are topical anticholinergic (like Atropine)or sympathomimetic dilating drops, tricyclic antidepressants, monoamine oxidase inhibitors, antihistamines, antiparkinsonian drugs, antipsychotic medications, and antispasmolytic agents.
    • Sulfa containing medications may induce angle-closure glaucoma by a different angle-closure mechanism, involving anterior rotation of the ciliary body.


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