What is the function of atropine?

Abbreviation pinyin: ATP

English name: atropine

English alias: atropine sulfate, atropine, borotropine

Category: antidote for organophosphorus poisoning

Atropine is a poisonous white crystalline alkaloid C 17H23NO3, which is extracted from Belladonna and other solanaceae plants. Its sulfate is mainly used to relieve spasm, reduce secretion, relieve pain and dilate pupils.

Drug description:

atropine sulfate

Pharmacologically, it is an anticholinergic drug that blocks M- cholinergic receptor and can relieve smooth muscle spasm (including relieving vasospasm and improving microvascular circulation); Inhibit gland secretion; Release the inhibition of vagus nerve on the heart and accelerate the heartbeat; Dilate pupils and increase intraocular pressure; Stimulate the respiratory center.

pharmacodynamics

Inhibit the activity of smooth muscle and gland innervated by cholinergic nerve after receptor, and stimulate or inhibit the central nervous system according to the dose of this product. Detoxification system antagonizes cholinesterase inhibitors at M cholinergic receptor site, such as increased secretion of trachea, bronchial mucus glands and salivary glands, contraction of bronchial smooth muscle, and hyperactivity of plant ganglion after stimulation. In addition, atropine can excite or inhibit the central nervous system in a dose-dependent manner. The effect on heart, intestine and bronchial smooth muscle is stronger and more lasting than other belladonna alkaloids.

pharmacokinetics

After oral administration, it is quickly absorbed from gastrointestinal tract and distributed to whole body tissues. Protein binding rate is moderate. After intramuscular injection, the plasma concentration reached its peak at 1.5 ~ 20 minutes, and reached 1 ~ 2 hours after oral administration. The effect usually lasts for 4 ~ 6 hours, and the pupil dilation effect is longer. The half-life is 1 1 ~ 38 hours. Mainly through the hydrolytic metabolism of hepatocyte enzymes, about 13 ~ 50% is excreted with urine in its original form within 12 hours.

Pharmacokinetics This product is easily absorbed from mucosa such as gastrointestinal tract, and can also be absorbed from eyes or a small amount from skin. After oral administration of 1h, the peak effect of t 1/2 is 3.7 ~ 4.3h The binding rate of plasma protein is 14% ~ 22%, and the distribution volume is 1.7L/kg, which can be rapidly distributed in the whole body and can pass through the blood-brain barrier and placenta. Half of the dose is metabolized by the liver and the other half is excreted by the kidney in its original form. Trace amounts were found in various secretions, including milk.

Indications are mainly used in clinic: (1) rescuing toxic shock caused by infection: adult 1 ~ 2 mg, child 0.03 ~ 0.05 mg/kg, intravenous injection, 1 time, once every 15 ~ 30 minutes, after 2 ~ 3 times. (2) Treatment of Asperger's syndrome caused by antimony: When severe arrhythmia is found, immediately inject 1 ~ 2 mg intravenously (diluted with 5% ~ 25% glucose solution 10 ~ 20 ml), and inject 1mg intramuscularly or subcutaneously, 15 ~ 30 minutes later. If there is no seizure after 48 hours, it can be gradually reduced and finally stopped. (3) Treatment of organophosphorus pesticide poisoning: ① For moderate poisoning, subcutaneous injection of 0.5 ~ 1 mg every time, every 30 ~ 60 minutes 1 time; Severe poisoning, intravenous injection of 1 ~ 2 mg every time, once every 15 ~ 30 minutes, and gradually reduce the amount after the condition is stable, and switch to intradermal injection. ② Single use: mild poisoning, subcutaneous injection of 0.5 ~ 1 mg every time, every 30 ~ 120 minutes/time; For moderate poisoning, subcutaneous injection of 1 ~ 2mg each time,1time,15 ~ 30min each time; In severe poisoning, 2 ~ 5 mg should be injected intravenously immediately, then 1 ~ 2~5mg each time, every 15 ~ 30 minutes 1 time, and the amount should be gradually reduced according to the condition, and the interval time should be extended. (4) Relieving visceral colic: including pain caused by gastrointestinal spasm, renal colic, biliary colic and gastric and duodenal ulcer, with subcutaneous injection of 0.5mg each time. (5) Administration before anesthesia: subcutaneous injection of 0.5mg can reduce the secretion of bronchial mucus during anesthesia, prevent postoperative pneumonia and eliminate the respiratory inhibition of morphine. (6) Used in ophthalmology: it can dilate pupils and regulate paralysis, and is used for keratitis and iridocyclitis. 1% ~ 3% eye drops or eye ointment for eyes. Press the inner canthus when dripping to prevent it from flowing into the nasal cavity and being absorbed and poisoned.

Anti-m choline drugs. ① It has spasmolytic effect on gastrointestinal dysfunction, but unstable effect on biliary colic and renal colic; ② For acute microcirculation disturbance, severe bradycardia, syncope complicated with carotid sinus hyperreflexia, I degree atrioventricular block; ③ As an antidote, it can be used for Asperger's syndrome, organophosphorus poisoning and acute mushroom poisoning caused by antimony poisoning; ④ Use before anesthesia to inhibit gland secretion, especially respiratory mucus secretion; ⑤ It can relieve the symptoms of rigidity and tremor in patients with Parkinson's disease and control their salivation and hyperhidrosis; ⑥ Ophthalmology is used for mydriasis, which has anti-inflammatory and analgesic effects on iridocyclitis.

Precautions (1) Frequent dry mouth and dizziness. In severe cases, pupils are dilated, skin is flushed, heart rate is accelerated, excitement, irritability, delirium and convulsions. (2) Patients with glaucoma and prostatic hypertrophy are prohibited. (3) In general, the oral dose is extremely high, 1 time 1mg, 1 day 3 mg; Maximum subcutaneous or intravenous injection, 1 times 2mg. When used for organophosphorus poisoning and Asperger's syndrome, the dosage can be determined according to the condition.

Poisoning occurs when the rescue dose exceeds 5mg, but few people die, because the poisoning dose (5 ~ 10 mg) is far from the lethal dose (80 ~ 130 mg). Patients with atropine poisoning by emergency oral administration can gastric lavage and catharsis to remove unabsorbed atropine. Short-acting barbiturates or chloral hydrate can be used when the excitement is too strong. Treatment of respiratory depression with nikethamide. In addition, neostigmine can be injected subcutaneously for 0.5 ~ 1 mg every 15 minutes 1 time until the pupil is narrowed and the symptoms are relieved.

Specification tablets: 0.3mg per tablet. Injection: 0.5 mg each (1 ml); 1mg(2ml)； 5 mg (1 ml). Eye drops: atropine sulfate 1g, sodium chloride 0.29g, anhydrous sodium dihydrogen phosphate 0.4g, anhydrous disodium hydrogen phosphate 0.47g, hydroxyethyl ester 0.03g, and distilled water to 100ml.

dosage

1. Adult oral dose: 0.3-0.6 mg once, three times a day. Maximum: 1mg once, 3mg a day. Common dosage for children: 0.0 1mg/kg/kg according to body weight, once every 4 ~ 6 hours.

2. The usual dose of subcutaneous, intramuscular or intravenous injection for adults: 0.3-0.5-3 mg; 0.5-3mg once a day; Maximum: 2 mg at a time.

3. Anti-arrhythmia adults are given 0.5- 1mg intravenously, once every 1-2 hours as needed, with a maximum dose of 2mg. Children were given 0.0 1-0.03mg/kg intravenously according to their weight.

4. Detoxification ① For Asperger's syndrome caused by antimony, intravenous injection of 1-2 mg, and injection of 1mg 30 minutes later. If the patient has no seizure, inject 1mg subcutaneously or intramuscularly every 3-4 hours as needed. ② When used for organophosphorus poisoning, intramuscular injection or intravenous injection of 1-2 mg (severe organophosphorus poisoning can be increased by 5- 10 times) is repeated every 10-20 minutes until cyanosis disappears, and the drug is continued until the condition is stable, and then the maintenance dose is used, sometimes for 2-3 days.

5. Anti-shock can improve microcirculation in adults. General body weight is 0.02-0.05 mg/kg, diluted with 50% glucose injection, and injected intravenously for 5- 10 minutes, once every 10-20 minutes, until the limbs of the patient are warm and the systolic blood pressure is above 10kPa(75mmHg), and then the drug is stopped gradually. Intravenous injection of 0.03-0.05 mg/kg for children according to their weight.

6. Before anesthesia, 0.5mg of intramuscular injection was given to adults at 0.5- 1 hour before operation, and 0.5 mg of subcutaneous injection was given to children weighing less than 3kg, 0.2mg of 7-9 kg, 0.3mg of 12- 16 kg and 20-27 kg.

[Preparation and specifications] Atropine sulfate tablets 0.3mg

Atropine sulfate injection (1) 1 ml: 0.5mg (2) 2ml: 1 mg (3) 1 ml: 5mg.

(1). Toxic shock caused by infection: adult 1-2mg, child 0.02-0.05 mg/kg; 1.5-30 minutes once, which can be increased after 2-3 times, and reduced or stopped when the condition improves. (2) Asperger's syndrome caused by antimony: In severe arrhythmia, intravenous injection of 1-2mg (diluted with 5-25% glucose solution 1-20 ml), 1.5-30 minutes later, then intravenous injection of 1mg. If there is no seizure, intramuscular or subcutaneous injection of 1 mg every 3-4 hours. If there is no attack after 48 hours, the dose can be gradually reduced until the drug is stopped. (3) organophosphorus pesticide poisoning: moderate, combined with pralidoxime, subcutaneous injection of 0.5-6544 each time. Severe poisoning, intravenous injection of 1-2mg every time, once every 15-30 minutes, gradually reduce the dose, and switch to intradermal injection after the condition is stable. When atropine was used alone, 0.5- 1mg was injected intradermally every time for mild poisoning, once every 30- 120 minutes; Moderate poisoning, once every 15-30 minutes1-2 mg; In severe poisoning, 2-5mg should be injected intravenously immediately, and then every time 1-2mg, once every 15-30 minutes. According to the condition, the dosage should be gradually reduced and the interval extended.

Don't be careful

(1) Those who are intolerant of other belladonna alkaloids are intolerant of this product.

(2) Intravenous atropine injection in pregnant women can cause fetal tachycardia.

(3) This product can be secreted into milk, which has the effect of inhibiting lactation.

(4) Infants are extremely sensitive to the toxic reaction of this product, especially those with spastic paralysis and brain injury. When the ambient temperature is high, there is a risk that the body temperature will suddenly rise due to sweating, so watch closely when applying.

(5) The elderly are prone to anti-M choline-like side effects, such as dysuria, constipation and dry mouth (especially in men), and it is also easy to induce undiagnosed glaucoma. Once found, the drug should be stopped immediately. This product is especially easy to reduce the sweat secretion of the elderly and affect heat dissipation. Use it with caution in summer.

(6) Use with caution in the following situations: ① brain injury, especially in children; ② Heart disease, especially arrhythmia, congestive heart failure, coronary heart disease and mitral stenosis. (3) Reflux esophagitis, weakened gastroesophageal motility and relaxation of lower esophageal sphincter can delay gastric emptying, thus promoting gastric retention and increasing gastroesophageal reflux; (4) Glaucoma patients are forbidden, and patients over 20 years old are at risk of inducing latent glaucoma; ⑤ Ulcerative colitis, when the dosage is large, the intestinal motility decreases, which can lead to paralytic intestinal obstruction and aggravate toxic Hirschsprung's disease; ⑥ Urinary tract infection (decreased bladder tension) and urinary tract obstructive diseases caused by prostatic hypertrophy can lead to complete urinary retention.

Glaucoma and prostatic hypertrophy are forbidden.

Management description

(1) Atropine 0.5- 1 mg has a mild excitatory effect on the central nervous system, and a large dose can cause mental disorder. A large number of central nervous systems changed from excitation to inhibition.

(2) Intravenous administration should be slow. A small amount of repeated administration can improve the tolerance to some adverse reactions, but at the same time, the curative effect will also decrease.

(3) When treating Parkinson's disease, the dosage should be gradually increased or the treatment scheme should be changed, and the drug should not be stopped suddenly, otherwise withdrawal symptoms may occur.

(4) For infants, patients with congenital stupidity, patients with brain injury or spasm, the dosage should be adjusted at any time as needed.

counteraction

(1) Common diseases include constipation, decreased sweating, dry mouth and nasopharynx, blurred vision, skin flushing, dysuria (especially in elderly patients) and dry mouth (especially in men).

(2) Rare cases include elevated intraocular pressure, allergic skin rash or herpes.

(3) Excessive manifestations are clumsy and unstable movements, unconsciousness, convulsions, hallucinations, delirium (more common in elderly patients), shortness of breath, slurred speech, abnormal heartbeat, excitability, nervousness and restlessness (more common in children).

Dry mouth, dizziness, flushing on face or skin, tachycardia, delirium or delirium. Extremely high doses can cause convulsions, excitement and blurred vision. Intravenous injection may cause cardiac arrest. Subcutaneous injection may cause drug eruption.

Arrhythmia is common in adults with atrioventricular separation, while in children it is atrial arrhythmia. Some patients have tachycardia or even ventricular fibrillation, which may be caused by the dose exceeding 1mg, but sometimes the dose of 0.5mg can also cause the above complications.

This medicine can increase the breathing speed and depth, which may be a reaction to the increase of dead space after bronchiectasis.

Recently, it has been reported that atropine can cause memory deficiency. It is reported that 57 patients with femoral neck fracture were given atropine before anesthesia and suffered from mental confusion after operation. It is reported that the use of atropine-containing patches can also cause central nervous system reactions, such as visual impairment and hallucinations.

The most common allergic reactions are contact dermatitis and conjunctivitis.

Eye drops can sometimes cause irritating conjunctivitis. The lacrimal sac should be compressed when used, especially for children. If absorbed through nasolacrimal duct, it may cause systemic symptoms. Mainly manifested as dry mouth, decreased saliva secretion, anhidrosis, skin flushing, dizziness, increased heart rate, irritability, blurred vision and shyness. Dry skin, fever, rash, especially on the face, neck and upper torso, may have desquamation.

When atropine is used to treat ametropia in children, there may be slight but amazing toxic reactions.

interaction

When (1) is used in combination with urine alkalizing drugs, it includes magnesium-containing or calcium-containing antacids, carbonic anhydrase inhibitors, sodium bicarbonate, citrate, etc. The excretion of atropine is delayed and the action time and/or toxicity are increased.

(2) Combined with amantadine, phenothiazine, other anticholinergic drugs, primidone, procainamide and tricyclic antidepressants, the toxic and side effects of atropine can be aggravated.

(3) When combined with monoamine oxidase inhibitors (including furazolidone and procarbazide). ), can strengthen the side effects of anti-m choline.

(4) When combined with metoclopramide, it can antagonize the effect of metoclopramide in promoting gastrointestinal motility.

Atropine prolongs the dissolution time of drugs in gastrointestinal tract, such as digoxin, and increases its absorption. It has additive effect on sedatives and other anticholinergic drugs.

This medicine is usually mainly used for administration before general anesthesia to relieve organ colic caused by smooth muscle spasm. It is also often used to treat infectious toxic shock or rescue severe organophosphorus poisoning or antimony poisoning. At this time, a large dose is needed to take effect, and a dose close to the toxic dose is often needed to achieve the effect of atropine, that is, symptoms such as moderate pupil dilation, flushing on the face and neck, dry mouth, increased heart rate, fever in limbs, and mild anxiety appear.

79 patients with cardiovascular system were given intravenous atropine 1mg after operation. More than13 patients have arrhythmia, and more than half of them are under 20 years old. Atrioventricular separation is common in adults, but it is atrial arrhythmia in children. Atropine 1.6 mg/kg in volunteers can cause the borderline rhythm of ECG without P wave, which appears before the heart rate increases. Healthy men were anesthetized by dental surgery, and 0.4 mg atropine was injected intravenously 5 minutes before anesthesia, which reduced the average arterial pressure, stroke volume and total peripheral vascular resistance. Atropine test was performed in patients with sick sinus syndrome. After intravenous injection of atropine (1mg), there was no change immediately. Multi-source ventricular premature beats occurred at 1 min, some of which were R waves on T waves, followed by paroxysmal ventricular tachycardia, lasting about 20 seconds. Borderline tachycardia for 2 minutes; 7 beats/min to sinus rhythm with a heart rate of 70 beats/min. Attempts to use atropine to increase heart rate during myocardial infarction are usually successful. However, after atropine was used in some patients with second degree atrioventricular block, the ventricular rate slowed down, and some patients developed tachycardia or even ventricular fibrillation. This complication may be due to the dose exceeding 1mg, but sometimes the dose of 0.5 mg can also cause the above complications.

Respiratory system This medicine can increase the breathing speed and depth, which may be a reaction to the increase of dead space after bronchiectasis.

Recently, some reports on nervous system pointed out that atropine can cause memory deficiency. It is reported that 57 patients with femoral neck fracture were given atropine before anesthesia, and mental confusion occurred after operation, of which 13 cases occurred on the first day after operation and 7 cases occurred within one week after operation. There is no difference in the incidence of general anesthesia or epidural anesthesia. It is reported that the use of atropine-containing patches can also cause central nervous system reactions, such as visual impairment and hallucinations.

1 A patient with special sensation experienced temporary central blindness after intravenous injection of atropine 0.8mg during spinal anesthesia, and the blink reflex and pupillary light and accommodation reflex disappeared, and the vision gradually returned to normal after dropping pilocarpine for several hours.

The most common allergic reactions are contact dermatitis and conjunctivitis. It is reported that atropine eye drops caused systemic allergic reaction in 2 cases, 1 case, 1 year. Atropine was injected 8 times, and fixed drug eruption occurred every time. 1 case had anaphylactic shock after intravenous injection of the drug.

Abnormal reaction) in patients with self-syndrome, atropine causes abnormal pupil dilation, which may be due to hereditary abnormal reaction, and the heart rate increases much faster than that of normal people. On the contrary, the pupil dilation time of patients with congenital albinism is shorter than that of normal people, but their responses to houmatopine, scopolamine and pilocarpine are normal.

Clinical manifestations of atropine overdose, reports of atropine poisoning in China, 5 cases of toxic psychosis; 1 case has dry mouth, dizziness, palpitation and flushing, followed by delirium and limb convulsion; 1 case had skin flushing, delirium, fidgety and paroxysmal limb spasm.

Drug interaction Atropine prolongs the dissolution time of drugs in gastrointestinal tract, such as digoxin, and increases its absorption. It has additive effect on sedatives and other anticholinergic drugs. It is unnecessary and dangerous to add atropine to antidiarrheal drugs to prevent abuse.

When interfering with experimental diagnosis, it can reduce the discharge of phenol red.

Prevention and treatment of adverse reactions

(1) Glaucoma, prostatic hypertrophy and high fever are prohibited. Those who are intolerant of other belladonna alkaloids are intolerant of this product.

(2) Intravenous atropine injection in pregnant women can cause fetal tachycardia.

(3) This product can be secreted into milk, which has the effect of inhibiting lactation.

(4) Infants are extremely sensitive to the toxic reaction of this product, especially those with spastic paralysis and brain injury. When the ambient temperature is high, there is a risk that the body temperature will suddenly rise due to sweating, so watch closely when applying.

(5) The elderly are prone to anti-M choline-like side effects, such as dysuria, constipation and dry mouth (especially in men), and it is also easy to induce undiagnosed glaucoma. Once found, the drug should be stopped immediately. This product is especially easy to reduce the sweat secretion of the elderly and affect heat dissipation. Use it with caution in summer.

(6) Use with caution in the following situations: ① brain injury, especially in children; ② Heart disease, especially arrhythmia, congestive heart failure, coronary heart disease and mitral stenosis. (3) Reflux esophagitis, weakened gastroesophageal motility and relaxation of extensor muscles in the lower esophagus can delay gastric emptying, thus promoting gastric retention and increasing gastroesophageal reflux; (4) Glaucoma patients are forbidden, and patients over 20 years old are at risk of inducing latent glaucoma; ⑤ Ulcerative colitis, when the dosage is large, the intestinal motility decreases, which can lead to paralytic intestinal obstruction and aggravate toxic Hirschsprung's disease; ⑥ Urinary tract infection (decreased bladder tension) and urinary tract obstructive diseases caused by prostatic hypertrophy can lead to complete urinary retention.

Sensitivity of organs to atropine

Atropine has a wide range of actions, and the sensitivity of various organs to atropine is different. With the increase of dose, the following phenomena can appear in turn: gland secretion decreases, pupil dilation and accommodation paralysis, bladder and gastrointestinal smooth muscle excitability decreases, heart rate increases, and toxic dose has a central role. Now it is described in turn as follows:

1. Atropine inhibits gland secretion by blocking M- choline receptor: Salivary glands and sweat glands are the most sensitive, which are obviously inhibited when using 0.5mg atropine, causing dry mouth and dry skin, and the secretion of lacrimal glands and respiratory tract is also greatly reduced. High dose can reduce the secretion of gastric juice, but it has little effect on the concentration of gastric acid, because gastric acid secretion is also regulated by humoral factors such as gastrin, and the secretion of HCO3- in the stomach is also inhibited (gastric acid is secreted by gastric parietal cells, and this secretion function is affected by many factors, mainly including nerve and humoral regulation). The nerve that dominates gastric acid secretion is vagus nerve. When the vagus nerve is excited, acetylcholine released from the end of postganglionic fibers directly acts on cholinergic receptors on the parietal cell membrane, causing an increase in hydrochloric acid secretion. The effect of acetylcholine can be blocked by atropine, a cholinergic receptor blocker. In terms of body fluid regulation, the endogenous substances that stimulate gastric acid secretion mainly include gastrin and histamine. Methamidocyanogen can block the binding of histamine and histamine receptor (H2 receptor) on parietal cells, thus reducing gastric acid secretion. When these factors affect gastric acid secretion at the same time, it is greater than the sum of individual effects, which is called reinforcement. Therefore, when any secretion blocker is used, such as methamidophos, it not only inhibits the reaction of parietal cells to histamine, but also reduces the effect of parietal cells on gastrin and acetylcholine because of the removal of histamine background.

2. Atropine blocks M cholinergic receptors, thus relaxing the sphincter of pupil and ciliary muscle, causing mydriasis, elevated intraocular pressure and accommodation paralysis, leading to photophobia. Both local eye drops and systemic administration can have these effects, which should be paid attention to.

(1) Atropine mydriasis relaxes the sphincter of pupil, making the function of mydriatic muscle dominated by norepinephrine dominant, thus achieving the purpose of mydriasis.

(2) Elevated intraocular pressure Due to pupil dilation, the iris retreats to the peripheral edge, which narrows the angular space of the anterior chamber and prevents aqueous humor from flowing back to the scleral venous sinus, resulting in increased intraocular pressure. Therefore, atropine is prohibited for glaucoma or those with a tendency to increase intraocular pressure.

(3) Atropine can relax the ciliary muscle and retreat to the outer edge, thus tightening the suspensory ligament, flattening the lens and reducing its refraction. It is only suitable for looking at distant objects, and cannot clearly image near objects on the retina, so the near objects are blurred. This effect is called regulatory paralysis.

3. Smooth Muscle Atropine can relax a variety of visceral smooth muscles, especially for hyperactive or spasmodic visceral smooth muscles. It can inhibit the intense spasm of gastrointestinal smooth muscle, reduce the amplitude and frequency of peristalsis and relieve gastrointestinal colic; It also has spasmolytic effect on bladder detrusor; But the spasmolytic effect on bile duct, ureter and bronchus is weak. The response of gastrointestinal sphincter mainly depends on the functional state of sphincter. For example, when the pyloric sphincter of stomach spasms, atropine has a relaxing effect, but the effect is not significant and not constant. Atropine has little effect on uterine smooth muscle.

4. Heart

(1) Atropine (0.5mg) can slightly and temporarily slow down the heart rate of some patients, usually 4-8 times per minute, which may be due to atropine blocking the M 1 receptor in the presynaptic membrane, thus reducing the inhibitory effect of Ach on the release of neurotransmitters in synapses. A large dose (1 ~ 2 mg) blocked the M2 receptor at the pacemaker of sinoatrial node, relieved the inhibitory effect of vagus nerve on the heart, and accelerated the heart rate. The degree of acceleration depends on the tension of vagus nerve. In young people with high vagus nerve tension, the heart rate is obviously accelerated. For example, intramuscular injection of 2 mg of atropine can increase the heart rate by 35 ~ 40 beats/min.

(2) Atropine in atrioventricular conduction can antagonize conduction block and arrhythmia caused by excessive vagal excitation. However, atropine should be used with caution in myocardial infarction, because atropine can accelerate the heart rate, aggravate myocardial ischemia and hypoxia, and may stimulate ventricular fibrillation.

5. The therapeutic dose of atropine has no obvious effect on blood vessels and blood pressure, which may be due to the lack of cholinergic innervation in many blood vessels. A large amount of atropine can relieve vasospasm, especially skin vasodilation, which can produce flushing and warmth. The mechanism of vasodilation is unknown, but it has nothing to do with the anti-M choline effect. It may be the compensatory heat dissipation response of the body to the temperature rise caused by atropine, or it may be the direct vasodilation effect of atropine.

6. A large dose of 1 ~ 2~5mg of central nervous system can stimulate the medulla oblongata and brain to a certain extent. When it is 2~5mg, the excitability is enhanced, and anxiety, talkativeness and anxiety appear; Poisoning doses (such as 10mg or more) often cause hallucinations, disorientation, dyskinesia and convulsions. , but also from excitement to inhibition, leading to coma and respiratory paralysis.