阿托品
**阿托品 (Atropine)** 是一種經典的抗膽鹼藥物，在獸醫學中主要用於治療心搏過緩、散瞳以進行眼科檢查，以及處理特定中毒（如有機磷和氨基甲酸酯中毒）。它也與抗膽鹼酯酶藥物結合使用，以拮抗神經肌肉阻斷。 > **臨床警告：** 不再建議將其作為麻醉前用藥常規給藥；應監測心率並在必要時專門用於處理心率過低。
作用機制: Atropine competitively **blocks the action of acetylcholine** at **muscarinic receptors** located at the terminal ends of the parasympathetic nervous system. This blockade → reverses parasympathetic effects → produces **mydriasis** (pupil dilation), **tachycardia**, **bronchodilation**, and general inhibition of gastrointestinal function.
各物種劑量
- Ophthalmic (mydriasis) · 1 drop in the affected eye · topical · q12-24h to cause mydriasis, then once q24-96h to maintain mydriasis
- Bradyarrhythmias · 0.01-0.03 mg/kg i.v. or 0.03-0.04 mg/kg i.m. · IV/IM · PRN · Low doses may exacerbate bradycardia; repetition of the dose will usually promote an increase in heart rate. IM dose can be given to prevent development of bradycardia during administration of potent opioids such as fentanyl.
- Organophosphate poisoning · 0.2-0.5 mg/kg (¼ dose i.v., ¾ i.m., s.c.) to effect; repeat as necessary; or 0.1-0.2 mg/kg (½ i.v., ½ i.m.) then i.m. q6h · IV/IM/SC · PRN or q6h
- Neuromuscular blockade antagonism · 0.04 mg/kg i.v. · IV · PRN · with edrophonium (0.5-1.0 mg/kg)
- Ophthalmic (mydriasis) · 1 drop in the affected eye · topical · q12-24h to cause mydriasis, then once q24-96h to maintain mydriasis
- Bradyarrhythmias · 0.01-0.03 mg/kg i.v. or 0.03-0.04 mg/kg i.m. · IV/IM · PRN · Low doses may exacerbate bradycardia; repetition of the dose will usually promote an increase in heart rate. IM dose can be given to prevent development of bradycardia during administration of potent opioids such as fentanyl.
- Organophosphate poisoning · 0.2-0.5 mg/kg (¼ dose i.v., ¾ i.m., s.c.) to effect; repeat as necessary; or 0.1-0.2 mg/kg (½ i.v., ½ i.m.) then i.m. q6h · IV/IM/SC · PRN or q6h
- Neuromuscular blockade antagonism · 0.04 mg/kg i.v. · IV · PRN · with edrophonium (0.5-1.0 mg/kg)
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Glaucoma
- Lens luxation
- Keratoconjunctivitis sicca (KCS / dry eye)
不良反應
- Sinus tachycardia
- Blurred vision (due to mydriasis)
- Drying of bronchial secretions
- Increased intraocular pressure (IOP)
- Reduced tear production
- Ventricular arrhythmias
- Hypersalivation (especially in cats, due to bitter taste of ophthalmic drops)
- Ileus (rare in small animals)
- Vomiting (rare in small animals)
藥物相互作用
- Bromides, iodides, sodium bicarbonate, alkalis, noradrenaline · Incompatible when mixed together · major
- Antihistamines · May enhance the activity of atropine · moderate
- Pethidine · May enhance the activity of atropine · moderate
- Benzodiazepines · May enhance the activity of atropine · moderate
- Phenothiazines · May enhance the activity of atropine · moderate
- Thiazide diuretics · May enhance the activity of atropine · moderate
- Sympathomimetics · May enhance the activity of atropine · moderate
- Alpha-2 agonists · Combining is not recommended · major
- Amitraz · May aggravate toxicity signs, leading to hypertension and gut stasis · major
- Tricyclic Antidepressants · Additive anticholinergic effects · moderate
- Alpha-2 Agonists (e.g., Dexmedetomidine) · May cause paradoxical hypertension and significantly increased myocardial workload; concurrent use is generally discouraged · major
- Metoclopramide · Atropine antagonizes the prokinetic effects of metoclopramide on the GI tract · moderate
監測
- Heart rate and rhythm (ECG)
- Pupillary light reflex and pupil size
- Intraocular pressure (IOP)
- Tear production (Schirmer Tear Test)
過量
Overdose may lead to severe sinus tachycardia, ventricular arrhythmias (which may be treated with lidocaine if severe), extreme mydriasis, severe drying of secretions, and gastrointestinal stasis.
VetSheet 藥物參考供持牌獸醫專業人員作臨床決策輔助之用,不能取代專業判斷或廠方最新藥品說明書。