atropine sulphate ointment

Practical's

1. Exp – 4 Date: 2/2/2015 ATROPINE SULPHATE OINTMENT AIM :- To prepare and dispense 10g of 1% atropine sulphate ointment

2. PRESCRIPTION:- Dr . N.Mohan , MD, MIMS Hospital, Nellimarla . For, Date : 2/2/2015 Name : Rakesh , Age: 45 yrs, Sex: Male, Address: Vizianagaram ∆ - Acute iritis R / Atropine sulphate – 100 mg Liquid paraffin – 1 g (w/v) Wool fat – 1 g Yellow soft paraffin – 8 g Mix and make an ointment Directions :- To apply on eyelid margins twice daily. Signature

3. APPARATUS:- Dispensing balance with metric system of weights, mortar and pestle, china dish, water bath, stirring glass rod, spatula and polythene satchet . CHEMICALS :- Atropine sulphate , liquid paraffin, wool fat, yellow soft paraffin. COMPOSITION :- Atropine sulphate – 100 mg Liquid paraffin – 1 g (w/v) Wool fat – 1 g Yellow soft paraffin – 8 g CALCULATION:- Atropine sulphate 1% = 1g in 100g, For 10g = 10/100X1 = 0.1g = 100 mg Oculentum : a. Yellow soft paraffin = 80% = 80g in 100g, For10g = 10/100X80 = 8g b. Liquid paraffin = 10% = 10g in 100g, For10g = 10/100X10 = 1g c. Wool fat = 10% = 10g in 100g, For10g = 10/100X10 = 1g

4. PROCEDURE:- Preparation of oculentum – 8g of yellow soft paraffin, 1g of wool fat and 1 g of liquid paraffin were weighed and taken in a china dish and heated on a water bath and stirred well with the glass rod till they melt. To this oculentum 100mg atropine sulphate was added gradually while continuing the trituration until it becomes smooth and uniform. Ointment was made cool and transferred to polythene satchet and is labelled properly .

5. Questions: 1. What have you prepared? A. Atropine sulphate eye ointment (1%) 2. How to apply? A. Lower eyelid margins to be everted and then to apply on the eyelid margins 3. Why yellow soft paraffin but not white soft paraffin is used? A. White soft paraffin is prepared by bleaching of yellow soft paraffin with chlorine; so this chlorine may cause irritation of the eye. 4. Why liquid paraffin is used? A. It is used externally as an ophthalmic lubricant as it is non-irritating in nature.

6. 5. Classify ointment bases? A. i . Hydrocarbon base: They are not absorbed by the skin, and therefore used when a superficial or simple protecting action is desired. They have great stability and never became rancid. Eg - soft paraffin, hard paraffin, paraffin ointment (hard paraffin 8%, soft paraffin 90% and bee’s wax 2%), oculentum (yellow soft paraffin 80%, wool fat 10%, liquid paraffin 10%). ii . Animal fat bases: They are used when the medicament is intended to be absorbed and to have a deeper action. Eg : lard, benzonated lard iii . Wool fat and wool alcohol bases: Eg : wool fat (anhydrous Lanolin), hydrous wool fat and wool alcohols. iv . Synthetic wax like substances: Emulsifying wax

7. 6. What are the effects of this ointment on eye? A. i . Mydriasis – Passive dilatation of pupil as the muscarinic effect on constrictor pupillae is blocked and unopposed effect of sympathetic dilatory fibres (alpha effect) occurs. ii . Cycloplegia (paralysis of accommodation) – Paralysis of ciliary muscle – suspensory ligament of lens are taught – lens are prevented from being more convex i.e , flattening of lens – paralysis of accommodation – eye is fixed for distant vision and near objects are blurred. iii . Loss of light reflex – As the constrictor pupillae cannot function iv . Intraocular tension (Normal 12-20 mm of Hg) may rise and may precipitate glaucoma. Narrowing of iridocorneal angle and thus prevention of drainage of aqueous humor through the canal of schlemm situated at the iridocorneal angle. v . Drying of the conjunctiva due to inhibition of lacrimal secretion vi . Paradoxical circumcorneal hyperemia/congestion due to dilatation of conjunctival blood vessels. vii . Photophobia due to pupillary dilation.

8. 7. What are the sources of atropine? A. Atropine is an alkaloid, obtained from Atropa belladonna, Datura stramonium . 8. What are the uses of atropine ointment ? A. a . As a mydriatic and cycloplegic for accurate measurement of errors of refraction in children below the age of 5 years (Because in children parasympathetic tone is high). For children over 5 years and in adults, Cyclopentolate (0.5%) or Tropicamide (0.5%) or Homatropine hydrobromide (2%) is used and this helps to determine the far point of eye easily. Mydriasis is often necessary for thorough examination of the retina and optic disc. Cyclopentolate and tropicamide lack cycloplegic effect (as drops). b . In treatment of acute iritis where the above mydriatics act by two ways (as ointment)– i . Prolonged mydriasis causes prolonged relaxation of iris ii . Patient abandons his effort of accommodation because he realizes that he cannot focus for near vision. So, iris will get rest. Any of the above mydriatics is instilled as 2 drops 3 times a day. c . In treatment of iridocyclitis , choroiditis , following cataract extraction, keratitis , complete cycloplegia and mydriasis are required in these conditions and it is instilled as 2 drops 3 times a day (as ointment). d . In treatment of posterior synechiae , atropine may be alternated with miotics to prevent or break adhesions between the iris and the lens (as drops).

9. 9. What are the contraindications of use of atropine ointment in eye? A. i . Narrow angle glaucoma/chronic wide angle glaucoma. ii . Intraocular lens transplantation iii . Subluxated lens iv . History of hypersensitivity to atropine (local irritation of eye, may produce swelling of the eyelids and conjunctivitis) 10. How long the effects of atropine remain? A. About 7-10 days, if not counteracted by cholinergic drugs. Only partially the effects are counteracted by pilocarpine (2%), physostigmine (0.5%) or DFP (0.025%).

10. 11. How will you differentiate mydriasis produced by sympathomimetic agent (ephedrine, phenylephrine ) from the same caused by muscarinic blockers? A. i . Light reflex lost in atropine induced mydriasis but not in mydriasis produced by sympathomimetic agent, because the pupillae remains intact and can be tested both in animals and human beings. ii . Loss of accommodation observed in atropine induced mydriasis but not in sympathomimetic induced mydriasis as there is no cycloplegia and can be tested in human beings only. iii . Conjunctival congestion is observed in atropine induced mydriasis but blanching of conjuctiva is observed in sympathomimetic agent induced mydriasis . This can be observed from distance.

11. 12. What are the systemic uses of atropine sulphate injection? A. i . Preanaesthetic medication SC or IM ii . During operation IV to counteract increased muscarinic effect of Ach iii . Immediately after operation along with neostigmine methylsulphate inj IV during decurarization iv . Cardiac arrest IV v . Severe sinus bradycardia with hypotension IV vi . High degree atrioventricular block IV vii . Slow idioventricular rates IV

12. LABEL ATROPINE SULPHATE OINTMENT Date:-2/2/2015 Name : Rakesh , Age: 45 yrs, Sex: Male, Address : Vizianagaram . Directions :- To apply on eyelid margins twice daily. Signature PHARMACY LAB, MIMS COLLEGE, NELLIMARLA FOR EXTERNAL USE ONLY