Adverse Drug Reactions And Orofacial Tissues Flashcards
How often do oral adverse effects by medicines occur?
Oral adverse effects by medicines are rare but their impact signifixant
How can an adverse drug reaction present in the oral cavity
Oral ulceration or blistering Lichenoid reaction/ lupus like eruptions Erythema multiforme Discoloration of mucosa or teeth Altered taste or sensation Reduced or increased salivary flow Salivary Gland or gingival swelling
When may an adverse reaction involve oropharyngeal candidosis
Following broad spectrum antibiotic use
What effect may bisphosphonate use have?
Osteonecrotic lesion in the bone of the Jaws may occur
Spontaneously or following tooth xla
Can adverse drug reactions have a genetic element? Give an example
Reaction seen with carbamazepine in individuals of Chinese descent
What is an adverse effect if the vasodilator antihypertensive drug hydralazine
Can predispose to symptoms that are almost indistinguishable from sjogrens syndrome.
Therefore may not be recognised as an adverse effect
Instead being misdiagnosed as a systemic disease
How can a hydralazine drug reaction be distinguished from sjogrens disease?
If the pt is suffering from a hydralazine drug reaction then normal histological findings in labial Gland biopsy will confirm this
What is hydralazine
An antihypertensive drug vasodilator
Can predispose to symptoms that are almost indistinguishable from sjogrens syndrome.
Therefore may not be recognised as an adverse effect
Instead being misdiagnosed as a systemic disease
When do clinical signs and symptoms of an adverse drug reaction present
The pt could be taking the medication for moths before clinical signs and symptoms become apparent
It’s quite rare for the pt to start a new drug and attend clinic the next week with symptoms of adverse drug reaction
What can help the clinician in diagnosing an adverse drug reaction
Ask the pt to bring in a print out of their current medication
This is particularly the case for pts who have been on the same medication for years
How is type 2 diabetes now controlled compared with the past and why is this important to clinical practice
Insulin is now also used to control type 2 diabetes mellitus in pts who previously were largely controlled with diet combined with oral hypoglycaemic age ts
The likelihood of a hypoglycaemic attack is much more in a type 2 diabetes who is controlled using insulin
Who is responsible for monitoring drug safety in clinical practice in the uk
The commission on human medicine CHM
What does the CHM encourage?
Using the yellow card system to report suspected adverse drug interactions
What does the yellow card do
Records details of the pt
Suspected drug
Pt details
Other concurrent medication
Can either be submitted by post or online
When regulatory authorities are considering advice on possible adverse drug reactions what clinical questions related to the drug therapy need to be considered
What are the manifestations of the adverse event
What proportion of pts taking a suspected drug will suffer symptoms
Are symptoms dose related
How long after taking the drug do symptoms appear
How long after cessation of drug therapy will the symptoms appear
How are sidee effects or adverse events usually listed?
Very common: greater than 1 in 10 Common: 1 in 100 to 1 in 10 Uncommon: 1 in 1000 to 1 in 100 Rare: 1 in 10000 to 1 in 1000 Very rare: less than 1 in. 10000
What are the stages of drug development, who is involved
Synthetic chemist’s structure activity studies, novel compounds
Analytical chemist’s (confirm purity)
Pharmacologists (detect activity, toxicological studies)
What are adverse drug reactions to dental mineralised tissues? Give an example
The visual and structural changes that can be induced by tetracycline therapy during mineralisation of the developing teeth
A clinically identical phenomenon can occur in adults given prolonged tetracycline therapy
Is tetracycline staining only developed in children taking the drug?
No. A clinically identical phenomenon can occur in adults given prolonged tetracycline therapy
How is the staining thought to occur following tetracycline therapy?
Tetracycline section into saliva
Surface remineralisation and demineralisation
What other antibiotic has an adverse effect on dental mineralised tissues? Can this be treated
Rifampicin
Teeth can be yellowed
Removed by polishing
Can drugs precipitate various orofacial changes in an unexpected manner that closely mimic naturally occurring diseases?
Yes
In this way drugs act as “precipitating factors’
When they produce an orofacial adverse reaction in a relatively predictable manner
What is an example of drugs as precipitating factors
Candidiasis following systemic antibiotic therapy or corticosteroid therapy either topically or systemically
What is the characteristic manifestation of systemic antibiotic therapy in the mouth
Pseudomembranous oral candidosis in the soft palate
The erythematous (painful form) may also occur
If a female suffers from candidosis where is it also likely to occur
Vagina
How can this Vaginal candidosis be prevented
Concomitant systemic use of antifungal fluconazole
If the pt is takinf antibiotic therapy what else may present apart from candidosis on the palate
A localised form of oral erythematous candidosis identical to median rhomboid glossotis
What should the pt be instructed to od at home to avoid median rhomboid glossotis and palatal candidosis
Pts should be instructed to rinse or gargle with water after inhaler use to clear residual drug
Since up to 80% of the steroid can remain in the oral cavity
How much of the steroid can remain the mouth if the pt doesn’t gargle after use
up to 80% of the steroid can remain in the oral cavity
What can using a spacer and gargling with water after steroid use prevent?
Palatal candidosis and median rhomboid glossotis potentially
What are bisphosphonates prescribed for
Osteoporosis mainly
Pagets disease, metastatic cancer affecting bone and hypocalcaemia of malignancy
How many groups of bisphosphonates exist
Three groups of bisphosphonates are recognised
How do bisphosphonates work
Two of the bisphonates inhibit the enzyme farnesyl pyrophosphate synthetase (important factor in osteoclast function)
The third bisphosphonate is incorporated into adenosine triphosphate leading to osteoclast apoptosis
How are bisphosphonates administered
Intravenously or orally
Who is most likely to develop BRONJ
Cancer pts receiving these drugs at high doses intravenously
Which appears to have less risk of adverse event oral or intravenous administration of bisphosphonates
Oral
How in bronj treated
Maybe
- Antibiotic therapy (clindamycin penetrates bone well) either as treatment or preventive capacity
- Local measures
Which antibiotic is used to treat Bronj why?
Clindamycin
Penetrates bone well
In what ways may drug therapy affect salivary Gland
There are 4 main ways in which drug therapy can affect salivary Gland structure or function
- Sialosis
- Sialorhea
- Salivary gland pain
- Xerostomia
What is sialosis
Non neoplastic
Non inflammatory
Persistent swelling of the salivary tissues
Usually of both the parotid glands
What salivary glands does sialosis affect
One or both parotid glands
What drugs are associated with sialosis
Phenylbutazone
Anti thyroid drug propylthiouracil
Isoprenaline
What do isoprenaline, anti thyroid drug propylthiouracil have in common
They can all cause sialosis
In clinical practice what is the commonets drug to cause sialosis
Alcohol
What is the prevalence of sialosis recorded in diabetic pts
25%
What mouthwash has been rarely reported as causing salivary swelling
Chlorhexidine
What is xerostomia
Dry mouth
True or false
There is no compelling evidence that increasing age of the pt results in reduced salivary function and xerostomia
True
True or false
The scientific basis linking a particular drug to causing xerostomia is sometimes lacking
True
What drugs are linked to xerostomia anecdotally
Tricyclic agents Eg amitriptyline and dosulepin
Given for depression anxiety muscle tension headache fibromyalgia
In clinical practice what drug most commonly causes xerostomia
Omeprazole
What is omeprazole
Proton pump inhibitor
Prescribed to inhibit gastric secretion
Leads to dry mouth (process unclear)
Why does polypharmacy make the diagnosis difficult
Taking multiple drugs makes it extremely difficult to attribute the onset of the dry mouth to one medicine
What is sialorrhoea
CO too much saliva
In many cases pts Co of too much saliva. Have underlying hypochondriasis
True or false
In many cases pts Co of too much saliva. Have underlying hypochondriasis
True
What may the cause of sialorrhoea be apart from hyoichindriasis
Use of drugs with cholinergic activity Eg tetrabenazine and cloazopine
What oral symptoms may a pt taking tetrabenazine and cloazopine have?
Siolorrhoea
These are cholinergic drugs
Stimulate salivary glands
What else may increase saliva production
Radioactive iodine
Possibly related to the agent being secreted in saliva and tears
What do amitriptyline, dosulepin and muscle relaxants have in common
Cause xerostomia
What is dosulepin
An antidepressant
What effects may drugs have on oral mucosa and skin?
Contact Hypersensitivity Connective tissue changes Pigmentary changes Vascular changes Lichenoid drug reaction Erythema multiforme Bullous type reactions Epithelial keratinisation changes Neurological changes
Can drugs have direct chemical changes on the oral mucosa? Give an example
Mucosal erosion due to placement of aspirin tablet adjacent to a painful carious tooth
Direct chemical effects occur as a result of direct exposure of an agent to the oral mucosa or skin it is not Uncommon to see a localised sloughing erosion at an intra oral site where. Pt has placed an aspirin tablet adjacent to a painful tooth
Sometimes pts hold an aspiring tablet directly in the mouth to relief the pain of oral ulceration
What is the pathophysiology of a mucosal aspirin burn
Dissolution of aspirin in saliva produces a low pH and the net result is effectively a chemical burn
What are drugs may cause an aspirin like burn?
Over the counter preparations of choline salicylate gel on the fitting surface of an upper denture to relive discomfort leads to palatal mucosa burn
Chronic acid, phenol, paraquat all produce usually more extensive burns
What is contact Hypersensitivity how may it affect the oral cavity
A range of commercial dental care preparations including mouthwashes gels toothpastes can cause mucosal changes due to Hypersensitivity reaction.
A frequently documented adverse oral reaction to toothpaste involves cinnamon which is often used as a flavouring agent
How can contact Hypersensitivity be treated
Patch testing points out the allergens (often delayed Hypersensitivity reaction occurs)
How can drugs cause connective tissue changes
Systemic drug therapy produces a proliferative response in the connective tissues which usually manifests as gingival hyperplasia
The mechanism of the drug induced effect is still not clear but appears to involve fibroblast proliferation and reduced fibroblast turnover
What drugs are associated with fibroblast proliferation and reduced fibroblast turnover
Phenytoin antiepileptic drug
Nifedipine calcium channel blocker antihypertensive
Ciclosporin immunosuppressant
And combined oral contraceptive
What is phenytoin
Anti epileptic drug
Causes fibroblast proliferation reduced fibroblast turnover
Manifests as gingival hyperasia
How does a Nifedipine adverse drug reaction manifest
Gingival hyperplasia
What is nifedipine
Calcium channel blocker antihypertensive
What is Ciclosporin
Immunosuppressant
What % of pts taking phenytoin will suffer some degree of hyperplasia within the first 3 months of starting medication
50%
What is the incidence of swelling associated with ciclosporin
30%
What is the incidence of swelling associated with nifidepine
15%
WHAT MAY CONTRIBUTE TO THE GINGIVAL HYPERPLASIA ASSOCIATED WITH PHENYTOIN
poor oral hygiene
Dose of drug
Duration of drug therapy
What may allow clinical resolution of the problem of gingival hyperplasia
Improved oh
Gingival surgery
Change in drug therapy
What does oral pigmentation as a result of drug therapy usually look like?
Bluish or blue grey appearance
How does drug induced pigmentation present
Symmetrical
On the hard palate
What are the drugs most frequently involved in drug induced pigmentation
Antimalarials
Antibiotics
If the pt hasn’t travelled abroad should you then discount anti malarial drugs
No
The pt may still have been prescribed anti malarial therapy since the same drugs can also be used as a second line treatment for rheumatoid arthritis
What is required to be safe when diagnosing Pigmentary changes
Biopsy to discount malignant melanoma
What is the main feature of histopathological exam of tissues involved in a drug induced oral pigmentation
Pigmentary incontenance
What is a fixed drug reaction
Appearance of a localised lesion at the same site each time a drug is taken
Reaction usually involves a drug that is taken intermittently such as fluconazole doxycycline fluconazole
What drugs may be involved in a fixed drug reaction
fluconazole doxycycline fluconazole
What elements can cause oral pigmentation
Metals Eg silver gold bismuth
Almgam tattoo
What is the most frequent pigementary lesion caused by metal
Amlagma tattoo
What is seen on biopsy of a suspected amalgam tattoo why is this surprising
A v small number of amalgam particles visible in the biopsy tissue
When compared to the depth of the dark clinical colour of the lesion
Can vascular changes occur in the mouth due to adverse drug reaction?
They’re not usually reported by pts unless they have taken to examining their oral mucosa
Even for experienced clinicians the changes observed are subjective and there are no recognized diagnostic criteria
If vascular changes do occur what is the medical history of this pt likely to be
Cancer pt
Secretion of an acidic drug Eg methotrexate into parotid saliva
What drugs are most frequently implicated in a Lichenoid reaction
NSAIDS Ace inhibitors Beta blockers Hypoglycaemic agents Anti malarials
What are Lichenoid drug reactions
Where drugs such as NSAIDS Ace inhibitors and Beta blockers cause lesions in the mouth resembling lichen planus
What is cephelaxin
Cefalexin, also spelled cephalexin, is an antibiotic that can treat a number of bacterial infections. It kills gram-positive and some gram-negative bacteria by disrupting the growth of the bacterial cell wall. Cefalexin is a beta-lactam antibiotic within the class of first-generation cephalosporins
What drugs cause pemphigus
Drugsthatcause pemphigusinclude: Thioldrugs, including penicillamine, captopril. Antibiotics: penicillins, cephalosporins, vancomycin. Antihypertensivedrugs: other angiotensin-converting enzyme inhibitors such as cilazapril, lisinopril, enalapril.
What is nicotinic stomatitis where does it present
Nicotine stomatitis, also often called smoker’s palate, is a reaction seen on the roof of the mouth caused by extreme heat in the mouth, most commonly from smoking. It is known by many other names includingnicotinic stomatitis,stomatitisnicotina and smoker’s keratosis.
What is erythema multiforme
Erythema multiforme(EM) is a skin condition of unknown cause; it is a type oferythemapossibly mediated by deposition of immune complexes (mostly IgM-bound complexes) in the superficial microvasculature of the skin and oral mucous membrane that usually follows an infection or drug exposure.
What drugs cause erythema multiforme
Manydrugshave been reported to triggererythema multiforme, including barbiturates, non-steroidal anti-inflammatorydrugs, penicillins, sulphonamides, nitrofurantoin, phenothiazines, and anticonvulsants
What skin condition presents with “target lesions”
EM erythema multiforme
What is another term for Lichenoid drug reaction
drug-induced lichen planus. If thereactionoccurs inside your mouth, it’s called orallichenoiddrug eruption. The rash can take some time to develop.
What is nicorandil
Nicorandil is a vasodilatory drug used to treat angina. Angina is chest pain that results from episodes of transient myocardial ischemia. This can be caused by diseases such as atherosclerosis, coronary artery disease and aortic stenosis. Angina commonly arises from vasospasm of the coronary arteries
What are the oral adverse effects of nicorandil
Nicorandilinducedulcersare very painful and distressing for patients. Clinically they appear as large, deep, persistentulcersthat have punched out edges. …Nicorandil, a nicotinamide ester, is a potassium channel activator used in the prevention and long term treatment of angina pectoris.
Define bulla
A large blister containing serous fluid
Define bollous
characterized by blisters or bullae on the skin.
What is grinspan syndrome
Grinspan syndromeis asyndromecharacterized by presence of the triad: essential hypertension, diabetes mellitus, and oral lichen planus. Oral lichen planus is thought to be a result of the drugs used for treatment of hypertension and diabetes mellitus but this is not confirmed.
What is the triad of grinspan syndrome
Essential hypertension
Oral lichen planus
Type 2 diabetes
What does the presentation of Essential hypertension Oral lichen planus Type 2 diabetes In a pt mean?
Grinspan syndrome
What is the aetiology of lichen planus
Unknown
How is lichen planus LP treated compared with Lichenoid reaction LR
The treatment of LP comprises mainly the utilization of corticosteroids and the LR
What is the cause of LR (how is this different from LP)
etiology of LRs is related to the contact with specific agents, such as metallic restorative materials, resins, and drugs, allowing the establishment of a cause-effect relationship. In this case, the disease is caused by the antigen fixation in the epithelial cells, which are destructed by the immune system
What is indirect immunofluorescence
Indirect immunofluorescenceassay: A laboratory test used to detect antibodies in serum or other body fluid. The specific antibodies are labeled with a compound that makes them glow an apple-green color when observed microscopically under ultraviolet light.
What is the homunculus theory
The termhomunculusis Latin for “little man.” It is used in neurology today to describe the map in the brain of sensory neurons in each part of the body (the somatosensoryhomunculus).
What two clinical features help to differentiate Lichenoid reaction from lichen planus
- Lack of symmetry
2. Tendency to affect the hard palate and floor of the mouth
When should Lichenoid reaction be considered as a DDx
If a pt reports onset after starting a new medication even if their relationship is many months later
What test can help differentiate LR from LP
Indirect immunofluorescence using a blood same from the pt
What indirect immunofluorescence of LR demonstrate
Circulating igG against the basal cell membrane
Is the indirect immunofluorescence test considered valid
Controversial
In grinspan syndrome what is the evidence of the oral lichen planus in the triad? Why is the syndrome questioned or deemed irrelevant by some
It is more likely to be a Lichenoid reaction related to antihypertensive medication
Therefore the true basis of the syndrome is under question
How does nicorandil work
It is a potassium channel activator
Used for prevention and long term treatment of angina
Where does nicorandil ulceration usually occur
Tongue and buccal mucosa
What is the onset of erythema multiforme
Rapid onset extensive oral ulcers
AND blood crusted lips
What drug is associated with inducing erythema multiforme
Co trimoxazole
Why is the use of Co trimoxazole limited to those situations where biological studies deem it necessary
Some evidence Co trimoxazole is associated with the onset of erythema multiforme
How should EM be treated
If the history reveals a close association with a medicine that the pt has commenced then this should be discontinued
Prescribe benzoate free preparations of drugs
What should be excluded in the diagnosis and tx of EM
Sensitivity to benzoic acid E210
And benzoate E211 E219
What is Glibenclamide
Glibenclamide, also known as glyburide, is a medication used to treat diabetes mellitus type 2. It is recommended that it be taken together with diet and exercise. It may be used with other antidiabetic medication. It is not recommended for use by itself in diabetes mellitus type 1. It is taken by mouth.
What sulphonylurea drug administered to pts with diabetes mellitus type 2 to augment insulin secretion may cause bullous type reactions
Glibenclamide
How can drug therapy precipitate a disease in susceptible individuals which is clinically and pathologically identical to the iatrogenic disease process
Eg a pt taking Glibenclamide to treat his diabetes presented with pemphigus vulgaris
What is pemphigus vulgaris
Pemphigus vulgaris (PV) is a rare and serious (potentially life-threatening) condition that causes painful blisters to develop on theskin and lining of the mouth, nose, throat and genitals.
Theblistersare fragile and can easily burst open, leaving areas of raw unhealed skin that are very painful and can put you at risk of infections.
There’s currently no cure for pemphigus vulgaris, but treatment can help keep the symptoms under control.
The conditioncan affect people of all ages, including children, but most cases develop in older adults between the ages of50 and 60.It isn’t contagious and can’t be passed from one person to another.
Symptoms of pemphigus vulgaris
Theblisters usually develop in the mouth first, before affecting the skin a few weeks or months later.

There may be times when the blisters are severe (flare-ups), followed by periods when they heal and fade (remission). It’s impossible to predict when this might happen and how severethe flare-upswill be.
Blisters in the mouth often turn into painful sores, which can make eating, drinking and brushing teeth very difficult.The voice can become hoarse if the blisters spread to the voice box (larynx).
Sores on the skin canjoin together to form large areas of painful, raw-looking skin, before crusting over and forming scabs.They don’t usually leave anyscars, althoughaffected skin canoccasionally become permanently discoloured.
As well as getting blisters in the mouth, they can also develop in other areas of the digestive system’s soft tissue lining, including the nose, throat, anus, genitals and vagina. The thin membrane that covers the front of the eye and inside of the eyelids (conjunctiva) can also be affected.
What is the most common form of pemphigus
Vulgaris
What type of Hypersensitivity reaction is pemphigus
Type II
What are the antibodies found in pemphigus against
The antibodies are formed againstdesmosomes, the cell adhesion proteins. As desmosomes are attacked, the layers of skin separate = a blister. These blisters are due to acantholysis, or breaking apart of intercellular connections through an autoantibody-mediated response. Over time the condition inevitably progresses without treatment: lesions increase in size and distribution throughout the body, behaving physiologically like a severe burn.
What is Rituximab
Monoclonal antibody used to treat autoimmune disorders It is used fornon-Hodgkin’s lymphoma,chronic lymphocytic leukemia,rheumatoid arthritis,granulomatosis with polyangiitis,idiopathic thrombocytopenic purpura,pemphigus vulgaris,myasthenia gravisandEpstein-Barr virus-positivemucocutaneous ulcers. It is given byslow injection into a vein.
How is pemphigus treated
Corticosteroids
How is pemphigoid different from pemphigus
pemphigoid does not featureacantholysis, a loss of connections between skin cells.
Which is more common pemphigoid or pemphigus
Pemphigoid
What is pemphigoid? What is it mediated by
Pemphigoidis a group of rareautoimmuneblisteringskin diseases
Usuqlly igG mediated
What is the pathophysiology of pemphigoid
The pathophysiology of bullous pemphigoid consists of two major components, which are immunologic and inflammatory. In the immunologic component, autoantibodies act against the hemidesmosomal bullous pemphigoid antigens BP230 (BPAg1) and BP 180(BPAg2 or type XVII collagen) which are located at the lamina lucida of the basement membrane zone. These antigens play an important role in the adhesion complexes that promote epithelial-stromal adhesion.[8]The predominant subclass of antibodies that acts against the antigens is IgG4. IgG1 and IgG2 antibodies are less frequently detected compared to IgG4 antibodies, while IgG3 antibodies are usually absent.[14]When the autoantibodies bind specifically to the target antigens, the complement system and mast cells are activated, thereby representing the inflammatory component. Inflammatory cells such as neutrophils and eosinophils are then attracted to the affected area. They are postulated to release proteolytic enzymes which degrade the hemidesmosomal proteins, resulting in blister formation.[8]
Other potential contributory factors including genetic factors, environmental exposures to infections and drugs as well as the phenomenon of epitope spreading are also known to cause bullous pemphigoid
What is the histopathology of pemphigoid
Lesional tissue, preferably of an intact vesicle or the edge of an intact bulla is obtained using punch biopsy for Haemotoxylin and Eosin (H&E)staining.
Typical histopathologic findings include:[17][18]
Sub-epidermal split with numerous eosinophils within the cleft.
A superficial dermal inflammatory cell infiltrate of variable intensity with lymphocytes, eosinophils, and neutrophils.
Eosinophlic spongiosis (Specifically in early lesion or may be seen in clinically erythematous skin surrounding the blister)
How direct immunofluorescence differ from indirect immunofluorescence
Direct immunofluorescenceEdit
Direct immunofluorescence (DIF) studies involves directly detecting tissue bound antibodies. Biopsy specimens for DIF should be taken from perilesional skin instead of lesional skin for H&E histopathologic evaluation.
DIF of bullous pemphigoid will show the presence of fine, continuous and linear deposits of IgG and/or C3 along the epidermal basement membrane. Other classes of immunoglobulins such as IgM and IgA are present in approximately 20% of cases and usually are less intense. In some cases with the deposits of IgA, patient may have oral lesion. At early stages of the disease, only C3 may be present.[18]
Indirect immunofluorescenceEdit
Indirect immunofluorescence is used to detect circulating antibodies targeting the antigens at the basement membrane zone in patients with pemphigoid. In this procedure, patient’s serum is collected and overlaid on salt-split normal human skin and incubated. Following this, the specimen will be stained for fluorescent detection of antibodies.
In bullous pemphigoid, circulating IgG targeting the basement membrane, mainly BP180 and BP230 hemidesmosomal proteins are detectable in 60-80% of patients. IgA and IgE classes can also be detected, but less frequently.[18]
What is hyperkeratinisation
is adisorderof the cells lining the inside of ahair follicle. It is the normal function of these cells to detach or slough off (desquamate) from the skin lining at normal intervals. The dead cells are then forced out of the follicle (primarily by the growing hair). However, in hyperkeratinization, this process is interrupted and a number of these dead skin cells do not leave the follicle because of an excess ofkeratin, a natural protein found in the skin. This excess of keratin, which is influenced by genetics, results in an increased adherence/bonding of dead skin cells together.
What drug most frequently induces hyperkeratinization
Nicotine
Apart from the nicotine what else has vee. Suggested to chase smoker’s keratosis/ smoker’s palate
The heat from smoke itself is also involved since similar appearance in the palate has been reported in jndividus who drink hot tea or coffee
What drugs may cause circumoral paraesthesia?
Topical polymyxinB
Acetaomine
Colistin
What do the following drugs have in common
Polymyxin b
Acetaomine
Colistin
What adverse drug reaction can they cause
Circumoral paraesthesia
What is the function of hydralazine and labetalol
Control blood pressure
What is labetalol
Labetalolis a medication used to treat high blood pressure and in long term management of angina. This includes essential hypertension, hypertensive emergencies, and hypertension of pregnancy. In essential hypertension it is generally less preferred than a number of other blood pressure medications.
What is hydralazine
Hydralazine, sold under the brand name Apresoline among others, is a medication used to treat high blood pressure and heart failure. This includes high blood pressure in pregnancy and very high blood pressure resulting in symptoms
