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5th yr- CMS2- Drugs > Adverse drug reactions: salivary glands and oral mucosa > Flashcards

Adverse drug reactions: salivary glands and oral mucosa Flashcards

1
Q

Define adverse drug reactions

A

Reactions that are unwarranted effects arising from a patients medication

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2
Q

What can adverse drug reactions be classified as

A
  1. Type A- Augmented reactions
  2. Type B- Bizarre reactions
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3
Q

What are type A reactions a result of

A

An exaggerated but otherwise normal pharmacological action of a drug given in the usual therapeutic dose

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4
Q

Give examples of structures that can be targeted by adverse drug reactions

A
  1. Salivary glands
  2. Oral mucosa
  3. Periodontal tissues
  4. Teeth
  5. Alveolar bone
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5
Q

Name one of the most widespread ADRs in dentistry

A

Drug induced xerostomia

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6
Q

How can salivary glands be affected by ADR

A
  1. Xerostomia
  2. sialorrhoea (Hypersalivaiton)
  3. gland swelling
  4. pain
  5. taste disturbances.
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7
Q

How do drugs inadvertently reduce saliva flow

A

The drugs compete with acetylcholine release at the parasympathetic effector junction
Salivary glands are under the control of the autonomic nervous system and hence are suppressed

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8
Q

List categories of drugs that can cause xerostomia

A
  1. Tricyclic antidepressants
  2. Muscarinic receptor antagonist
  3. α-Receptor antagonist Antipsychotics
  4. Diuretics
  5. Histamine H1 receptor blockers
  6. Histamine H2 receptor blockers
  7. Central antihypertensives
  8. Angiotensin-converting enzyme inhibitors
  9. Serotonin antagonists
    10 .Noradrenaline re-uptake inhibitors
  10. Dopamine re-uptake inhibitors
  11. Appetite suppressants
  12. Systemic bronchodilators
  13. Opioids
  14. Proton pump inhibitors
  15. Cytotoxic drugs Retinoids
  16. Anti-HIV drugs
  17. Antimigraine drugs
    19 .Decongestants
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9
Q

Give an example of a tricyclic antidepressant that can cause xerostomia

A

Amitriptyline

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10
Q

Give an example of a muscarinic receptor antagonist that can cause xerostomia

A

Oxybutynin

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11
Q

Give an example of an alpha receptor antagonist that can cause xerostomia

A

Terazosin

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12
Q

Give examples of antipsychotics that can cause xerostomia

A

Phenothiazines
lithium

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13
Q

Give an example of a diuretic that can cause xerostomia

A

Furosemide

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14
Q

Give an example of a histamine H1 receptor blocker that can cause xerostomia

A

Chlorphenamine

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15
Q

Give an example of a histamine H2 receptor blocker that can cause xerostomia

A

Cimetidine

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16
Q

Give an example of a hypertensive that can cause xerostomia

A

Moxonidine

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17
Q

Give an example of a angiotensin converting enzyme inhibitor that can cause xerostomia

A

Lisinopril

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18
Q

Give an example of a serotonin antagonist that can cause xerostomia

A

Fluoxetine

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19
Q

Give an example of a noradrenaline reuptake inhibitor that can cause xerostomia

A

Reboxetine

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20
Q

Give an example of a dopamine re uptake inhibitor that can cause xerostomia

A

Bupropion

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21
Q

Give examples of appetite suppressants that can cause xerostomia

A

Fenfluramine
Phentamine

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22
Q

Give an example of a bronchodilator that can cause xerostomia

A

Tiotropium

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23
Q

Give an example of an opioid that can cause xerostomia

A

Morphine

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24
Q

Give an example of a proton pump inhibitor that can cause xerostomia

A

Omeprazole

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25
Q

Give an example of a cytotoxic drug that can cause xerostomia

A

5 Fluorouracil

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26
Q

Give an example of a retinoid that can cause xerostomia

A

Isotretinoin

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27
Q

Give an example of a anti HIV Drug that can cause xerostomia

A

Didanosine and HIV protease inhibitors

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28
Q

Give an example of a anti migraine that can cause xerostomia

A

Rizatriptan

29
Q

Give an example of a Decongestants that can cause xerostomia

A

Pseudoephedrine

30
Q

List some of the oral problems associated with xerostomia

A
  1. Impaired speech, eating and swallowing
  2. Pts more susceptible to oral infections
  3. Increased risk of dental caries
  4. Increased risk of angular chelitis
  5. Mucosal ulceration
  6. Development of leukoplakia
  7. Can effect denture retention
31
Q

Give examples of local measures we can take to tackle drug induced xerostomia

A
  1. Frequent sips of water
  2. Sugar free chewing gum
    3, Taking the dug at night time to reduce xerostomic effect
32
Q

Give an example of a drug ghat can be use to help manage xerostomia

A

Pilocarpine 50mg

33
Q

What are the problems associated with pilocarpine

A

unwanted effects including:
1. increased sweating
2. headaches
3. nausea
4. urinary frequency
5. palpitations

34
Q

What is sialorrhoea

A

Hypersalivation (drooling)

35
Q

Name the drug most frequently associated with sialorrhoea

A

clozapine (an antipsychotic that is first lien treatment for management of schizophrenia)

36
Q

Which gland in the mouth can be most affected by ADR causing pain and swellings

A

Parotid gland

37
Q

Give examples of drugs that can induce pain or swelling in the salivary glands

A
  1. Iodine (can concentrate Inyo parotid gland)
  2. Chorohexidine (can lead to parotid swelling-rare)
38
Q

How can drugs induce abnormalities of taste

A
  1. Reducing serum zinc levels
  2. Direct iteration with proteins or taste receptor buds
39
Q

What can taste disturbances be classified/ described as

A
  1. hypogeusia - decreased sensitivity in taste perception
  2. ageusia - a total loss of the ability to taste
  3. dysgeusia.- a distortion in perception of the correct taste of a substance, e.g. sour for sweet
40
Q

Give examples of drugs that can lead to taste disturbance

A
  1. Drugs that contain a sulfhydryl group eg penillamine and captopril
  2. Thiazide diuretics eg bendroflumethiazide

both of these deplete the body of zinc

41
Q

Give examples of how ADR can manifest in the oral mucosa and tongue

A
  1. Drug-induced vesiculobullous conditions
  2. oral ulceration
  3. lichenoid eruptions
  4. other white lesions of the oral mucosa
  5. discoloration of the oral mucosa.
42
Q

Give examples of drug induced vesiculobullous conditions

A
  1. erythema multiforme
  2. mucous membrane
  3. pemphigoid
  4. pehmpigus vulgaris
43
Q

Give examples of drug categories that have been cited to cause vesiculobullous lesions

A
  1. Analgesics
  2. Antibiotics
  3. Calcium channel blockers
  4. Antiepileptic
  5. Antifungals
  6. Diuretics
  7. Antidiabetics
  8. Hormones
  9. Miscellaneous
44
Q

Give examples of analgesics that have been cited to cause vesiculobullous lesions

A
  1. Aspirin
  2. Diclofenac
  3. diflunisal
  4. mefenamic acid
  5. piroxicam
  6. ibuprofen
45
Q

Give examples of antibiotics that have been cited to cause vesiculobullous lesions

A
  1. Clindamycin
  2. streptomycin
  3. tetracyclines
  4. vancomycin
  5. co-trimoxazole
46
Q

Give examples of calcium channel blockers that have been cited to cause vesiculobullous lesions

A
  1. Diltiazem
  2. nifedipine
  3. verapamil
  4. amlodipine
47
Q

Give examples of anti epileptics that have been cited to cause vesiculobullous lesions

A

Carbamazepine and phenytoin

48
Q

Give examples of antifungals that have been cited to cause vesiculobullous lesions

A

Fluconazole and griseofulvin

49
Q

Give examples of diuretics that have been cited to cause vesiculobullous lesions

A

Hydrochlorothiazide and furosemide

50
Q

Give example of antidiabetites that have been cited to cause vesiculobullous lesions

A

Chlorpropamide and tolbutamide

51
Q

Give example of hormones that have been cited to cause vesiculobullous lesions

A

Mesterolone, progesterone

52
Q

Give example of other medications that have been cited to cause vesiculobullous lesions

A

Quinine,
retinol,
mercury,
omeprazole,
zidovudine

53
Q

What is oral lichen planus

A

A chronic inflammatory oral mucosal disease of unknown aetiology

54
Q

Give example of drugs that have been assocated with lichen planus

A
  1. ACE-1 inhibitors, e.g. captopril
  2. Antimalarials
  3. β-Adrenoceptor blockers, e.g. propranolol
  4. Carbamazepine
  5. Chloral hydrate
  6. Chlorpropamide
  7. Cinnarizine
    8.Dipyridamole
  8. Furosemide
  9. Ketoconazole
  10. Lincomycin
  11. Lithium
  12. Lorazepam
  13. Mercury (amalgam)
  14. Metronidazole
  15. NSAIDs
  16. Oral contraceptives
  17. Penicillins
  18. Phenytoin
    20 .Quinine
  19. Rifampicin
  20. Streptomycin
  21. Sulfonamides
  22. Tetracyclines
  23. Thiazide diuretics
  24. Tolbutamide
55
Q

Give an example of an ADR that can cause discolouration the of the oral mucosa

A

Black hairy tongue

56
Q

Which drugs can cause black hairy tongue

A

Oral penicillins and other topical antimicrobials

57
Q

What colours can the oral mucosa be stained in due to adverse drug reactions

A
  1. Blue
  2. Brown
  3. Black
  4. Grey
58
Q

What might turn the oral mucosa blue

A
  1. Amiodarone
  2. Antimalarials
  3. Bismuth
  4. Mepacrine
    5 .Minocycline
  5. Phenazopyridine
  6. Quinidine
  7. Silver Sulfasalazine
59
Q

What might turn the oral mucosa brown

A
  1. Aminophenazone
  2. Betel nut
  3. Bismuth
  4. Busulfan
  5. Clofazimine
  6. Contraceptives
  7. Cyclophosphamide
  8. Diethylstilbestrol
  9. Doxorubicin
  10. Doxycycline
  11. Fluorouracil
  12. Heroin
  13. Hormone-replacement therapy
  14. Ketoconazole
  15. Menthol
  16. Methaqualone
  17. Minocycline
  18. Phenolphthalein
  19. Propranolol
  20. Smoking
  21. Zidovudine
60
Q

What might turn the oral mucosa black

A
  1. Betel nut
  2. Bismuth
  3. Methyldopa
  4. Minocycline
61
Q

What might turn the oral mucosa grey

A
  1. Amiodiaquine
  2. Chloroquine
  3. Fluoxetine
  4. Hydroxychloroquine
62
Q

Give example of local irriants that can be drug induced

A
  1. Aspirin burn
  2. oral burns
63
Q

What can cause oral burns

A
  1. Aspirin
  2. Cocaine
  3. potassium chloride
  4. isoprenaline
  5. pancreatin
  6. ergotamine tartrate.
64
Q

Why do oral burns happen

A

Usually due to sucking the tablet rather than swallowing it

65
Q

What can drug induced ulcerations be categorised as

A
  1. Local irritants leading to oral burns
  2. Drug related aphthous-type ulceration
  3. Fixed drug eruptions
66
Q

What are aphthous ulcerations characterised by

A

Multiple recurrent small round or ovoid ulcers

67
Q

Give examples of drugs that can cause aphthous-type ulcerations

A
  1. certain NSAIDs,
  2. β-adrenoceptor blockers,
  3. captopril (an ACE-1 inhibitor)
  4. nicorandil (a potassium channel activator)
  5. protease inhibitors
  6. tacrolimus (immunosuppressant agent)
68
Q

What are fixed drug eruptions

A

repeated ulcerations at the same site in response to a particular drug or other compound.
A type IV (delayed hypersensitivity reaction)

69
Q

Give examples of drugs that have been implicated to cause fixed drug eruptions

A
  1. Lidocaine
  2. Chlorhexidine
  3. Penicillamine
  4. Salicylates
  5. Sulfonamides

5th yr- CMS2- Drugs (3 decks)

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