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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
Give an example of a cytotoxic drug that can cause xerostomia
5 Fluorouracil
26
Give an example of a retinoid that can cause xerostomia
Isotretinoin
27
Give an example of a anti HIV Drug that can cause xerostomia
Didanosine and HIV protease inhibitors
28
Give an example of a anti migraine that can cause xerostomia
Rizatriptan
29
Give an example of a Decongestants that can cause xerostomia
Pseudoephedrine
30
List some of the oral problems associated with xerostomia
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
Give examples of local measures we can take to tackle drug induced xerostomia
1. Frequent sips of water 2. Sugar free chewing gum 3, Taking the dug at night time to reduce xerostomic effect
32
Give an example of a drug ghat can be use to help manage xerostomia
Pilocarpine 50mg
33
What are the problems associated with pilocarpine
unwanted effects including: 1. increased sweating 2. headaches 3. nausea 4. urinary frequency 5. palpitations
34
What is sialorrhoea
Hypersalivation (drooling)
35
Name the drug most frequently associated with sialorrhoea
clozapine (an antipsychotic that is first lien treatment for management of schizophrenia)
36
Which gland in the mouth can be most affected by ADR causing pain and swellings
Parotid gland
37
Give examples of drugs that can induce pain or swelling in the salivary glands
1. Iodine (can concentrate Inyo parotid gland) 2. Chorohexidine (can lead to parotid swelling-rare)
38
How can drugs induce abnormalities of taste
1. Reducing serum zinc levels 2. Direct iteration with proteins or taste receptor buds
39
What can taste disturbances be classified/ described as
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
Give examples of drugs that can lead to taste disturbance
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
Give examples of how ADR can manifest in the oral mucosa and tongue
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
Give examples of drug induced vesiculobullous conditions
1. erythema multiforme 2. mucous membrane 3. pemphigoid 4. pehmpigus vulgaris
43
Give examples of drug categories that have been cited to cause vesiculobullous lesions
1. Analgesics 2. Antibiotics 3. Calcium channel blockers 4. Antiepileptic 5. Antifungals 6. Diuretics 7. Antidiabetics 8. Hormones 9. Miscellaneous
44
Give examples of analgesics that have been cited to cause vesiculobullous lesions
1. Aspirin 2. Diclofenac 3. diflunisal 4. mefenamic acid 5. piroxicam 6. ibuprofen
45
Give examples of antibiotics that have been cited to cause vesiculobullous lesions
1. Clindamycin 2. streptomycin 3. tetracyclines 4. vancomycin 5. co-trimoxazole
46
Give examples of calcium channel blockers that have been cited to cause vesiculobullous lesions
1. Diltiazem 2. nifedipine 3. verapamil 4. amlodipine
47
Give examples of anti epileptics that have been cited to cause vesiculobullous lesions
Carbamazepine and phenytoin
48
Give examples of antifungals that have been cited to cause vesiculobullous lesions
Fluconazole and griseofulvin
49
Give examples of diuretics that have been cited to cause vesiculobullous lesions
Hydrochlorothiazide and furosemide
50
Give example of antidiabetites that have been cited to cause vesiculobullous lesions
Chlorpropamide and tolbutamide
51
Give example of hormones that have been cited to cause vesiculobullous lesions
Mesterolone, progesterone
52
Give example of other medications that have been cited to cause vesiculobullous lesions
Quinine, retinol, mercury, omeprazole, zidovudine
53
What is oral lichen planus
A chronic inflammatory oral mucosal disease of unknown aetiology
54
Give example of drugs that have been assocated with lichen planus
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 9. Furosemide 10. Ketoconazole 11. Lincomycin 12. Lithium 13. Lorazepam 14. Mercury (amalgam) 15. Metronidazole 16. NSAIDs 17. Oral contraceptives 18. Penicillins 19. Phenytoin 20 .Quinine 21. Rifampicin 22. Streptomycin 23. Sulfonamides 24. Tetracyclines 25. Thiazide diuretics 26. Tolbutamide
55
Give an example of an ADR that can cause discolouration the of the oral mucosa
Black hairy tongue
56
Which drugs can cause black hairy tongue
Oral penicillins and other topical antimicrobials
57
What colours can the oral mucosa be stained in due to adverse drug reactions
1. Blue 2. Brown 3. Black 4. Grey
58
What might turn the oral mucosa blue
1. Amiodarone 2. Antimalarials 3. Bismuth 4. Mepacrine 5 .Minocycline 6. Phenazopyridine 7. Quinidine 8. Silver Sulfasalazine
59
What might turn the oral mucosa brown
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
What might turn the oral mucosa black
1. Betel nut 2. Bismuth 3. Methyldopa 4. Minocycline
61
What might turn the oral mucosa grey
1. Amiodiaquine 2. Chloroquine 3. Fluoxetine 4. Hydroxychloroquine
62
Give example of local irriants that can be drug induced
1. Aspirin burn 2. oral burns
63
What can cause oral burns
1. Aspirin 2. Cocaine 3. potassium chloride 4. isoprenaline 5. pancreatin 6. ergotamine tartrate.
64
Why do oral burns happen
Usually due to sucking the tablet rather than swallowing it
65
What can drug induced ulcerations be categorised as
1. Local irritants leading to oral burns 2. Drug related aphthous-type ulceration 3. Fixed drug eruptions
66
What are aphthous ulcerations characterised by
Multiple recurrent small round or ovoid ulcers
67
Give examples of drugs that can cause aphthous-type ulcerations
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
What are fixed drug eruptions
repeated ulcerations at the same site in response to a particular drug or other compound. A type IV (delayed hypersensitivity reaction)
69
Give examples of drugs that have been implicated to cause fixed drug eruptions
1. Lidocaine 2. Chlorhexidine 3. Penicillamine 4. Salicylates 5. Sulfonamides

5th yr- CMS2- Drugs (3 decks)

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