Adverse drug reactions: salivary glands and oral mucosa Flashcards
Define adverse drug reactions
Reactions that are unwarranted effects arising from a patients medication
What can adverse drug reactions be classified as
- Type A- Augmented reactions
- Type B- Bizarre reactions
What are type A reactions a result of
An exaggerated but otherwise normal pharmacological action of a drug given in the usual therapeutic dose
Give examples of structures that can be targeted by adverse drug reactions
- Salivary glands
- Oral mucosa
- Periodontal tissues
- Teeth
- Alveolar bone
Name one of the most widespread ADRs in dentistry
Drug induced xerostomia
How can salivary glands be affected by ADR
- Xerostomia
- sialorrhoea (Hypersalivaiton)
- gland swelling
- pain
- taste disturbances.
How do drugs inadvertently reduce saliva flow
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
List categories of drugs that can cause xerostomia
- Tricyclic antidepressants
- Muscarinic receptor antagonist
- α-Receptor antagonist Antipsychotics
- Diuretics
- Histamine H1 receptor blockers
- Histamine H2 receptor blockers
- Central antihypertensives
- Angiotensin-converting enzyme inhibitors
- Serotonin antagonists
10 .Noradrenaline re-uptake inhibitors - Dopamine re-uptake inhibitors
- Appetite suppressants
- Systemic bronchodilators
- Opioids
- Proton pump inhibitors
- Cytotoxic drugs Retinoids
- Anti-HIV drugs
- Antimigraine drugs
19 .Decongestants
Give an example of a tricyclic antidepressant that can cause xerostomia
Amitriptyline
Give an example of a muscarinic receptor antagonist that can cause xerostomia
Oxybutynin
Give an example of an alpha receptor antagonist that can cause xerostomia
Terazosin
Give examples of antipsychotics that can cause xerostomia
Phenothiazines
lithium
Give an example of a diuretic that can cause xerostomia
Furosemide
Give an example of a histamine H1 receptor blocker that can cause xerostomia
Chlorphenamine
Give an example of a histamine H2 receptor blocker that can cause xerostomia
Cimetidine
Give an example of a hypertensive that can cause xerostomia
Moxonidine
Give an example of a angiotensin converting enzyme inhibitor that can cause xerostomia
Lisinopril
Give an example of a serotonin antagonist that can cause xerostomia
Fluoxetine
Give an example of a noradrenaline reuptake inhibitor that can cause xerostomia
Reboxetine
Give an example of a dopamine re uptake inhibitor that can cause xerostomia
Bupropion
Give examples of appetite suppressants that can cause xerostomia
Fenfluramine
Phentamine
Give an example of a bronchodilator that can cause xerostomia
Tiotropium
Give an example of an opioid that can cause xerostomia
Morphine
Give an example of a proton pump inhibitor that can cause xerostomia
Omeprazole
Give an example of a cytotoxic drug that can cause xerostomia
5 Fluorouracil
Give an example of a retinoid that can cause xerostomia
Isotretinoin
Give an example of a anti HIV Drug that can cause xerostomia
Didanosine and HIV protease inhibitors
Give an example of a anti migraine that can cause xerostomia
Rizatriptan
Give an example of a Decongestants that can cause xerostomia
Pseudoephedrine
List some of the oral problems associated with xerostomia
- Impaired speech, eating and swallowing
- Pts more susceptible to oral infections
- Increased risk of dental caries
- Increased risk of angular chelitis
- Mucosal ulceration
- Development of leukoplakia
- Can effect denture retention
Give examples of local measures we can take to tackle drug induced xerostomia
- Frequent sips of water
- Sugar free chewing gum
3, Taking the dug at night time to reduce xerostomic effect
Give an example of a drug ghat can be use to help manage xerostomia
Pilocarpine 50mg
What are the problems associated with pilocarpine
unwanted effects including:
1. increased sweating
2. headaches
3. nausea
4. urinary frequency
5. palpitations
What is sialorrhoea
Hypersalivation (drooling)
Name the drug most frequently associated with sialorrhoea
clozapine (an antipsychotic that is first lien treatment for management of schizophrenia)
Which gland in the mouth can be most affected by ADR causing pain and swellings
Parotid gland
Give examples of drugs that can induce pain or swelling in the salivary glands
- Iodine (can concentrate Inyo parotid gland)
- Chorohexidine (can lead to parotid swelling-rare)
How can drugs induce abnormalities of taste
- Reducing serum zinc levels
- Direct iteration with proteins or taste receptor buds
What can taste disturbances be classified/ described as
- hypogeusia - decreased sensitivity in taste perception
- ageusia - a total loss of the ability to taste
- dysgeusia.- a distortion in perception of the correct taste of a substance, e.g. sour for sweet
Give examples of drugs that can lead to taste disturbance
- Drugs that contain a sulfhydryl group eg penillamine and captopril
- Thiazide diuretics eg bendroflumethiazide
both of these deplete the body of zinc
Give examples of how ADR can manifest in the oral mucosa and tongue
- Drug-induced vesiculobullous conditions
- oral ulceration
- lichenoid eruptions
- other white lesions of the oral mucosa
- discoloration of the oral mucosa.
Give examples of drug induced vesiculobullous conditions
- erythema multiforme
- mucous membrane
- pemphigoid
- pehmpigus vulgaris
Give examples of drug categories that have been cited to cause vesiculobullous lesions
- Analgesics
- Antibiotics
- Calcium channel blockers
- Antiepileptic
- Antifungals
- Diuretics
- Antidiabetics
- Hormones
- Miscellaneous
Give examples of analgesics that have been cited to cause vesiculobullous lesions
- Aspirin
- Diclofenac
- diflunisal
- mefenamic acid
- piroxicam
- ibuprofen
Give examples of antibiotics that have been cited to cause vesiculobullous lesions
- Clindamycin
- streptomycin
- tetracyclines
- vancomycin
- co-trimoxazole
Give examples of calcium channel blockers that have been cited to cause vesiculobullous lesions
- Diltiazem
- nifedipine
- verapamil
- amlodipine
Give examples of anti epileptics that have been cited to cause vesiculobullous lesions
Carbamazepine and phenytoin
Give examples of antifungals that have been cited to cause vesiculobullous lesions
Fluconazole and griseofulvin
Give examples of diuretics that have been cited to cause vesiculobullous lesions
Hydrochlorothiazide and furosemide
Give example of antidiabetites that have been cited to cause vesiculobullous lesions
Chlorpropamide and tolbutamide
Give example of hormones that have been cited to cause vesiculobullous lesions
Mesterolone, progesterone
Give example of other medications that have been cited to cause vesiculobullous lesions
Quinine,
retinol,
mercury,
omeprazole,
zidovudine
What is oral lichen planus
A chronic inflammatory oral mucosal disease of unknown aetiology
Give example of drugs that have been assocated with lichen planus
- ACE-1 inhibitors, e.g. captopril
- Antimalarials
- β-Adrenoceptor blockers, e.g. propranolol
- Carbamazepine
- Chloral hydrate
- Chlorpropamide
- Cinnarizine
8.Dipyridamole - Furosemide
- Ketoconazole
- Lincomycin
- Lithium
- Lorazepam
- Mercury (amalgam)
- Metronidazole
- NSAIDs
- Oral contraceptives
- Penicillins
- Phenytoin
20 .Quinine - Rifampicin
- Streptomycin
- Sulfonamides
- Tetracyclines
- Thiazide diuretics
- Tolbutamide
Give an example of an ADR that can cause discolouration the of the oral mucosa
Black hairy tongue
Which drugs can cause black hairy tongue
Oral penicillins and other topical antimicrobials
What colours can the oral mucosa be stained in due to adverse drug reactions
- Blue
- Brown
- Black
- Grey
What might turn the oral mucosa blue
- Amiodarone
- Antimalarials
- Bismuth
- Mepacrine
5 .Minocycline - Phenazopyridine
- Quinidine
- Silver Sulfasalazine
What might turn the oral mucosa brown
- Aminophenazone
- Betel nut
- Bismuth
- Busulfan
- Clofazimine
- Contraceptives
- Cyclophosphamide
- Diethylstilbestrol
- Doxorubicin
- Doxycycline
- Fluorouracil
- Heroin
- Hormone-replacement therapy
- Ketoconazole
- Menthol
- Methaqualone
- Minocycline
- Phenolphthalein
- Propranolol
- Smoking
- Zidovudine
What might turn the oral mucosa black
- Betel nut
- Bismuth
- Methyldopa
- Minocycline
What might turn the oral mucosa grey
- Amiodiaquine
- Chloroquine
- Fluoxetine
- Hydroxychloroquine
Give example of local irriants that can be drug induced
- Aspirin burn
- oral burns
What can cause oral burns
- Aspirin
- Cocaine
- potassium chloride
- isoprenaline
- pancreatin
- ergotamine tartrate.
Why do oral burns happen
Usually due to sucking the tablet rather than swallowing it
What can drug induced ulcerations be categorised as
- Local irritants leading to oral burns
- Drug related aphthous-type ulceration
- Fixed drug eruptions
What are aphthous ulcerations characterised by
Multiple recurrent small round or ovoid ulcers
Give examples of drugs that can cause aphthous-type ulcerations
- certain NSAIDs,
- β-adrenoceptor blockers,
- captopril (an ACE-1 inhibitor)
- nicorandil (a potassium channel activator)
- protease inhibitors
- tacrolimus (immunosuppressant agent)
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)
Give examples of drugs that have been implicated to cause fixed drug eruptions
- Lidocaine
- Chlorhexidine
- Penicillamine
- Salicylates
- Sulfonamides