Drugs affecting salivary flow

Question 1

Recount appropriate pt questions regarding xerostomia

Answer 1

(A postive response to 1/5 correlates with decrease in saliva)

1. Does your mouth usually feel dry
2. Does your mouth feel dry when eating a meal
3. Do you have difficulty swallowing dry foods
4. Do you sip liquids to aid in swallowing dry foods
5. Is the amounts of saliva in your mouth too little most of the time?

Question 2

Recall drugs most commonly associated with xerostomia as ADE

Answer 2

Antihistamines, decongestants, antidepressants, antipyschotics, antiHTNs
** 1st generation antihistamines have strong anti-cholinergic activity –> chlorpheniramine

Question 3

Explain the etiology of Sjorgrens syndrome and appropriate tx plan.

Answer 3

AI with destruction of tear and salivary glands. Tx aimed at symptomatic relief and dental care.
DMARDS, avoid meds that cause dryness and alcohol, muscarinic agonists

Question 4

Contrast the pharmacology of muscarinic agonists cevimeline and pilocarpine.

Answer 4

Cevimeline: CYP3A3/4, 2D6 interactions, M3»>M1; CI in asthma, glaucoma, iritis, caution in angina, breast feeding, bronchitis, arrhythmias, cardiac disease, children cholelithiasis, COPD, driving, MI, nephrolithiasis, pregnancy
Pilocarpine: No CYP activity, targets all muscarinic receptors, same CI as cevimeline but more caution with pyschosis due to greater CNS activity

Question 5

What drugs are used for sialorrhea?

Answer 5

botulinum, scopolamine (anti-cholinergics)