Drugs Affecting Salivary Flow

Question 1

What are the parasympathomimetics used for xerostomia?

Answer 1

Cevimeline (Evoxac)

Pilocarpine (Pilocar)

Question 2

T or F. Saliva production is a parasympathetic-mediated phenomenon

Answer 2

T.

Question 3

What drugs have anticholinergic effects?

Answer 3

Antihistamines such as diphenhydramine and chlorpheniramine

Decongestants such as pseudoephedrine

AntiHTNs such as methyldopa, CCBs, and metoprolol

Anticholinergics such as atropine and scopolamine

Question 4

What are some causes of temporary xerostomia?

Answer 4

short term anticholinergic drug use (e.g. antihistamines),

viral infection (e.g. mumps),

dehydration, anxiety

Question 5

What are some endocrine disorders associated with xerostomia?

Answer 5

DM and hypothyroidism

Question 6

What are some infections associated with xerostomia?

Answer 6

HIV, Hep C

Question 7

What are some neurological disorders associated with xerostomia?

Answer 7

Parkinson’s disease and Bell’s palsy

Question 8

What are some genetic conditions associated with xerostomia?

Answer 8

CF, Down syndrome, celiac disease

Question 9

Other causes of xerostomia?

Answer 9

head and neck radiation

graft vs. host disease

Bone marrow transplant

Question 10

Notes about Sjogren syndrome

Answer 10

This is an autoimmune disease marked by destruction of tear and salivary glands producing enlarged parotids, dry eyes, and mouth (among other things). Treatment/management usually involves saliva substitutes, DMARDs, and emphasis on tooth care

Question 11

What are some potential consequences of xerostomia?

Answer 11

-increased risk of mucosal and tongue lesions

risk of candidiasis, dental caries, and other oral infection

taste alteration

Question 12

Describe the mechanism of salivary production

Answer 12

Ach binds to Gq coupled M3 muscarinic Ach receptors which caused phospholipase C to generate IP3 to promote Ca2+ release. Ca2+ release activates apical Cl- channels and basolateral K+ channels. Efflux of Cl- into the acinar lumen draws Na+ across the cells, and the osmotic gradient generates fluid secretion

Question 13

Question 14

Describe Cevimeline (Evoxac)

Answer 14

this is partially-selective M3-receptor agonist (with some M1 activity) on the lacrimal and salivary gland epithelium

Question 15

When should Cevimeline never be used?

Answer 15

asthma, closed angle glaucome or iritis

Question 16

How is pilocarpine different from cevimeline?

Answer 16

it does not show any receptor sub-types selectivity, acting upon al muscarinic receptors regardless of location

Question 17

What is another use of amifostine besides nephro-protection with use of cisplatin by acting as a free-radical scavenger?

Answer 17

it can also be used for radioprotection of the neck and head during radiation therapy to protect the salivary (parotid) glands and prevent xerostomia

Question 18

What are some drugs that can be used for hypersalivation?

Answer 18

PO glycopyrrolate, an anticholinergic

botox injections or scopolamine patches

Question 19

What are some other uses of scopolamine?

Answer 19

prevention of N/V with motion sickness

reduction in spastic states in parkinsonism

induce pupil dilation

Question 20

Answer 20