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 chlorpheniramineDecongestants such as pseudoephedrineAntiHTNs such as methyldopa, CCBs, and metoprololAnticholinergics 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 radiationgraft vs. host diseaseBone 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 lesionsrisk of candidiasis, dental caries, and other oral infectiontaste 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

Describe Cevimeline (Evoxac)

Answer 13

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

Question 14

When should Cevimeline never be used?

Answer 14

asthma, closed angle glaucome or iritis

Question 15

How is pilocarpine different from cevimeline?

Answer 15

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

Question 16

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

Answer 16

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 17

What are some drugs that can be used for hypersalivation?

Answer 17

PO glycopyrrolate, an anticholinergicbotox injections or scopolamine patches

Question 18

What are some other uses of scopolamine?

Answer 18

prevention of N/V with motion sicknessreduction in spastic states in parkinsonisminduce pupil dilation