Drugs affecting salivary flow: Sweatman Flashcards
Describe how dry mouth can impact pt health and adherence to oral meds. How do you teach your pts to swallow?
If their mouths are dry, they will have trouble swallowing. Ask them if their mouths are dry all the time, or if they just wake up with a dry mouth at night. This will help exclude mouth breathing at night as a cause.
Characterize, by class, the drugs most commonly associated with xerostomia as an adverse effect.
::Antihistamines- diphenhydramine, chlorpheniramine
::Decongestents- pseudoephedrine
::Antidepressants- Amitryptiline
::Antipsychotics- Haloperidol, Phenothiazine derivatives
::Antihypertensives- reserpine, methyldopa, HCTZ, furosemide, metoprolol, CCBs
::and of course, Anticholinergics- atropine, scapolamine
Explain PSNS and SNS regulation of saliva secretion.
Bonus: does vasoactive intestinal peptide (VIP) increase or decrease salivary secretion potential?
Saliva secretion is under PSNS control.
Ach binds M3 receptor. M3 receptor initiates cascade that results in Ca release from ER —> Cl- efflux into lumen of salivary acini. Water and Na follow Cl- into lumen. BOOM, salivation. M3 also causes vasodilation = more blood flow to salivary glands = more water for saliva.
SNS (a-1, a-2) causes local vasoconstriction which reduces blood flow to salivary glands, thus water volume that can be secreted.
Bonus: VIP increases salivary potential by causing local synthesis of NO, dilating BVs and increasing blood flow to salivary glands.
Contrast the pharm of cevimeline, pilocarpine, and amifostine, and discuss appropriate clinical utilization.
Both tx xerostomia.
Cevimeline has M3 receptor selectivity.
Contraindications of Cevimeline: asthma, closed-angle glaucoma or iritis.
Pilocarbine acts on all muscarinic receptors, regardless of location. Bc of this, can cause psychosis due to CNS effects.
Amifostine is a radioprotective agent that is a scavenger of free radicals. Reduces acute and chronic xerostomia in addition to preventing iatrogenic cancer of irradiated organs.
Recall the classes of drugs used in the tx of hypersalivation and their MOAs.
Glycopyrrolate used to treat neurological sialorrhea due to cerebral palsy.
Botox used to tx sialorrhea due to intrinsic hypersecretion of glands (blocks release of vesicles containing salivary components)
Scopolamine used to prevent n/v of motion sickness, reduction of salivation and bronchial secretions, reduction in spastic states in parkinsonism, cytoplegic refraction and pupil dilation (think, effects of SNS).
