modulation of salivary gland function Flashcards
parasympatholytics
reduce saliva secretion
- propantheline
- methantheline
- glycopyrolate
- atropine
parasympathomimetics
increase saliva secretion
- pilocarpine
- bethanechol
- cevimelin
why is drug-induced xerostomia a concern?
- older adults take more meds
- over 400 meds cause xerostomia
- oral health impact of xerostomia is consequential
drug categories that cause xerostomia
sympathomimetics** diuretics cardio meds anticholinergics** tricyclic antidepressants** antihistamines psychotropic agents antiparkinsons antineoplastic muscle relaxants
herbal preparations that cause xerostomia
st johns wort
gingko biloba
manifestations of xerostomia
- perio problems
- altered taste and mouth soreness
- dry, pale, red, atrophic tissues
- devoid of papillae, atrophic, inflamed
- increased caries
- oral pain and infections
- difficulty speaking, chewing, swallowing
rationale for treatment of xerostomia
- keep mouth moist
- prevent caries, candida infection, and palliative relief
palliative measures to treat xerostomia
- sip water freq
- avoid alcoholic mouth rinses
- let ice melt in mouth
- restrict caffeine
- humidify sleep area
- coat lips with vaseline
saliva substitues
sodium carboxymethylcellulose 0.5% aqueous solution
-xero-lub, salivart, moi-stir, orex
fluoride therapy for xerostomia
-stannous fluoride gel 0.4 %
apply to teeth daily for 5 mins – 5-10 drops in plastic carrier
-SnF2 gels (Gel Kam)
when should neutral pH sodium fluoride gel (1% Thera-Flur-N) be considered?
when taste of acidulated SnF2 gels is poorly tolerated or where there is etching of ceramic restorations
No more than ____ mg of NaF should be dispensed in a container. PTD: _____
no more than 264 mg NaF
PTD (probable toxic dose): 5 mg F/kg —-1.1 mg NaF/kg
what overgrows in a xerostomia environment?
candida albicans
plaque
antifungal therapy for xerostomia
- nystatin (topical)–not absorbed in GI tract
- fluconazole (systemic)
what type of mouth rinse can be used to treat xerostomia?
chlorhexidene (Peridex broad spectrum antimicrobial agent)
ketoconazole
prototype azole compound not often used bc of serious drug drug interactions and adverse effects like gynecomastia in males and menstrual irregs in females
the parasympathetic division has a _____ pregang and a_____ post gang
longer pregang
shorter postgang
the PNS releases _____ at ____- receptors
acetylcholine at muscarinic receptors
for both the PNS and SNS, _____ is released at _____ receptors
acetylcholine at nicotinic receptors
The SNS releases _____ at _____ receptors
norepinephrine at adrenergic receptors
the _____ pathway is dominant in salivary stim
cholinergic
The pregang fibers are _______ and the post gang fibers are ______ at SNS
pregang are shorter
post are longer
Parasympathomimetic agents to treat xerostomia
- mimic acetylcholine
- I.e. Pilocarpine (salagen)
- muscarinic receptor agonist–initial doses of 15 mg/day can increase to 30 mg a day
- sig increase in parotid, submand, sublingual secretions
- max flow 30 mins after admin and back to base in 3hrs
- doesn’t regenerate function, just stimulates it
- no effect on blood pressure/HR
- contraindications–asthma and complete loss of salivary gland function
bethanechol
parasympathomimetic agent
-used in divided doses of 75-200 mg/day without complaints of GI upset and reduced tendency for sweating
cevimeline
evoxac
- treatment for Sjogren’s syndrome
- 30 mg tid
pilocarpine activates what receptor in an acinar cell to form saliva?
M3 (muscarinic)
function of PI3
inositol triphosphate
-releases Ca stores
DAG function
diacyl glyercol
-gates Ca entry
parasympatholytic drugs: antisialogoges
- treat hypersecretion; transient modulation
- competitive antagonists for M receptors
- reduce salivary gland secretion
- contraindications–glaucoma, CVD, prostate hypertrophy
- side effects–blurred vision, drowsiness, tachycardia, decreased intestinal or bladder action
quaternary ammonium compounds
- can’t access brain (preferred)
- propantheline (pro-banthine)
- methantheline (banthine)
- glycopyrrolate (robinul)
propantheline (pro-banthine)
- atropine like drug
- inhibits salivation before dental procedure
- adult dose = 15 mg tab 30-40 mins before appt
- second tab given if desired effect doesn’t happen
- children–half dose
methantheline (banthine)
- alternate drug for propantheline
- more intense side effects
- adult dose–50 mg po or 100 mg
glycopyrrolate (robinul)
- quarternary amine of anticholinergic class
- greater per mg potency than propantheline
- longer duration of action
- less sedation and CNS effect than scopolamine
- better therapeutic index than atropine
- less cardiac side effects
atropine
antagonist for musc. receptors
-access brain–adverse effects
