modulation of salivary gland function

Question 1

parasympatholytics

Answer 1

reduce saliva secretion

• propantheline
• methantheline
• glycopyrolate
• atropine

Question 2

parasympathomimetics

Answer 2

increase saliva secretion

• pilocarpine
• bethanechol
• cevimelin

Question 3

why is drug-induced xerostomia a concern?

Answer 3

1. older adults take more meds
2. over 400 meds cause xerostomia
3. oral health impact of xerostomia is consequential

Question 4

drug categories that cause xerostomia

Answer 4

sympathomimetics**
diuretics
cardio meds
anticholinergics**
tricyclic antidepressants**
antihistamines
psychotropic agents
antiparkinsons
antineoplastic 
muscle relaxants

Question 5

herbal preparations that cause xerostomia

Answer 5

st johns wort

gingko biloba

Question 6

manifestations of xerostomia

Answer 6

• 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

Question 7

rationale for treatment of xerostomia

Answer 7

• keep mouth moist

- prevent caries, candida infection, and palliative relief

Question 8

palliative measures to treat xerostomia

Answer 8

• sip water freq
• avoid alcoholic mouth rinses
• let ice melt in mouth
• restrict caffeine
• humidify sleep area
• coat lips with vaseline

Question 9

saliva substitues

Answer 9

sodium carboxymethylcellulose 0.5% aqueous solution

-xero-lub, salivart, moi-stir, orex

Question 10

fluoride therapy for xerostomia

Answer 10

-stannous fluoride gel 0.4 %
apply to teeth daily for 5 mins – 5-10 drops in plastic carrier
-SnF2 gels (Gel Kam)

Question 11

when should neutral pH sodium fluoride gel (1% Thera-Flur-N) be considered?

Answer 11

when taste of acidulated SnF2 gels is poorly tolerated or where there is etching of ceramic restorations

Question 12

No more than ____ mg of NaF should be dispensed in a container. PTD: _____

Answer 12

no more than 264 mg NaF

PTD (probable toxic dose): 5 mg F/kg —-1.1 mg NaF/kg

Question 13

what overgrows in a xerostomia environment?

Answer 13

candida albicans

plaque

Question 14

antifungal therapy for xerostomia

Answer 14

• nystatin (topical)–not absorbed in GI tract

- fluconazole (systemic)

Question 15

what type of mouth rinse can be used to treat xerostomia?

Answer 15

chlorhexidene (Peridex broad spectrum antimicrobial agent)

Question 16

ketoconazole

Answer 16

prototype azole compound not often used bc of serious drug drug interactions and adverse effects like gynecomastia in males and menstrual irregs in females

Question 17

the parasympathetic division has a _____ pregang and a_____ post gang

Answer 17

longer pregang

shorter postgang

Question 18

the PNS releases _____ at ____- receptors

Answer 18

acetylcholine at muscarinic receptors

Question 19

for both the PNS and SNS, _____ is released at _____ receptors

Answer 19

acetylcholine at nicotinic receptors

Question 20

The SNS releases _____ at _____ receptors

Answer 20

norepinephrine at adrenergic receptors

Question 21

the _____ pathway is dominant in salivary stim

Answer 21

cholinergic

Question 22

The pregang fibers are _______ and the post gang fibers are ______ at SNS

Answer 22

pregang are shorter

post are longer

Question 23

Parasympathomimetic agents to treat xerostomia

Answer 23

• 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

Question 24

bethanechol

Answer 24

parasympathomimetic agent

-used in divided doses of 75-200 mg/day without complaints of GI upset and reduced tendency for sweating

Question 25

cevimeline

Answer 25

evoxac

• treatment for Sjogren’s syndrome
• 30 mg tid

Question 26

pilocarpine activates what receptor in an acinar cell to form saliva?

Answer 26

M3 (muscarinic)

Question 27

function of PI3

Answer 27

inositol triphosphate

-releases Ca stores

Question 28

DAG function

Answer 28

diacyl glyercol

-gates Ca entry

Question 29

parasympatholytic drugs: antisialogoges

Answer 29

• 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

Question 30

quaternary ammonium compounds

Answer 30

• can’t access brain (preferred)
• propantheline (pro-banthine)
• methantheline (banthine)
• glycopyrrolate (robinul)

Question 31

propantheline (pro-banthine)

Answer 31

• 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

Question 32

methantheline (banthine)

Answer 32

• alternate drug for propantheline
• more intense side effects
• adult dose–50 mg po or 100 mg

Question 33

glycopyrrolate (robinul)

Answer 33

• 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

Question 34

atropine

Answer 34

antagonist for musc. receptors

-access brain–adverse effects