Nose and Mouth

Question 1

Pseudoephedrine

Answer 1

Nose and Mouth
NASAL DECONGESTANT (ORAL)
Phenylephrine α1 adrenergic
- easily converted to METH
Therapeutic Use
• Hay fever
• Allergic rhinitis
• Sinusitis
• Common cold (membrane congestion)
MOA
• Act at adrenergic receptors in nasal mucosa by affecting the sympathetic tone and provoking vasoconstriction
• Constriction of nasal mucosa leads to shrinkage → promotes draining
• Improves ventilation and stuffy feeling
ADE
• Cardiovascular stimulation – *elevated blood pressure, tachycardia or arrhythmias
• CNS stimulation – *restlessness, *insomnia, anxiety, tremors and (rarely) hallucinations
• *Skin rashes and urinary retention
C/I
• *Monoamine oxidase inhibitor (MAOI) therapy
• *Hypersensitivity
• Sustained Release formulation: children under 12

Question 2

Oxymeta-zoline

Answer 2

Nose and Mouth
DECONGESTANT (NASAL SPRAYS)
Therapeutic Use:
• *Nasal congestion
MOA
• Agonist at α-adrenergic receptors produces vasoconstriction (similar to nasal oral decongestants) in arterioles of the nasal mucosa
ADE
• Headache
• Burning
• Stinging
• Dryness
• *Rebound congestion 
o Can lead to *dependence

Question 3

Xerostomia

Answer 3

Nose and Mouth
Dry Mouth Causes 
Lifestyle
o Smoking
o Mouth breathing
Medical conditions
o Sjogren’s syndrome
o HIV
o Diabetes
o Cystic fibrosis
Medications
o Chemotherapy
- Antidepressants
o Antihistamines
MOA
• Diminished salivary gland function
• Nerve damage
• Dehydration

Question 4

Pilocarpine

Answer 4

Nose and Mouth
Partial agonist at the muscarinic receptor 
Therapeutic Use
• *Sjorgren’s syndrome – autoimmune disease glands that produce tears and saliva are destroyed
• *Glaucoma
MOA
- stimulates salivary secretion
ADE
• nausea
• vomiting
• diarrhea
• urinary urgency
• salivation
• sweating
- cutaneous vasodilation

Question 5

Thrush

Answer 5

Nose and Mouth
• Yeast infection caused by the spread of the Candida albicans fungus
Main Sx 
o White patches or plaques on tongue or oral mucous membrane, red/swollen lips
Other Sx 
o Redness or soreness
o Difficulty swallowing
o Cracking at corners of mouth

Question 6

Nystatin

Answer 6

Nose and Mouth
Polyene macrolide 
Therapeutic Use:
• Suppression of local candida infections including:
o *Oral Thrush
o Vaginal candidiasis
MOA
- forms pores in fungal membranes, leading to loss of intracellular content
ADE
• *Diarrhea
- *Rash
• *Nausea
• *Tachycardia

Question 7

Clotrimazole

Answer 7

Nose and Mouth
Therapeutic Use 
• *Oral Thrush
• Vaginal yeast infections
MOA
• Blocks fungal P450 and interferes with ergosterol (main constituent of fungal membrane) synthesis
ADE
• Blistering
• *Peeling
• *Burning
• General irritation of the skin
• Erythema

Question 8

Medications Affecting Taste and Smell

Answer 8

Nose and Mouth
• *Antifungals
• *Antihypertensive (interesting since so many people taking)
• *Antidepressants
• Antineoplastic agents
• Antibiotics
Mechanism of Taste Disturbance
• Dysgeusia
o *Bad taste: Bitter, metallic, salty
• Hypogeusia
o *Loss of taste
o True taste loss reflects taste bud mediated sensations such as sweet, sour, bitter, and salty
• *Drugs can influence chemosensory function in many ways:
o Drying the mucosa, nasal engorgement
o *Alteration of receptors (alter how they function)
o *Alteration of neurotransmission