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GI > PHARM: Drugs Affecting Salivary Flow > Flashcards

PHARM: Drugs Affecting Salivary Flow Flashcards

1
Q

For what type of pills should you: put capsule on tongue, medium sip of water (no swallowing), bend head forward by tilting chin toward chest, swallow capsule and water with head bent forward.

A

Floating pills

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2
Q

For what type of pills should you: put pill on back of tongue then seal mouth around water bottle and swallow water/ pill together

A

sinking pills

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3
Q

Which antihistamines cause xerostomia?

A

diphenhydramine

chlorpheniramine

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4
Q

Which decongestants cause xerostomia?

A

pseudoephedrine

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5
Q

Which antidepressants cause xerostomia?

A

amitryptiline

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6
Q

Which antipsychotics cause xerostomia?

A

Haloperidol

Phenothiazine derivatives

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7
Q

Which antihypertensives cause xerostomia?

A 
Reserpine
Methyldopa
Cholorthiazidine
Furosemide
Metoprolol
CCGs
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8
Q

Which anticholinergics cause xerostomia?

A

atropine

scopolamine

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9
Q

What are two mays to treat xerostomia?

A

Parasympatheticomimetics

Saliva substitutes

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10
Q

Are salliva substitutes effective?

A

no strong evidence these are effective (gum may be preferred in patients with residual secretory capacity)

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11
Q

What is the auto-immune disease that causes destruction of salivary glands?

A

Sjogren syndrome

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12
Q

How do you treat Sjogren’s?

A

DMARDs (to suppress the immune system)

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13
Q

What receptors control salivary secretion?

A

M3 or M2

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14
Q

What neurotransmitter stimulates M3 or M2 to stimulate salivary secreiton?

A

acetylcholine

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15
Q

Binding of Ach to M3 or M3 receptor causes what?

A

upregulation of PLC to generate IP3 (binds to and opens IP3 receptor on ER and leads to release of calcium)

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16
Q

What does the initial increased calcium from M3 receptor binding lead to?

A

stimulation of calcium induced calcium release via IP3 receptor and ryanodine receptor (cyclic ADP ribose)

17
Q

How does increasing intracellular calcium lead to salivation?

A

increased intracellular Ca2+ activates the apical membrane Cl- channel and the basolateral K+ channel (flow of Cl- into acinar lumen draws Na+ and water across)

18
Q

How do non-innervated M3 receptors at salivary gland blood vessels get activated?

A

exogenously added muscarinic agonists

19
Q

What is the result of activation of non-innervated M3 receptors at salivary gland blood vessels?

A

dilation of salivary gland blood vessels (via NO release)

20
Q

Which type of innervation effects the M3 receptors at the salivary glands?

A

parasympathetic nervous system

21
Q

What type of saliva is produced by parasympathetic innervation?

A

copious but protein poor

22
Q

True or false: saliva can be modified by sympathetic signals.

A

TRUE

23
Q

How does activation of alpha-1 receptors affect salivation?

A

increased salivary gland secretions and constriction of salivary gland blood vessels

24
Q

How does activation of alpha-2 receptors affect salivation?

A

only causes constriction of salivary gland blood vessels.

25
Q

What type of saliva is produced by sympathetic innervation?

A

sparse but protein rich

26
Q

What drug is notable for having muscarinic receptor selectivity (high binding affinity for M3 receptors on lacrimal and salivary gland epithelium)?

A

cevimeline

27
Q

What other type of receptor is affected by cevimeline?

A

partial direct M1-receptor agonist activity in the CNS

28
Q

Which drug interacts with ALL muscarinic receptors? What is the consequence of this?

A

Pilocarpine (has greater CNS activity and may lead to psychosis)

29
Q

What are the contraindications to using cevimeline and pilocarpine?

A

Asthma, closed angle glaucoma, iritis

30
Q

List come conditions that should raise caution when using cevimeline and pilocarpine.

A 
Angina
Use of beta-blockers
Cardiac arrhythmias
MI
Bronchitis
COPD
Age extremes: children, geriatric
Breast-feeding
Pregnancy
Reduced visual acuity (not for people who need to drive)
31
Q

What drug is a free-radical scavenger that can be used for radioprotection to the head and neck when the parotid gland receives intense radiation?

A

amifostine

32
Q

What does amifostine prevent?

A

reduces acute and chronic xerostomia from radiation while preserving anti-tumor effects

33
Q

List 3 drugs used to treat hypersalivation (sialorrhea)?

A
  • Oral anti-cholinergics (ex. glycopyrrolate)
  • Botox injections
  • Scopolamine
34
Q

Which type of drug are used to prevent bronchial secretions and salivation prior to surgery?

A

Scopolamine

35
Q

Which drug is used in some neurologic conditions (ex. Cerebral palsy) that feature hypersalivation?

A

Oral Anticholinergics

GI (21 decks)

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