What are the parasympathomimetics used for xerostomia?
T or F. Saliva production is a parasympathetic-mediated phenomenon
What drugs have anticholinergic effects?
Antihistamines such as diphenhydramine and chlorpheniramine
Decongestants such as pseudoephedrine
AntiHTNs such as methyldopa, CCBs, and metoprolol
Anticholinergics such as atropine and scopolamine
What are some causes of temporary xerostomia?
short term anticholinergic drug use (e.g. antihistamines),
viral infection (e.g. mumps),
What are some endocrine disorders associated with xerostomia?
DM and hypothyroidism
What are some infections associated with xerostomia?
HIV, Hep C
What are some neurological disorders associated with xerostomia?
Parkinson's disease and Bell's palsy
What are some genetic conditions associated with xerostomia?
CF, Down syndrome, celiac disease
Other causes of xerostomia?
head and neck radiation
graft vs. host disease
Bone marrow transplant
Notes about Sjogren syndrome
This is an autoimmune disease marked by destruction of tear and salivary glands producing enlarged parotids, dry eyes, and mouth (among other things). Treatment/management usually involves saliva substitutes, DMARDs, and emphasis on tooth care
What are some potential consequences of xerostomia?
-increased risk of mucosal and tongue lesions
risk of candidiasis, dental caries, and other oral infection
Describe the mechanism of salivary production
Ach binds to Gq coupled M3 muscarinic Ach receptors which caused phospholipase C to generate IP3 to promote Ca2+ release. Ca2+ release activates apical Cl- channels and basolateral K+ channels. Efflux of Cl- into the acinar lumen draws Na+ across the cells, and the osmotic gradient generates fluid secretion
Describe Cevimeline (Evoxac)
this is partially-selective M3-receptor agonist (with some M1 activity) on the lacrimal and salivary gland epithelium
When should Cevimeline never be used?
asthma, closed angle glaucome or iritis
How is pilocarpine different from cevimeline?
it does not show any receptor sub-types selectivity, acting upon al muscarinic receptors regardless of location
What is another use of amifostine besides nephro-protection with use of cisplatin by acting as a free-radical scavenger?
it can also be used for radioprotection of the neck and head during radiation therapy to protect the salivary (parotid) glands and prevent xerostomia
What are some drugs that can be used for hypersalivation?
PO glycopyrrolate, an anticholinergic
botox injections or scopolamine patches
What are some other uses of scopolamine?
prevention of N/V with motion sickness
reduction in spastic states in parkinsonism
induce pupil dilation