PHARM: Drugs Affecting Salivary Flow

Question 1

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.

Answer 1

Floating pills

Question 2

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

Answer 2

sinking pills

Question 3

Which antihistamines cause xerostomia?

Answer 3

diphenhydramine

chlorpheniramine

Question 4

Which decongestants cause xerostomia?

Answer 4

pseudoephedrine

Question 5

Which antidepressants cause xerostomia?

Answer 5

amitryptiline

Question 6

Which antipsychotics cause xerostomia?

Answer 6

Haloperidol

Phenothiazine derivatives

Question 7

Which antihypertensives cause xerostomia?

Answer 7

Reserpine
Methyldopa
Cholorthiazidine
Furosemide
Metoprolol
CCGs

Question 8

Which anticholinergics cause xerostomia?

Answer 8

atropine

scopolamine

Question 9

What are two mays to treat xerostomia?

Answer 9

Parasympatheticomimetics

Saliva substitutes

Question 10

Are salliva substitutes effective?

Answer 10

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

Question 11

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

Answer 11

Sjogren syndrome

Question 12

How do you treat Sjogren’s?

Answer 12

DMARDs (to suppress the immune system)

Question 13

What receptors control salivary secretion?

Answer 13

M3 or M2

Question 14

What neurotransmitter stimulates M3 or M2 to stimulate salivary secreiton?

Answer 14

acetylcholine

Question 15

Binding of Ach to M3 or M3 receptor causes what?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

How does increasing intracellular calcium lead to salivation?

Answer 17

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)

Question 18

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

Answer 18

exogenously added muscarinic agonists

Question 19

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

Answer 19

dilation of salivary gland blood vessels (via NO release)

Question 20

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

Answer 20

parasympathetic nervous system

Question 21

What type of saliva is produced by parasympathetic innervation?

Answer 21

copious but protein poor

Question 22

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

Answer 22

TRUE

Question 23

How does activation of alpha-1 receptors affect salivation?

Answer 23

increased salivary gland secretions and constriction of salivary gland blood vessels

Question 24

How does activation of alpha-2 receptors affect salivation?

Answer 24

only causes constriction of salivary gland blood vessels.

Question 25

What type of saliva is produced by sympathetic innervation?

Answer 25

sparse but protein rich

Question 26

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

Answer 26

cevimeline

Question 27

What other type of receptor is affected by cevimeline?

Answer 27

partial direct M1-receptor agonist activity in the CNS

Question 28

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

Answer 28

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

Question 29

What are the contraindications to using cevimeline and pilocarpine?

Answer 29

Asthma, closed angle glaucoma, iritis

Question 30

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

Answer 30

``` 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) ```

Question 31

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?

Answer 31

amifostine

Question 32

What does amifostine prevent?

Answer 32

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

Question 33

List 3 drugs used to treat hypersalivation (sialorrhea)?

Answer 33

- Oral anti-cholinergics (ex. glycopyrrolate) - Botox injections - Scopolamine

Question 34

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

Answer 34

Scopolamine

Question 35

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

Answer 35

Oral Anticholinergics