2. pharmacological management of salivary disorders

management of dry mouth

• pilocarpine

• artificial saliva substitutes

pilocarpine mechanism of action

a cholinergic agonist that stimulates muscarinic receptors in the salivary glands increasing saliva production

pilocarpine dosage

5 mg orally 3 times a day

pilocarpine monitoring

watch for signs of excessive sweating or cardiac symptoms

pilocarpine side effects

• sweating

• nausea

• rhinitis

• GI discomfort due to broad stimulation of cholinergic receptors

pilocarpine patient counselling

advise patients to stay hydrated and inform their doctor if experiencing excessive sweating or dizziness

artificial saliva mechanism of action

products mimic the lubricating function of natural saliva providing moisture to oral mucosa

artificial saliva usage

apply as needed especially before meals or bedtime

artificial saliva side effects

minimal, possible mild irritation

artificial saliva patient counselling

regular use recommended to maintain oral comfort and acidic formulations should be avoided to prevent dental decay

management of excessive salivation

• glycopyrronium bromide

• botulinum toxin injections

glycopyrronium bromide mechanism of action

anticholinergic that reduces saliva production by blocking muscarnic receptors

glycopyrronium bromide rationale for use

manage excessive saliva production in conditions like parkinsons disease

glycopyrronium bromide dosage

1-2 mg orally 3 times daily

glycopyrronium bromide monitoring

watch for anticholinergic side effecs especially in elderly patients

glycopyrronium bromide side effects

• dry mouth

• constipation

• blurred vision

• confusion due to systemic anticholinergic effects

glycopyrronium bromide patient counseling

encourage hydration

caution with activities requiring alertness

report urinary retention or confusion

Botulinum toxin injections mechanism of action

temporarily paralyses the salivary glands by blocking acetylcholine release reducing saliva production

glycopyrronium bromide rational for use

effective for sailorrhea when oral medications are inadequate

glycopyrronium bromide administration

injected into the major salivary glands every 3-6 months by healthcare professional

glycopyrronium bromide side effects

dry mouth

potential swallowing difficulties

glycopyrronium bromide patient counselling

inform patients that effects are temporary and injections may be needed regularly

managment for imflammation of salivary glands

antibiotics like amoxicillin/clindamycin

Amoxicillin/clindamycin mechanism of action

antibiotics kill or inhibit bacterial growth causing the infection

Amoxicillin/clindamycin rationale for use

to treat bacterial infections of the salivary glands

Amoxicillin/clindamycin dosage

Amox- 500mg 3 times daily

Clind- 300mg 4 times daily

Amoxicillin/clindamycin monitoring

monitor for symptoms resolution and any signs of allergic reactions or GI issues

Amoxicillin/clindamycin side effects

• diarrhea

• nausea

• allertic reactions due to disruption of normal flora

• immune responses

Amoxicillin/clindamycin patient counselling

complete full course

take with food

report severe diarrhoea

management of salivary gland stones

NSAIDs (Nonsteroidal anti-inflammatory drugs) like ibuprofen

ibuprofen mechanism of action

reduces inflammation and pain by inhibiting prostaglandin synthesis

ibuprofen rational for use

manages pain and inflammation associated w SGS

ibuprofen dosage

400-600mg orally every 4-6 hours as needed

ibuprofen monitoring

watch for GI discomforts, particularly for long term use

ibuprofen side effects

gastric irritation

risk of ulcers due to inhibition of protective prostaglandins in the stomach lining

ibuprofen patient counselling

take with food

avoid long term use

seek medical advice if experiencing stomach pain