8/9- GI + salivary drugs

what drug: treats GERD + stimulates GI tract motility- may cause Parkinson’s like symptoms

Metoclopromide

what drugs: antacids used to neutralize gastric acids

1. magnesium + aluminum hydroxide: Tums, Rolaids

2. calcium carbonate: Maalox, Mylanta

what 2 drugs: mucosal protective agent

1. Bismuth (Pepto-Bismol)

2. sucalfrate (Carafate)

what 3 drug classes: all may inhibit GI absorption of tetracycline

1. Calcium carbonate antacids: Rolaids, Tums

2. magnesium antacids: Maalox, Mylanta

3. mucosal barrier agents: sucalfate (Carafate) or Bismuth (Pepto Bismol)

what other drugs can magnesium antacids (Maalox, Mylanta) inhibit absorption of

1. digoxin

2. iron

3. chlorpromazine

4. indomethacin

important dental DDI for mucosal protective agents (sucalfrate)

decreases absorption of: tetracyclines, azole antifungals, quinolone antibiotics → therefore take these drugs 2 hrs before taking sucalfrate

what drug: H2 receptor antagonist- decreases histamine/gastrin induced gastric acid secretion

H2 antihistamines: Cimetidine, ranitidine, etc.

what drug: H2 antihistamine that is a generalized inhibitor of drug metabolism in liver

Cimetidine (Tagamet)

what drug: H2 antihistamine that was used to treat peptic ulcers but had antiandrogenic side effects

Cimetidine (Tagamet)

what drugs: H2 antihistamines that don’t inhibit liver drug metabolizing enzymes

Ranitidine (Zantac), famotidine, nizatidine

what drug: GI drugs that reduce acid secretion by >90%

PPIs

what drugs: proton pump inhibitors (PPIs)

1. Omeprazole (Prilosec)

2. Lansoprazole (Prevacid)

3. Esomeprazole (Nexium)

4. Pantoprazole (Protonix)

5. Rabeprazole (Aciphex)

mechanism of PPIs

irreversibly binds to proton pump of parietal cell, suppressing H⁺ secretion into the gastric lumen

T/F: PPIs are given in an inactivated form

true, becomes activated in an acidic environment

what drug: can alter metabolism of diazepam + triazolam via 3A4 inhibition

Omeprazole

dental risk of PPIs

especially omeprazole, may increase risk of dental implant failure by decreasing osseointegration

what drug: decreases absorption of azole antifungals

PPIs

PPIs increase the risk of what 2 infections

1. C. dificile infection

2. pneumonia

what drug: can cause esophageal candidiasis, mucosal atrophy of tongue, dry mouth, increase risk of fractures, pseudomembranous colitis

PPIs

what drug: potassium-competitive acid blocker (P-CAB) used to treat acid-related diseases

vonoprazen, novel drug created for gastric + duodenal ulcers, reflux esophagitis

mechanism of vonoprazen

reversible inhibits gastric hydrogen potassium ATPase

what drug: synthetic analog of prostaglandin PGE-1 that stimulates mucous secretion + decreases gastric acid secretion

Misoprostol, used to prevent NSAID induced gastric ulcers

T/F: Misoprostol is less effective than H2 blockers + PPIs

true

what drug: decreases PG synthesis → increasing acid secretion + decreasing production of protective mucosal barrier

aspirin

recommended treatment for H. pylori infection

bismuth quadruple therapy:

1. bismuth

2. PPI

3. tetracycline

4. metronidazole

what drug: peripherally acting opioids used for diarrhea

1. Loperamide (Imodium)

2. diphenoxylate (Lomotil)

what drug: anti-diarrheal drug subject to abuse by addicts to get high or prevent going into withdrawal

Loperamide (Imodium)

Loperamide (Imodium) mechanism

decreases intestinal motility by acting on presynaptic opioid receptors in the enteric nervous system to inhibit ACh release + decrease peristalsis

what drug: anti-cholinergic drug used to reduce seasickness

Scopolamine

what drug: selective 5-HT3 receptor blocker used to reduce chemotherapy nausea + vomiting

Ondansetron (Zofran)

mechanism of selective 5-HT3 receptor blockers

reduces CN X activity → prevents activation of vomiting center in medulla oblongata + blocks serotonin 5-HT3 receptors

what drug: immunomodulator that inhibits TNF-alpha

Infliximab (Remicade)

what drug: human monoclonal antibody that is used to treat inflammatory disorders like Crohn’s disease

Infliximab (Remicade)

what drug: corticosteroid used to treat GI inflammatory disorders like Crohn’s

Prednisone

what’s subjective sialorrhea

sensation of having too much saliva in the mouth even though there is volumetric decrease in the saliva → resulting in thick, ropey, stringy, foamy, viscous saliva

anticholinergics’ effect on saliva production

affects serous production by competing w/ or blocking ACh receptors on M1 + M3 (muscarinic) receptors

newly discovered salivary gland

tubarial glands

what does saliva look like when there is salivary hypofunction present

thick, stringy, viscous, bubbly

unstimulated vs. stimulated saliva volume during salivary hypofunction

• unstimulated: <0.16 mL/min

• stimulated: <0.5 mL/min

critical level of unstimulated saliva volume

<0.1 mL/min

3 categories of the Challacombe scale used to distinguish salivary hypofunction

1. mild

2. moderate

3. severe

3 levels of mild salivary hypofunction according to Challacombe scale

1. mirror sticks to buccal mucosa

2. mirror sticks to tongue

3. frothy saliva

3 levels of moderate salivary hypofunction according to Challacombe scale

1. no saliva pooling in floor of mouth

2. tongue shows generalized shortened papillae

3. altered gingival architecture

4 levels of severe salivary hypofunction according to Challacombe scale

1. glossy appearance of oral mucosa, esp palate

2. tongue lobulated/fissured

3. cervical caries in more than 2 teeth

4. debris on palate or sticking to teeth

definition of xerostomia

subjective sensation of dry mouth

2 major types of sialogogues

1. pilocarpine

2. cevimeline

both are cholinergic agonists (stimulators)

arginine can be administered to

generate alkali in the oral cavity → raise pH of oral cavity + stop demineralization

7 other things to help w/ salivary hypofunction

1. xylitol

2. artificial saliva

3. caphosol + neutrasal:

4. oral lubricants: vitamin E, borage seed oil, EVOO

5. high fluoride toothpaste (1.1%)

6. silver diamine fluoride

7. biotene