Common Oral Cavity Disorders & Nausea and Vomiting

candidiasis

What causes white plaques on buccal mucosa, palate, tongue, or oropharynx?

Clomitrazole troches or nystatin suspension

What is the first time tx for candidiasis?

clotrimazole

What tx for candidiasis is more effective than fluconazole and nystatin?

fluconazole

If there is no response to tx for candidiasis or it returns-- what is the second line treatment?

chlorhexidine 0.12% oral rinse

or

dilute bleach solution

What can you prescribe if there is denture involvement with candidiasis?

topical antifungal creams

What can be given for angular cheilitis?

systemic antifungal- fluconazole

If a pt presents with pain on swallowing and is found to have esophageal candidiasis-- what should be prescribed?

fluconazole 3x a week

for pts with recurrent esophageal candidiasis- what is the the prophylaxis treatment?

fluconazole daily until CD4 >200

for pts with HIV with a CD4 count of <200 and have esophageal candidiasis what should be prescribed?

nystatin

What tx for candidiasis has this MOA:

-Binds to sterols in the fungal cell membrane

-Pore in membrane

-allowing loss of essential cellular constituents

shake suspension well

What is the education to be given for a pt with nystatin prescribed?

clotrimazole AND fluconazole

What medication/s for candidiasis tx has this MOA:

inhibits production of sterols

–Inhibits enzyme activity, resulting in buildup of intra-fungal hydrogen peroxide

increases INR in warfarin

What is the Drug-drug interaction for fluconazole?

fluconazole

What medication used for candidiasis can cause QT prolongation and at a higher dose (400mg) is a pregnancy category D?

HSV-1

What virus presents with multiple intraoral vesicular lesions and erosions with an inflammatory base?

Systemic antiviral- Acyclovir or Valacyclovir

or

topical antiviral (decreases healing time by 1/2 day)

What are the treatments for HSV-1 acute episodic treatment that have prodromal symptoms?

systemic antivirals at lower daily doses

What is the chronic suppressive tx for HSV-1?

both acyclovir and valacyclovir

What antiviral can have these ADEs:

malaise, nausea, diarrhea, headache

both acyclovir and valacyclovir

What antiviral drug has drug interactions with phenytoin and valproic acid causing decreased concentrations?

both acyclovir and valacyclovir

This is the MOA for what treatment of HSV-1

•interferes with viral DNA replication by terminating the DNA chain

valacyclovir

What is a prodrug converted into acyclovir?

aphthous ulcerations

What is the medical term for canker sores and presents as localized, shallow, round to oval ulcers with a grayish base?

triamcinolone acetonide (medium potency topical steroid)

What is the symptomatic relief for aphthous ulcers?

triamcinolone acetonide

What drug for treating aphthous ulcers has this MOA:

•synthetic corticosteroid with anti-inflammatory, antipruritic and anti-allergic properties

applied 2-4 times a day after meals AND at bedtime - apply a thin film over lesions and DO NOT RUB IN

What is the education for treating aphthous ulcers with triamcinolone acetonide?

5ml swish and spit or swallow 4 times daily

What is the education when prescribing magic mouthwash suspension?

diphenhydramine

What magic mouthwash has antihistamine and analgesic effects?

lidocaine

What magic mouthwash has topical anesthetic quality?

maalox

What magic mouthwash has antiacid quality to help coat the sore?

tetracycline

What magic mouthwash has antibiotic quality?

glucorticoids

What magic mouthwash has anti-inflammatory steroid quality?

nystatin

What magic mouthwash has antifungal treatment (typically for cancer)?

xerostomia (dry mouth)

What is a result of decrease in saliva production that presents with dry, thin pale mucosa, fissured tongue, etc. ?

•Antihistamines

•Antimuscarinics

•Antipsychotics

•Antidepressants

•Diuretics

(BLOCKERS OF ACETYLCHOLINE)

What are 5 classes of drugs that cause dry mouth?

topical fluoride

What is prevention of complications treatment for dry mouth?

pilocarpine

cevimeline

(both contraindicated with pts with uncontrolled asthma or narrow angle glaucoma)

What are two prescription therapies for dry mouth treatment that causes saliva stimulation with cholinergic agents?

saliva replacement

What is the otc therapy for dry mouth?

hydroxyethylcellulose or carboxymethylcellulose

What are the active enzymes in biotene used as a OTC therapy for dry mouth?

xylitol

What is an OTC therapy for dry mouth that can be in the form of saliva, lozenges, or patch?

Anticonvulsants

Antibiotics

Antineoplastic agents

Digoxin and antiarrhythmics

Opioids

NSAIDs

Oral contraceptives

Oral & injectable hypoglycemic agents

Iron supplements

Radiation therapy

What are some examples that cause medication induced N/V?

brainstem

Where is the vomiting center located?

outside BBB

Where is the chemotrigger zone located?

block the receptors associated with nausea and vomiting

what is the MOA for antiemetic Medications?

serotonin receptor antagonist

What antiemetic medication group has this MOA:

block 5-HT3 receptor on vagal afferents of upper GI tract and in the CTZ

dopamine antagonist

What antiemetic medication group has this MOA:

block DA2 receptors in the CTZ

muscarinic cholinergic antagonist (anticholinergic)

What antiemetic medication group has this MOA:

block muscarinic receptor such that acetylcholine can't bind in the pathway from the inner ear to VC

histamine antagonist (antihistamine)

What antiemetic medication group has this MOA:

block H1 receptor and muscarinic receptors in the pathway from the inner ear to VC

neurokinin-1-type antagonist

What antiemetic medication group has this MOA:

blocks NK1 receptor such that substance P can't bind in the brain

•Antihistamines

•Anticholinergic agents

•Prokinetic agents

•Serotonin antagonists

•Dopamine antagonists

What are the commonly used pharmacologic options for Nausea and vomiting?

Ondansetron

Granisetron

Palosetron

What is a drug from the serotonin 5HT3 antagonist class that is used for NV?

headache, dizziness, QT prolongation

What are the possible SEs for Serotonin Antagonists?

Prochlorperazine

Perphenazine

Chlorpromazine

Promethazine (BBW)

What are some drugs in the dopamine antagonist in class phenothaizines that are used for N/V?

promethazine also blocks histamine

What drug has a BBW for tissue necrosis from extravasation in IV administration regarding respiratory depression in children <2yo?

Haloperidol

Droperidol

What are some drugs in the dopamine antagonist in class butyrophenone that are used for N/V?

droperidol

What drug in the dopamine antagonist group has a BBW regarding QT interval prolongation?

All block DA2 receptors potentially result in associated extrapyramidal movement disorder, sedation, orthostatic hypertension, anticholinergic effect

What are the side effects for dopamine antagonist drug group?

dopamine antagonists

What drug group for treating N/V should not be used in Parkinson's disease?

•Diphenhydramine (Benadryl)

•Dimenhydrinate (Dramamine)

•Meclizine (Antivert)

•Hydroxyzine (Atarax, Vistaril)

•Promethazine (Phenergan) antihistamine and d2 blocker

(ALL FIRST GENERATION!!--> Bc need to cross BBB!)

What are some drugs in the antihistamine group used to treat N/V used for motion sickness by blocking the H1 receptor and Ach receptor?

sedative, anticholinergic ( dry mouth , dry secretions, urinary retention, blurred vision)

What are some SEs for the antihistamine drug group used to treat N/V?

scopolamine

What is a patch applied behind the ear every 72 hours that is very effective for motion sickness because it blocks M1 receptor in the pathway from inner ear to VC?

anticholinergic, sedation

What are the SEs for scopolamine?

•Aprepitant (Emend) PO

•Fosaprepitant (Emend) IV

What are two drugs in the class Substance P/Neurokinin- 1 Antagonists for treating N/V and used as adjunct agents in chemotherapy?

teratogenic potential

What is the primary consideration when selecting NVP treatment?

Ginger

Sea Band Mama Morning

Pyridoxine

What are some OTC options for treating NVP?

Pyidoxine/ Doxylamine

What is the first line tx for NVP?

Promethazine (vitamin B6) or Metoclopramide

(Ondansetron 2/3rd line)

What are the 2nd line treatments for NVP?

vertigo

tx: antihistamine (meclizine or dimenhydrinate)

or

benzodiazepines

What is the sensation that the environment is moving/spinning and how would you treat it?

meclizine or dimenhydrinate

(antihistamines)

What are the inner ear suppressant treatments used for vertigo?

motion sickness

What is the off balance/nauseous due to repeated motion?

no, do not affect the inner ear

Are 5HT3 receptor antagonists effective for vertigo?

scopolamine patch

( or meclizine or dimenhydrinate)

What is the first line tx for motion sickness?

promethazine

What should NOT be given to children less than 2yo and caution in older children for N/V due to possibly causing respiratory depression?

Ondansetron

(BRAT diet)

What is the drug of choice for N/V in pediatrics?

ondansetron but watch out for headache

What are the possible txs for N/V in geriatrics?

1st generation antihistamines

scopolamine

metoclopramide

What are some drugs that should NOT be used in geriatrics to treat N/V?