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Continuing Professional Development
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evidence in patient care
whether they are experiencing
xerostomia as a result of their
medicines and assisting with its
management. It is worth noting that
recommendations to prescribers
regarding xerostomia can be
formally documented as clinical
interventions. For example, this
could be documented as 'toxicity'
if xerostomia occurs as a result of
drug therapy, or as a 'drug selection'
issue if you are concerned that the
prescribed medicine might worsen
xerostomia (for more information,
see the PSA Standard and Guidelines
for Pharmacists Performing Clinical
Interventions).26 If necessary, a
Home Medicines Review could be
recommended for more complex
patients given that elderly people
taking multiple medicines that
contribute to xerostomia might well be
at risk of other issues. For example,
an elderly patient with xerostomia
who is taking multiple medications
with additive anticholinergic effects
might also be at risk of falls,
fractures and impaired physical and
1. Fox PC, Busch KA, Baum BJ. Subjective reports of
xerostomia and objective measures of salivary gland
performance. J Am Dent Assoc. 1987; 115:581--84.
2. Hopcraft MS, Tan C. Xerostomia: an update for
clinicians. Aust Dent J. 2010; 55:238--44; quiz 353.
3. Thomson WM, Chalmers JM, Spencer AJ, et al.
The occurrence of xerostomia and salivary gland
hypofunction in a population-based sample of older
South Australians. Spec Care Dentist. 1999; 19:20--23.
4. Navazesh M, Christensen C, Brightman V. Clinical
criteria for the diagnosis of salivary gland hypofunction.
J Dent Res. 1992; 71:1363--69.
5. Porter SR, Scully C. Adverse drug reactions in the
mouth. Clin Dermatol. 2000; 18:525--32.
6. Olver IN. Xerostomia: a common adverse effect of
drugs and radiation. Aust Prescr. 2006; 29:97--98.
7. Chrischilles EA, VanGilder R, Wright K, et al.
Inappropriate medication use as a risk factor for self-
reported adverse drug effects in older adults. J Am
Geriatr Soc. 2009; 57:1000--06.
8. Jano E, Aparasu RR. Healthcare outcomes associated
with beers' criteria: a systematic review. Ann
Pharmacother. 2007; 41:438--47.
9. Fick DM, Cooper JW, Wade WE, et al. Updating the
Beers criteria for potentially inappropriate medication
use in older adults: results of a US consensus panel of
experts. Arch Intern Med. 2003; 163:2716--24.
10. McLeod PJ, Huang AR, Tamblyn RM, et al. Defining
inappropriate practices in prescribing for elderly
people: a national consensus panel. Can Medi Assoc J.
11. Visvanathan V, Nix P. Managing the patient presenting
with xerostomia: a review. Int J Clin Pract. 2010;
12. Dirix P, Nuyts S, Vander Poorten V, et al. The influence
of xerostomia after radiotherapy on quality of life:
results of a questionnaire in head and neck cancer.
Support Care Cancer. 2008; 16:171--9.
13. Davies AN, Broadley K, Beighton D. Xerostomia in
patients with advanced cancer. J Pain Symptom
Manage. 2001; 22:820--5.
14. Sreebny LM, Valdini A, Yu A. Xerostomia. Part II:
Relationship to nonoral symptoms, drugs, and diseases.
Oral Surg Oral Med Oral pathol. 1989; 68:419--27.
15. Orellana MF, Lagravere MO, Boychuk DG, et al.
Prevalence of xerostomia in population-based samples:
a systematic review. J Public Health Dent. 2006;
16. eTG Complete [online]. Melbourne: Therapeutic
17. Risheim H, Arneberg P. Salivary stimulation by
chewing gum and lozenges in rheumatic patients with
xerostomia. Scand J Dent Res. 1993; 101:40--3.
18. Bjornstrom M, Axell T, Birkhed D. Comparison between
saliva stimulants and saliva substitutes in patients with
symptoms related to dry mouth. A multi-centre study.
Swed Dent J. 1990; 14:153--61.
19. Fox PC, van der Ven PF, Baum BJ, et al. Pilocarpine for
the treatment of xerostomia associated with salivary
gland dysfunction. Oral Surg Oral Med Oral Pathol.
20. LeVeque FG, Montgomery M, Potter D, et al. A
multicenter, randomized, double-blind, placebo-
controlled, dose-titration study of oral pilocarpine for
treatment of radiation-induced xerostomia in head and
neck cancer patients. J Clin Oncol. 1993; 11:1124--31.
21. Rieke JW, Hafermann MD, Johnson JT, et al. Oral
pilocarpine for radiation-induced xerostomia: integrated
efficacy and safety results from two prospective
randomized clinical trials. Int J Radiat Oncol Biol Phys.
22. Hamlar DD, Schuller DE, Gahbauer RA, et al.
Determination of the efficacy of topical oral pilocarpine
for postirradiation xerostomia in patients with head
and neck carcinoma. Laryngoscope. 1996; 106:972--6.
23. Fife RS, Chase WF, Dore RK, et al. Cevimeline for
the treatment of xerostomia in patients with Sjogren
syndrome: a randomized trial. Arch Intern Med. 2002;
24. Khurshudian AV. A pilot study to test the efficacy of oral
administration of interferon-alpha lozenges to patients
with Sjogren's syndrome. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod. 2003;95:38--44.
25. Sasse AD, Clark LG, Sasse EC, et al. Amifostine
reduces side effects and improves complete response
rate during radiotherapy: results of a meta-analysis. Int
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26. Pharmaceutical Society of Australia. Standard
and guidelines for pharmacists performing clinical
interventions [online]. 2011. At: www.psa.org.au/
1. The prevalence of xerostomia
in the community is estimated
2. Which ONE of the following
xerostomia is correct?
a) Xerostomia is defined as objective
b) The majority of patients with
xerostomia have salivary gland
c) Xerostomia is defined as the
perception of dryness in the
d) Xerostomia is always accompanied
by a reduction in salivary flow.
3. Which of the following drug
groups is NOT commonly
associated with xerostomia?
a) Urinary antispasmodics.
c) Tricyclic antidepressants.
d) Macrolide antibiotics.
4. Amifostine is indicated
in which of the following
a) Xerostomia due to multiple
b) Salivary gland hypofunction due to
primary Sjogren's syndrome.
c) Reduction of xerostomia due to
radiotherapy for head and neck
d) Xerostomia due to anxiety.
A score of 4 out of 5 attracts 1 CPD credit.
5. One of your regular customers
mentions to you that their
mouth feels dry, and that they
now have difficulty swallowing
dry foods. You notice on
their medication profile that
they recently started taking
amitryptyline for pain. You
discuss with the customer
that their dry mouth might
be due to their amitriptyline
and suggest that they discuss
this with their prescriber. This
clinical intervention could
be documented using the
DOCUMENT system as a:
a) drug selection issue.
b) compliance issue.
c) monitoring issue.
d) toxicity issue.
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