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Oral fungal infection (candidosis) and enlargemenof salivary glands from si- aladenitis are seen commonly in patients with modera-to-severe salivary gland hypofunction [2 order cialis super active 20mg free shipping,20] generic cialis super active 20 mg fast delivery. The risk of infection is increased in people who wear dentures effective 20mg cialis super active, smokers and diabetics cheap 20 mg cialis super active overnight delivery; in patients with Sjogren�s syndrome and connective tissue diseases tread with corticosroids or other immunosuppressants. These drugs also contribu to candidiasis because they reduce the natural resistance of the mucosa. Lack of saliva creas difculties in wearing dentures while promoting the developmenof denture stomatitis [1,2]. In cases when there is still some residual salivary function iwas shown thasaliva stimulans (local or sysmic stimulation of secretory gland) produce grear relief than saliva substitus. When salivary glands are irreversible dama- 78 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Mravak-Stipetic: Xerostomia - diagnostics and treatmenged and withoucapability to produce saliva, as is in the cases of head and neck ra- diotherapy or advanced sysmic disease (e. When salivary function is preserved stimulation of salivary glands aimed to increase the salivary output, include: 1. Local stimulation The combination of chewing and acidic tas, as provided by chewing gums or solid food or fruits, preferentially acidic (apple, pinneapple, carrots etc. Patients with dry mouth musbe told noto use sweets, sweener in food and drink and various other sugar products due to the increased risk for dental caries. Use of acupuncture in the treatmenof xerostomia have focused earlier mainly on a curative approach when the salivary gland tissues are already damaged and xerostomia is present. Electrical stimulation has also been used as a therapy for salivary hypofunction buhas been inadequaly investigad clinically. A device thadelivers a verylow- voltage electrical charge to the tongue and pala has been described although its efecwas modesin patients with dry mouth [16]. Sysmic stimulation Any agenthahas the ability to infuence salivary glands to increase production of saliva is rmed a secretagogue. The mechanism of action for salivary stimulation of a mucolytic agenbromhexine and anetholetrithione is nofully understood. No proven benefto salivary function 79 Rad 514 Medical Sciences, 38(2012) : 69-91 M. Mravak-Stipetic: Xerostomia - diagnostics and treatmenhas been shown for bromhexine yeimay stimula lacrimal function in patients with Sjogren�s syndrome although this is controversial. Ihas been suggesd thaanetholetrithione may up-regula muscarinic receptors and increased saliva fow in patients with mild salivary gland hypofunction, buwas inefective in patients with marked salivary gland hypofunction. As a parasympathomimetic agenicauses stimulation of cholinergic receptors on the surface of acinar cells. Pilocar- pine increases salivary output, stimulating any remaining gland function. Currenindications are for patients following radiotherapy and for those with Sjogren�s syn- drome. In doses of up to 15 mg/day, iincreases secretion of saliva, and for optimal results patients should be tread during 8-12 week. Afer the administration of pilocarpine, salivary outpuincreases rapidly, usually reaching a maximum within 1 hour. Stimulation of the salivary glands during radiation therapy has been suggesd as a possible means of reducing damage to the glands. The synergistic efecof anetholetrithione in combination with pilocarpine was shown [20]. The mechanism of action of anetholetrithione may be to increase the number of cell surface receptors on salivary acinar cells and pilocarpine stimulas the receptors thus, in combination, these drugs have synergistic efec[20]. Pilocar- pine is contraindicad in patients with pulmonary disease, asthma, cardiovascular disease, gastroinstinal diseases and glaucoma [20]. Cevimeline is another parasympathomimetic agonisthahas been recently approved for the treatmenof oral dryness in patients with Sjogren�s syndrome. Due to similar side efects as to those of pilocarpine imusbe prescribed with caution.
Medications for treating this syndrome bupropion with the nicotine patch has shown 37 have not been adequately tested best cialis super active 20mg. Therefore some clinicians smoking cessation medication and the frst in its have used moderate doses of the older tricyclic class targeting specifcally the neurobiology of antidepressants (e order cialis super active 20 mg without a prescription. It reduces the smoker’s to treat withdrawal from marijuana as they also craving for nicotine by binding to nicotine recep- have anticholinergic and sedating qualities but do tors in the brain and thereby reducing withdrawal not cause a high generic 20 mg cialis super active with visa, nor are they abused effective 20 mg cialis super active. A Stimulant intoxication: Agitation, paranoia and daily, uninterrupted dose of disulfram is continued psychosis are treated with antipsychotics, often until the person is in full and mature recovery and combined with benzodiazepines. Stimulant withdrawal: There are no standard Naltrexone in its oral form is usually taken once a effective agents to treat stimulant withdrawal, day but can be taken at a higher dose every second though dopamine-enhancing agents such as or third day. The amantadine, bupropion, and desipramine have injectable form of naltrexone is taken once a month. This area has not Because of the way acamprosate is absorbed, it must been well researched. During the initial 6 weeks of If injected intravenously, buprenorphine will cause therapy, clients should use one lozenge every 1 to 2 opioid withdrawal. This is an advantage for persons who do lozenges in 6 hours or a maximum of 20 lozenges not live near a methadone clinic. The lozenges should be used for up to 12 People should continue to take naltrexone, acam- weeks with no more than 20 lozenges used a day. Generally, for the tion, including the nicotine patch, gum, and frst 3 days of treatment, individuals take 150 mg, lozenge. The approved course of varenicline treatment is 12 weeks; however, an additional 12 weeks of treat- The nicotine patch is available in three strengths ment may increase the likelihood of long-term and a “step-down” approach is used: 21 mg for 6 smoking cessation for some individuals. For the weeks, then 14 mg for 2 weeks, then 7 mg for 2 frst 3 days of treatment, individuals take 0. A new patch next four days, and then 1 mg twice a day for the needs to be reapplied each day, at roughly the same remainder of the treatment period. Individuals therapies for periods longer than is usually recom- who smoke fewer than 25 cigarettes per day should mended. In general, the more intense the treatment initiate therapy with the 2 mg strength, and heavier for tobacco cessation (e. Specifc combinations of gum should be chewed every 1 to 2 hours while frst line medications shown to be effective include awake; at least nine pieces of gum daily. The underlying recommended dosage of the nicotine lozenge is desire to quit must be present or bupropion and based on the “time to frst cigarette” of the day. Most of these are mild and • Tingling sensation in arms and legs subside with continued use of the gum. Potential side effects for acamprosate (Side effects Nicotine lozenges: nausea, hiccups, heartburn. Other factors that might sweating, thirst, chest pain, rapid heart rate, increase the odds of seizure and are classifed as blurred vision, dizziness, and confusion. Specifcally, the warning notes withdrawal for up to three days and block the that depressed mood, agitation, changes in effect of any opioids taken for up to three days. Patients that have a Substances found in tar in cigarettes stimulate change in personality, increase in anger or enzymes in the liver, and fuctuations in an thoughts of suicide should be immediately individual’s smoking pattern can result in higher referred back to their doctor. Nicotine on withdrawal for 24 hours, reduces or eliminates hands can get into nose or eyes, causing stinging drug craving, and blocks the euphoric effects of and redness. It is associated with depression and anxiety about spasm of the coronary arteries (the heart’s blood vessels). In contrast, it is needs to be increased as a woman progresses possible to detoxify women dependent on heroin through pregnancy, due to increases in blood who are abusing illicit opioids by using a metha- volume and metabolic changes specifc to preg- done taper. Buprenorphine has been examined in pregnancy Generally, dosing of methadone is for a 24-hour and appears not to cause birth defects but it may be period.