COM Pharmacology & Medication Management 2 — Questions and Answers
Question 1: Which class of antihypertensive medications is most commonly associated with drug-induced gingival overgrowth that can interfere with orofacial myofunctional therapy?
- Beta-blockers
- Calcium channel blockers (Correct answer)
- ACE inhibitors
- Diuretics
Correct answer: Calcium channel blockers
Calcium channel blockers such as nifedipine and amlodipine are the most common antihypertensives linked to gingival overgrowth.
Question 2: A patient undergoing orofacial myofunctional therapy reports chronic use of opioid analgesics. Which oral side effect should the COM clinician monitor most closely?
- Gingival hyperplasia
- Xerostomia and reduced mucosal lubrication (Correct answer)
- Macroglossia
- Increased salivary flow
Correct answer: Xerostomia and reduced mucosal lubrication
Opioids reduce salivary flow via anticholinergic mechanisms, causing xerostomia that compromises oral tissue health.
Question 3: Botulinum toxin type A injections used in bruxism management primarily work by:
- Blocking sodium channels in sensory nerves
- Inhibiting acetylcholine release at the neuromuscular junction (Correct answer)
- Increasing GABA activity in the brainstem
- Reducing cortisol-mediated muscle tension
Correct answer: Inhibiting acetylcholine release at the neuromuscular junction
Botulinum toxin prevents ACh vesicle fusion at the neuromuscular junction, producing temporary chemodenervation of targeted muscles.
Question 4: Which over-the-counter antihistamine most significantly impairs salivary flow and could complicate myofunctional exercises requiring adequate oral lubrication?
- Loratadine (Claritin)
- Cetirizine (Zyrtec)
- Diphenhydramine (Benadryl) (Correct answer)
- Fexofenadine (Allegra)
Correct answer: Diphenhydramine (Benadryl)
Diphenhydramine is a first-generation antihistamine with strong anticholinergic activity, producing pronounced xerostomia.
Question 5: A child patient's parent reports the child takes methylphenidate for ADHD. How might this medication affect orofacial myofunctional therapy sessions?
- It may cause macroglossia interfering with tongue posture
- It may reduce attention span and compliance when worn off
- It typically improves focus but may cause bruxism or jaw clenching (Correct answer)
- It has no clinically relevant orofacial effects
Correct answer: It typically improves focus but may cause bruxism or jaw clenching
Stimulant medications like methylphenidate can cause bruxism and jaw clenching as side effects while generally improving focus during the medicated window.
Question 6: A patient taking a tricyclic antidepressant (TCA) for chronic pain presents for OMT. The COM should anticipate:
- Hypersalivation requiring frequent pauses
- Significant xerostomia and potential lip incompetence (Correct answer)
- Tongue enlargement due to fluid retention
- Increased muscle tone improving myofunctional exercise response
Correct answer: Significant xerostomia and potential lip incompetence
TCAs have strong anticholinergic properties producing xerostomia, which can worsen lip seal and oral rest posture.
Question 7: Which topical agent is sometimes applied to the tongue or palate to facilitate tactile awareness during myofunctional therapy and must be selected to avoid allergic reactions?
- Lidocaine 20% spray
- Capsaicin cream
- Chlorhexidine gluconate rinse
- Glycerin or flavored food-grade substances (Correct answer)
Correct answer: Glycerin or flavored food-grade substances
Food-grade glycerin or palatable flavored substances provide sensory cues without anesthetic or irritant risks during OMT exercises.
COM Pharmacology & Medication Management 2
Which class of antihypertensive medications is most commonly associated with drug-induced gingival overgrowth that can interfere with orofacial myofunctional therapy?