Medicines & Therapeutics in OM

Question 1

carbamazepine

Answer 1

carbamazepine decreases neuronal excitability or enhances inhibition by altering sodium, potassium or calcium conductance or by affecting the δ-aminobutiric acid (GABA), glutamate or other neurotransmitters that may be concerned in seizure activity
used to treat epilepsy, trigeminal neuralgia, peripheral neuropathy in diabetes

Question 2

licenced medicines

Answer 2

proven in evidence to the MHRA to have efficacy & safety at defined doses in a child and/or adult population when treating specified medical conditions
usually clinical trial data provided by the manufacturer
post licence surveillance via MHRA

Question 3

unlicenced medicines

Answer 3

not have evidence of efficacy submitted for condition under tx
will be ‘licenced’ but for another condition & is used at discretion of treating physician
pt must be informed that it is ‘off licence’ and pt must be given PIL specific to condition under tx
drug manufacturer supplied PIL will be for the licenced condition

Question 4

unlicenced topical steroids

Answer 4

betamethasone mouthwash
beclomethasone metered dose inhaler
both used for treating aphthous ulcers & lichen planus

Question 5

PIL

Answer 5

pt information leaflet

Question 6

medical devices that inc ‘dry mouth’ tx

Answer 6

salivix pastilles
saliva orthana
biotene oral balance
artificial saliva dpf
glandosane

Question 7

what must be considered when prescribing

Answer 7

clinical indication
licenced or unlicensed for this use
dose & route of admin
important warnings for pt
drug interactions & caution
tx duration & monitoring

Question 8

what must be on a prescription

Answer 8

pt name address age
pt identifier i.e. DoB/CHI
no of days tx
drug to be prescribed
drug formulation & dosage
instructions on quantity to be dispensed
instructions to be given to pt
signed - identifier of prescriber

Question 9

prescription validity

Answer 9

6mths from date issued
more than 1 item on script
more than one repeated dispensing occasion

Question 10

advantages of written instructions

Answer 10

stressed pt may not remember instructions
language issues may prevent proper understanding
contact no for pt if issues
legal protection if post tx course questioned

Question 11

advice to be given to pt

Answer 11

take drugs at correct time & finish course
unexpected reactions: stop & contact prescriber
known side effects should be discussed e.g. metronidazole & alcohol
keep medicine safe & out of reach of children

Question 12

legal requirement for dentist

Answer 12

to sign prescription as this confirms all other information is correct and has been checked

Question 13

non steroid topical tx of oral mucosal lesions

Answer 13

CHX mouthwash
benzdamine mouthwash/spray
OTC remedies i.e. igloo, listerine, bonjela
anything else that pt finds helpful (that is not harmful)

Question 14

steroid based topical tx of oral mucosal lesions

Answer 14

hydrocortisone mucoadhesive pellet
betamethasone mouthwash
beclomethasone metred dose inhaler

Question 15

betamethasone prescription

Answer 15

unlicenced product so supply PIL
use betnesol tabs 0.5mg:
2 tablets (1mg) with 10ml of water 2mins rinsing 2x daily
refrain from eating / drinking for 30mins after use
do not swallow
do not rinse after use

Question 16

beclomethasone MDI

Answer 16

unlicenced product so supply with PIL
dental prescribing is 50mch/puff device
position device correctly i.e. exit vent directly over ulcer area
2 puffs
2-4x daily
don’t rinse after use

Question 17

systemic tx

Answer 17

for specialist use only:
1. disease modulators i.e. colchicine
2. steroids i.e. prednisolone - can be pulsed for intermittent troublesome ulcers, high dose/short duration 30mg for 5days, need to ensure not used too frequently; once each month
3. immune suppressants i.e. hydroxychloroquine for lichen planus, azathioprine
4. immunotherapy i.e. adalimumab, enterecept
infection risks, cancer risks, adverse drug reactions
only for use by specialist
always communicate proposed tx to GP

Question 18

systemic steroid risk

Answer 18

if prolonged course or repeated short courses over many months (3mths continuous or gaps of 2 weeks or less between pulses of pred):
- adrenal suppression - steroid dependency so don’t stop suddenly, taper dose
- cushingoid features
- osteoporosis risk - bone prophylaxis, calcium supps & bisphosphonates
- peptic ulcer risk - PPI prophylaxis
- mood / sleep alteration