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BDS4 Oral Medicine > Medicines & Therapeutics > Flashcards

Medicines & Therapeutics Flashcards

1
Q

What are the 4 medication subtypes most commonly used in oral medicine?

A
  • antimicrobials
  • topical steroids
  • benzdamine mouthwash
  • carbamazepine
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2
Q

What subcategories of antimicrobials are used in oral medicine?

A
  • anti-virals
  • anti-fungals
  • antibiotics
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3
Q

What type of antimicrobial is most commonly used in oral medicine?

A

anti-fungals and anti-virals
- most commonly fungi and viruses producing acute or chronic oral disease

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4
Q

What two types of topical steroids are used in oral medicine?

A
  • inhaled steroids
  • steroid mouthwash
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5
Q

What is carbamazepine used for?

A

management of facial pain

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6
Q

What are the 5 classifications of medications?

A
  • general sales
  • pharmacy medicines
  • prescription only medicines
  • controlled drugs
  • medical devices
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7
Q

Which classification do most dental medicines fit into?

A
  • pharmacy or general sale
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8
Q

What classification of medicines are antimicrobials?

A
  • prescription only
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9
Q

What are controlled medicines?

A

medications with specific legislations restricting prescription, possession and use, sometimes used in oral medicine

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10
Q

Give an example of a medical device used in dentistry

A

saliva substitutes

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11
Q

What are licensed medicines?

A

medicines which have been proven in evidence to the MHRA to have efficacy and safety at defined doses in a child and/or adult population when treating a specified medical condition

they are subject to post licence surveillance via the MHRA

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12
Q

What is the MHRA?

A

Medicines and Healthcare products Regulatory Agency

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13
Q

Can a medication only have one licensed purpose?

A

Medications can gain further licences for additional uses by subjecting to clinical trials and post licence surveillance

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14
Q

What are unlicensed medications?

A

medicines that have not have any evidence of efficacy submitted for the condition under treatment?

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15
Q

What must be carried out when prescribing an unlicensed medication?

A
  • must be licensed for another condition
  • use is at the discretion of the treating physician
  • patient must be aware of the off-licence use
  • patient must be provided with a PIL specific to the treatment being carried out
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16
Q

What are the licensed and unlicensed uses of colchicine?

A
  • licensed
    • treatment of gout
  • unlicensed
    • treatment of oral ulceration
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17
Q

What antiviral is used in oral medicine and what is it used to treat?

A
  • aciclovir
    • primary herpetic gingivostomatitis
    • recurrent herpetic lesions
    • shingles (recurrent herpes zoster)
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18
Q

What antifungals are used in oral medicine and what are they used to treat?

A
  • miconazole, fluconazole and nystatin
    • acute pseudomembranous candidiasis
    • acute erythematous candidiasis
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18
Q

What topical steroids are used in oral medicine and what are they sued for?

A
  • betamethasone mouthwash
    • treat aphthous ulcers and lichen planus
      • unlicensed for this purpose
  • beclomethasone metered dose inhaler
    • treat aphthous ulcers and lichen planus
      • unlicensed for this purpose (asthma)
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19
Q

How are beclomethasone inhalers used in oral medicine?

A
  • for treatment of aphthous ulcers and lichen planus
    • inhaler nozzle held over affected area
    • puff delivers steroid powder
    • powder only present in desired area
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20
Q

What must be given to a patient that has been prescribed an unlicensed medication?

A
  • specific patient information leaflet for unlicensed use
    • standardised leaflets available to print
    • recommend throwing out old PIL
    • put new PIL in medication box
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21
Q

What are medical devices?

A

a product which does not achieve its primary intended by pharmacological, immunological or metabolic means

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22
Q

Why are artificial salivas considered medical devices?

A

they replace missing saliva and do not achieve this by pharmacological, immunological or metabolic means

23
Q

Provide examples of salivary substitutes that are regularly prescribed in primary care

A
  • saliva pastilles
  • saliva orthana
  • biotin oral balance
  • artificial saliva DPF
  • glandosane
24
Q

What types of medications are used in oral medicine which cannot be prescribed in primary care?

A
  • tricyclic antidepressants
  • gabapentin/pregabalin
  • azathioprine
  • mycophenolate
  • hydroxychloroquine
  • colchicine
25
Q

What are tricyclic antidepressants used for in oral medicine?

A

tricyclic antidepressants, such as amitriptyline and nortriptyline, are used to manage oro-facial pain as they work centrally in the CNS to reduce pain transmission.

26
Q

What are gabapentin and pregabalin used for in oral medicine?

A

management of pro-faical pain in case of neuropathic pain where there is damage to the nerves

27
Q

What immunosuppressants are used in oral medicine and when are they used?

A

azathioprine and mycophenolate

  • used to treat inflammatory and immunological mucosal conditions where simple treatments have failed
28
Q

What immune modulators are used in oral medicine and when are they used?

A

hydroxychloroquine and colchicine

  • used to treat inflammatory and immunological mucosal conditions where simple treatments have failed
29
Q

What type of medications are commonly used to treat lichen planus and why?

A
  • anti-fungals and topical steroids
    • overlying fungal infection
    • underlying immunological change
30
Q

What must be considered when prescribing a medication?

A
  • clinical indication
    • what is the most appropriate medication
  • licensed or unlicensed?
    • if a licensed drug is available it should be used
  • dose and route of administration
    • different for each patient
  • warnings for patient
    • interactions
      • e.g. anti-fungals and statins
      • e.g. metronidazole and alcohol
    • cautions
  • treatment duration and monitoring
    • immuno-modulating drugs
      • regular blood tests at clinic or GP
31
Q

Who must write a prescription for the patient?

A
  • best practice is dentist writing prescription
    • other staff members can write it
    • prescribing dentist must sign
31
Q

What details must be included on a prescription?

A
  • patient name, address and age
  • patient DoB and CHI
  • number of days of treatment
  • drug to be prescribed
  • drug formulation and dosage
  • instructions on quantity to be dispensed
  • instructions to be given to the patient
  • signature of prescriber
32
Q

Discuss prescription validity

A
  • valid 6 months from date issued
  • can have more than one item on a script
    • best practice to do individual
  • one prescription can allow repeat dispensing
33
Q

What are important points for writing a prescription?

A
  • must be legible
    • dentists cannot prescribe on computers
  • write full instructions in ink
    • avoid abbreviations
  • dentist must sign prescription
    • if not written by dentist, they must first check for any errors
  • private prescriptions should include GDC number of prescribing dentist
    • should be in identifiable prescription paper
34
Q

What are the advantages of written instructions for patients?

A
  • reminder for patient once they are home
    • many patients will be stressed
    • may not remember instructions given
  • help to overcome language issues
    • multilingual options
    • large print options
  • contact number for patients
    • emergency contact for 24/7 access
    • in case of any issues
  • legal protection
    • document that patient was given leaflet
    • protection if post-treatment course questioned
35
Q

What advice should be given to patients on prescription of medication?

A
  • take medicine at correct time every day
  • always finish the course
  • stop taking medication in case of unexpected reactions
    • contact prescriber
  • discuss known side effects
    • e.g. metronidazole and alcohol
  • keep medicines safe
    • keep out of reach of children
36
Q

What guidance should be followed for prescribing drugs for mucosal disease?

A

SDCEP Drugs in Dentistry

37
Q

What are the two sections of SDCEP drugs in dentistry relevant to mucosal disease?

A
  • non-seteroid topical therapy
    • for inconvenient lesions with discomfort
  • steroid topical therapy
    • for disabling immunologically driven lesions
38
Q

What non-steroidal topical treatments are available for oral mucosal lesions?

A
  • chlorhexidine mouthwash
    • can be diluted 50% with water
  • benzdamine mouthwash or spray
    • topical anaesthetic for pain relief
  • OTC remedies
    • iglu
    • listerine
    • bonjela
39
Q

What non-steroid topical treatment should be avoided?

A
  • anything the patient finds helpful can be used
    • check it is not harmful
      • e.g. bleach, aspirin
40
Q

What steroid based topical treatment of oral mucosal lesions are available?

A
  • hydrocortisone mucoadhesive pellet
  • betamethasone mouthwash
  • beclomathasone mouthwash
41
Q

How are hydrocortisone mucoadhesive tablets used?

A

tablet placed on ulcer and allowed to dissolve

42
Q

How is betamethasone mouthwash used?

A
  • unlicensed product for oral mucosal lesions
    • tailored PIL required
  • betnesol 0.5mg tablets
    • 2 tablets (1mg)
    • 2 tsp water (10ml)
    • 2 minutes rinsing
    • twice daily
    • do not swallow
    • do not rinse after use
    • no eating/drinking for 30 minutes after use
43
Q

What advice must be given in the patient information leaflet for betamethasone mouthwash?

A
  • accepted and proven effective treatment for condition
    • licensed for other medical conditions
  • for use in age 12 and above
    • use with caution below 12
  • dose frequency and use
  • hazards of exceeding standard dose
    • safe to use as directed
    • no standard steroids side effect risk
    • diabetes, osteoporosis, adrenaline suppression
    • no steroid card needed if used properly
  • known side effects
    • small risk of oral candida
  • special instructions
    • spit out to avoid systemic steroid effects
    • don’t rinse mouth after use
44
Q

How is beclomethasone metered dose inhaler (MDI) used?

A
  • unlicensed product for oral mucosal lesions
    • tailored PIL required
  • 50mcg/puff device
    • position device correctly
      • exit vent directly over ulcer area
    • 2 puffs
    • 2-4 times daily
    • don’t rinse after use
45
Q

What type of beclomathasone MDI must be prescribed?

A

pressurised device
- not breath activated device

45
Q

What advice must be given in the patient information leaflet for beclomethasone MDI?

A
  • accepted and proven effective treatment for condition
    • licensed for other medical conditions
      • asthma
      • COPD
  • dose range and frequency
  • technique used for oral lesions
    • different from lung conditions
  • known side effects
    • small oral candida risk
  • special instructions
    • do not rinse mouth as effect will be lost
46
Q

What systemic treatments are used only by specialists in oral medicine?

A
  • disease modulators
    • colchicine
  • steroids
    • prednisolone
  • immune surpassants
    • hydroxychloroquine
      • lichen planus
    • azathioprine
    • mycophenolate
  • immunotherapy
    • adalimumab
    • enterecept
47
Q

What is prednisolone used for in oral medicine?

A
  • pulsed for intermittent troublesome ulcers
    • high dose in short duration
      • 30mg for 5 days
    • cannot be used too frequently
      • once each month
48
Q

What is is systemic steroid risk and when does its become relevant?

A
  • can occur for prolonged courses or repeated short courses over many months
    • 3 months continuous
    • gaps of 2 weeks or less between pulses
  • adrenaline suppression
    • steroid dependancy
    • do not stop suddenly, taper dose
  • Cushingoid features
    • osteoporosis risk
      • bone prophylaxis
      • Ca supplements and bisphosphonates
        • DEXA bone density scan
  • peptic ulcer risk
    • proton pump inhibitor prophylaxis
  • mood/sleep alteration
    • very quick onset
  • mania/depression risk
    • very quick onset
49
Q

Why must caution be taken for systemic treatments such as immune suppressants and immunotherapy?

A
  • infection risk
  • cancer risk
  • adverse drug reactions
  • only for use by a specialist in communication with GP as may be medical issues the OM specialist is unaware of
50
Q

What screening must be carried out for patients in preparation for systemic immunomodulatory treatments?

A
  • blood borne viruses
    • hepatitis B
    • hepatitis C
    • HIV
  • full blood count (FBC)
  • electrolytes
  • liver function tests
  • thiopurine methyltransferase (TPMT)
    • only for azathioprine use
  • zoster antibody screen
  • epstein-barr virus screen (EBV)
  • chest x-ray
    • evidence of previous or active tuberculosis (TB)
  • cervical smear up to date
  • pregnancy test
51
Q

Why must patients be screened in preparation for systemic immunomodulatory treatments?

A

must ensure that immunosuppression will not harm the patient and that there are no pre-existing medical conditions which have not yet been detected

52
Q

What does the planning of immunomodulatory treatment involve?

A
  • full consent from the patient
    • alternative treatment options discussed
  • patient information given and patient reviewed
    • short term risk
      • acute drug reaction
    • long term risk
      • cancer risk increased
        • especially azathioprine and skin cancer
    • effective contraception used
      - pregnancy planned with clinical care team
  • treatment outcome understood by patient and clinician
    • complete remission
    • acceptable level of symptoms
    • trial treatment
      • 6 months then reassess benefit and need for treatment

BDS4 Oral Medicine (3 decks)

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