therapeutic drugs in oral medicine

Question 1

when would you give non-steroid topical therapy

Answer 1

for inconvenient lesions with discomfort

Question 2

when would you give steroid topical therapy

Answer 2

for disabling immunologically driven lesions

Question 3

what are the options for non-steroid topical treatment of oral mucosal lesions

Answer 3

chlorohexidine mouthwash
benzdamine mouthwash or spray
OTC remedies = Bonjela, Igloo

Question 4

what must you warn pt about when giving Chlorohexdine moutwash

Answer 4

can cause dental staining if use before foods with high pigment
should be advised to use last thing at night

Question 5

what is benzdamine mouthwash

Answer 5

NSAID
good for painful mucosal conditions
useful topical anaesthetic/ain relief = especially before mealtimes

Question 6

what are options of steroid based topical treatment

Answer 6

hydrocortisone mucoadhesvie tablet
betamethasone mouthwash
beclomethasone MDI

Question 7

how does hydrocortisone tablet work

Answer 7

requires prolonged contact with mucosa to work
allow tablet to dissolve over the ulcer
as they dissolve they would adhere through formation of a gel which protects ulcer and gives some relief from discomfort but also hold drug in contact

Question 8

how does betamethasone mouthwash work

Answer 8

give betnesol tablets 0.5mg and dissolve in 10mls water and rinse for 2 mins daily

Question 9

problem with betamethasone mouthwash

Answer 9

not licensed for the use of treating oral mucosal lesions
need to supply pt with a tailored pt information leaflet instead

Question 10

advantages of betamethasone mouthwash

Answer 10

can increase concentration by adding more tablets
can rinse more often daily for better effect

Question 11

what does MDI stand for

Answer 11

meter dose inhaler

Question 12

how does beclomethasone inhaler work

Answer 12

puffer applied directly onto the mucosa above where lesion is present and activated twice which allows puffer to be sprayed directly onto mucosa
sticks and is absorbed
used 2-4 x day

Question 13

what type of lesions is beclomethasone good for

Answer 13

isolated lesions, not for widespread lesions

Question 14

what type of lesions is betamethsone mouthwash good for

Answer 14

widespread lesions, not as good for isolated lesions

Question 15

what is the problem with beclomethasone being used for mucosal lesions

Answer 15

not licensed for this use, need to provide pt with tailored information leaflet

Question 16

what type of puffer device must be used

Answer 16

pressure device not a breath activated one

Question 17

why must a pressure inhaler device be used and not puffer

Answer 17

because cannot such the steroid from the device onto mucosa as it will just go into airways

Question 18

what are the systemic treatment options

Answer 18

disease modulators
steroid inflammatory reducers
immune suppressants
immunotherapy

Question 19

example of disease modulators

Answer 19

colchicine

Question 20

systemic steroid inflammatory reducers example

Answer 20

prednisolone

Question 21

how is prednisolone used

Answer 21

high dose/short duration = 30mg for 5 days
used for intermittent troublesome ulcers
very good at reducing immunological problems quickly but if used for too long will get standard steroid side effects

Question 22

what are the risks of systemic steroids

Answer 22

• adrenal suppression
• cushingoid features
• osteoporosis risk
• peptic ulcer risk
• mood /sleep alteration
• mania/depression risk

Question 23

how can you get adrenal suppression from systemic steroids

Answer 23

steroid dependancy
means you can’t stop them suddenly, need to taper them off

Question 24

how can we minimise osteoporosis risk from systemic steroids

Answer 24

bone prophylaxis
calcium supplements and Bisphosphonates

Question 25

examples of immunosuppressants

Answer 25

hydroxychloroquine azathioprine, mycophenolate

Question 26

examples of immunotherapy medications

Answer 26

adalimumab, intercept

Question 27

what checks need to be carried out on pt prior to starting systemic immunomodulatory treatment

Answer 27

must ensure no pre-existing medical conditions that have not yet been detected blood borne virus screen = Hep B, Hep C, HIV tuberculosis risk FBC electrolyes LFC thiopurine methytransferase (TPMT) = only for azathioprine zoster AB screen EBV chest x-ray cervical smear up to date pregnancy test

Question 28

what medicines are used in oral medicien

Answer 28

antimicrobials topical steroids dry mouth medication mouthwash topical treatments systemic medical treatments

Question 29

what is meant by a licensed medication

Answer 29

a medicine that has been proven in evidence to the MHRA to have efficacy and safety at defined doses in a child and/or adult population when treating specified medical conditions

Question 30

what must you do if a medicine causes an adverse effect that is not recognised as a common side effect

Answer 30

yellow-card scheme

Question 31

what does unlicensed medication mean

Answer 31

medicines that have not had evidence of efficacy submitted for the condition under treatment does not mean medicine has no efficacy it just means there is no evidence of that efficacy from the MHRA will be 'licensed medicines' but for another condition

Question 32

if giving a pt an unlicensed medicine what must you do

Answer 32

gives them a patient information leaflet specific to the condition under treatment (the manufacturers PIL will be for the condition the medication is licensed for)

Question 33

example of antiviral medication used in oral med

Answer 33

acyclovir

Question 34

what is acylovir used for

Answer 34

treat primary herpetic gingivostomatitis treat recurrent herpetic lesions treat shingles = recurrent herpes zoster

Question 35

examples of antifungals

Answer 35

miconazole, fluconazole, nystatin

Question 36

what are antifungals used to treat in oral med

Answer 36

acute pseudomembranous candidiasis acute erythematous candidiasis oral mucosal infectons

Question 37

what are beclomethasone MDI puffer and betamethasone mouthwash used for

Answer 37

treating aphthous ulcers treating lichen planus

Question 38

other than betamethasone mouthwash what other mouthwash can be used for oral med

Answer 38

benzydamine hydrochloride mouthwash

Question 39

what is carbamazepine used for now, and what did it used to be for

Answer 39

trigeminal neuralgia now used to be for epilepsy

Question 40

what is a 'medical device'

Answer 40

something used to treat or alleviate disease, but don't achieve action by pharmacological, metabolic or immunological means

Question 41

examples of dry mouth treatment

Answer 41

salivax pastilles saliva orthana biotene orla balance artificial salive DPF glandosane

Question 42

why are dry mouth treatments referred to as medical devices

Answer 42

they are not providing any pharmacological input, just a lubricant

Question 43

what medicines are used in oral med specialist practice

Answer 43

tricyclic antidepressants gabapentine/pregablin = chronic pain management azathioprine mycophenolate hydroxychloroquine colchicine

Question 44

what must be included on a prescription

Answer 44

pts naem, address, age pt idenitifier = CHI, DOB number of days of treatment drug to be prescribed drug formulation and dosage instructions on quantity to be dispensed instructions to be given to pt signed = identifier of prescriber

Question 45

how long is a prescription valid

Answer 45

6 months from date of issue

Question 46

advantages of written pt instructions

Answer 46

stressed pt may not remember instructions language issues may prevent proper understanding contact number for pt with issues legal protection if post-treatment course questioned drug interactions included