1. Medicines and Therapeutics Flashcards
What are the 5 classifications of medicines?
General OTC
Pharmacy only medicines
Prescription only
Controlled drugs
Medical devices
What are licensed medicines?
These are drugs that have a proven efficacy and safety at a defined dose in children or adults for treating a specific medical condition
How do medicines become licensed?
Usually via clinical trials and the data is provided by manufacturer to prove efficacy of drug at treating medical condition and making diff to pts quality of life or quantity
What is the yellow card scheme?
This is where medicines are licensed under surveillance and any adervse effects must be reported to MHRA unless already common side effect
What is an unlicensed medicine?
Medicine that has no evidence of efficacy proven for condition which is is being used to treat (this doesn’t mean it doesn’t have efficacy just that theres no evidence to MHRA)
What is an off license or off label drug?
This is where a medicine has found to be licensed and has efficacy and safe dose at treating another condition but it is then found to be effective for another condition but the cost for conducting a clinical trial is too high so it can be used for this other condition at clinicians discretion but condition must provide all instructions to pt (PIL)
Why must we inform pt medicine is used off license?
As the normal PIL will be for the licensed use of the medication
When would we not use an off licensed medication?
if theres already a licensed med for that condition
What is acyclovir used to treat?
It is an anti-viral used to treat HERPES SIMPLEX, SHINGLES
If pt has herpes simplex and finds toothbrushing difficult what can we recommend?
CHX mouthwash to control plaque accumulation if too painful to brush effectively and can help control secondary infection - CHX 0.2% 300ml mouthwash 10ml 2x day for 1 min
OR
Hydrogen peroxide mouthwash 6% 300ml, 15ml diluted in tumbler of warm water 3x day
What is the prescription of aciclovir as an anti-viral?
5 day regime
200mg tablets, 25 tabelets, 1 5x day
What can be used to treat herpes labialis?
Aciclovir 5% cream - best used in prodromal stage as this is when ulcer is forming - after it appears on lip then healing process has already began
send 2g, 5% cream use every 4 hours 5x day for 5 days
Why can aciclovir be given for shingles?
To reduce pain and incidence of post herpetic neuralgia
tx is 800mg tablets, 35 tablets 1 tablet 5x day for 7 days
What are some examples of anti-fungal drugs?
Miconazole
Fluconazole
Nystatin
CANT GIVE AZOLES TO PTS ON WARFARIN OR STATINS!!
What group of pts can’t be prescribed -AZOLES?
Warfarin pts
statin pts
What can anti-fungal drugs be used to treat?
Acute pseudomembranous candidiasis
acute erythematous candidiasis
What is thrush also known as?
Acute pseudomembranous candidiasis - can usually be scraped off and is common in pts taking inhaled corticosteroids, diabetics and broad spectrum antibiotic pts and immunocompromised pts
What is the prescription of flucozaole for fungal infection?
Fluconazole capsules 50mg
7 capsules 1 day for 7 days
What Is the prescription of miconazole for fungal infections?
Miconazole oromucosla gel 20mg/g - send 80g tube - apply pea sized four times a day after food
What can we prescribe if pt can’t take -AZOLES?
Nystatin oral suspension - 100,000 units/ml send 30ml and 1ml after food 4x day for 7 days
What term is used for denture stomatitis?
Chronic atrophic candidiasis
What advice do we give for pts with denture stomatitis?
Advise pt to brush palate
proper cleaning of dentures (CHX or sodium hypochlorite for acrylic only)
leave dentures out for as long as possible during tx
What is the tx for denture stomatitis?
fluconazole 50mg, 1 tablet once a day for 7 days
Miconazole gel 20mg/g apply pea sized after food 4x day for 7 days after lesions have healed (can apply gel to denture fitting surface and then refit)
or nystatin - oral suuspension 100,000units/ml, 30ml, 1ml 4x day after food for 7 days - hold for 5 mins then swallow
What is angular chelitis?
Common on oral commissures and is often caused by candida infection - more common in denture wearers die to reduced OVD
What is miconazole effective against? 2
CANDIDA
GRAM POSITIVE COCCI
If pt has angular chelitis with no denture what is the likely cause?
Straph or staph infection and in this case we would use sodium fusidate
What lesions are creams used for?
Cream used for WET
What lesions are ointments used for?
Ointments used for DRY
If pt has wet angular chelitis what would be a good treatment?
Miconazole cream 2% - 20g tube to angles of mouth 2x day
What prescription of sodium fusidate?
Sodium fusidate ointment 2% 15g tube 4x day to angles of mouth
What are some topical steroids we can use in dentistry?
betamethasone mouthwash
beclomethasone metered dose inhaler
What is betamethasone mouthwash used for?
Apthous ulcer
Lichen planus
What is beclomethasone metered dose inhaler used for?
Apthous ulcer
Lichen Planus
What is a betamethasone mouthwash?
This is a corticosteroid tablet that aims to reduce inflammation, swelling and mouth irritation - IT ISNT TO BE SWALLOWED - NEED TO SPIT OUT
What is the prescription of bethamethasone mouthwash?
Bethametasone soluble tablets - 500mcg - send 100 tablets and 1 tablet to be dissolved in 10ml water as mouthwash for 4x day
What is beclomethasone metered dose inhaler?
This is normally used for management of airway disease such as asthma and COPD but instead we can use it off-licence for tx of apthous ulcer or LP
What is important when using beclomethasone metered dose inhaler?
That we explain to pt how its used, give pt leaflet specific to their use
What is the prescprtion for beclmethasone metered dose inhalers?
beclomethasone pressurised inhaler, CFC free, 50mg metered inhalation
one 200-dose unit
1-2 puffs onto ulcers 2x day
What is a medical device?
This is an instrument, apparatus, appliance, implant, software etc that is used to dx, prevent, monitor treat or alleviate a disase or injury and does not achieve its primary aim via pharmacological immunological or metabolic means
its like a prosthetic limb or saliva replacement - no pharmacological input !!
How do we write a prescription 15 marks??
- PTS NAME, ADRESS, AGE
- PTS CHI NUMBER
- NO OF DAYS TX IS INTENDED FOR
- DRUG TO BE PRESCRIBED
- DRUG DOSE, DRUG FORM (TABLET, CREAM ETC), QUANTITY OF DRUG REQUIRED
- HOW LONG TO TAKE DRUG FOR
- PT INSTRUCTIONS ON QUANITTY AND WHEN TO TAKE
- GDC NUMBER AND SIGNATURE AND ADRESS OF PRACTISE
How long are prescriptions valid for?
6 months from date issued
How many items can be put on script?
can include more than one but consider legibility
What can we do if drugs have short shelf span?
Some immunomodulatory mouthwashes have short shelf life so supply needs renewed more free such as monthly - can inform pharmacist to issue prescription monthly for this
Who is responsible for the prescription?
The dentist
What should a written PIL include?
What the medicine is - how it is used, how to use it
unwanted side effects
common normal side effects
contact no if pt feels something is wrong
time to take drug
finish course unless unexpected rxn
keep safe from kids
include drug interactions
