Common medications Flashcards
What are proton pump inhibitors (PPIs)?
Types - Omeprazole, Lansoprazole
What - Decreases acid secretion in stomach
How - Irreversibly blocks gastric proton pump of parietal cells, reducing production of stomach acid
When - for patients with acid reflux, indigestion, peptic ulcer
Warnings - If patient has marked palatal erosion, that doesn’t match with diet or habits consider getting them checked for acid reflux with GP. Long term acid reflux linked to Barrett’s Oesophagus, a pre cancerous condition
What are Statins?
Types - Simvastatin, Atorvastatin
What - Reduces serum cholesterol
How - Competitive inhibition of an enzyme, which results in production of cholesterol. This stops cholesterol forming and decreases the level of low-density lipoprotein cholesterol in blood
When - Statins prescribed to people diagnosed with cardiovascular disease or if likely to develop this in next 10years
Warnings - Avoid using statins with azole antifungals and this leads to increase in skeletal muscle pain, cramps and damage
What are beta2agonists?
Types - Salbutamol
What - Relaxes smooth muscle
How - Act directly on beta2receptos, causing smooth muscle relaxation resulting in bronchodilation and vasodilation. Have rapid onset of action, within 15mins and their effects last up to 4 hours
When - People suffering from asthma, or chronic obstructive pulmonary disease
Warnings - Fluoride varnish contains allergen colophony, avoid application in individuals hospitalised from asthma attack
What are Selective Serotonin reuptake inhibitors?
Types - Citalopram, Fluoxetine
What - Increase serotonin levels
How - Inhibit reuptake of serotonin, increasing serotonin availability in brain. thought to have positive influence on mood, emotion and sleep
When - SSRI’s first line of treatment for people suffering depression. Can also be prescribed for people with obsessive compulsive disorder, post traumatic stress disorder and generalised anxiety disorder
Warning - SSRI’s can cause dry mouth, place focus on comprehensive OHI and fluoride therapy for patients
What are sodium channel blockers?
Types - Phenytoin, Carbamazepine
What - Reduces occurrence of seizures
How - Inhibit influx of sodium ion through cell membranes, slowing rate of depolarisation and reducing cell excitability
When - Primarily treat epilepsy but can be used to treat nerve pain such as trigeminal neuralgia
Warnings - Phenytoin known to cause gingival hyperplasia, can manage this with impeccable OH practice
What are anti-diabetic drugs?
Types - Metformin
What - Decreases blood sugar levels
How - Reduces production of glucose by liver and lowers intestinal absorption of glucose. Improves body’s sensitivity to insulin by increasing peripheral glucose uptake and use
When - Metformin first line treatment for type 2 diabetes
Warnings - Risk of developing periodontitis is two to three times higher in people with diabetes, patients need to understand good glycaemic control
What are thyroid hormones?
Type - Levothyroxine
What - regulates metabolism
How - Is a synthetic form of thyroxine T4, hormone produced by thyroid gland. T4 converted to T3 in body. These hormones help maintain brain function, temperature, metabolism and other bodily functions
When - Patient with underactive thyroid or after thyroid removal
Warnings - Thyroid disease often autoimmune. Be aware of other poss autoimmune diseases like Sjogrens and rheumatoid arthritis
What are oral anticoagulants that are Vitamin K antagonists?
Type - Warfarin, Acenocourmarol, Phenindione
What - Prevent blood clot formation
How - Warfarin targets enzyme, Vitamin K-epoxide reductase. Prevent formation of Vitamin k-dependent clotting factors II, VII, IX and X. Results in slowed production of prothrombin and therefore increased clotting time.
When - anticoagulant therapy recommended when patient at increased risk of TIA’s, strokes, heart attacks, DVTs or pulmonary embolisms
Warnings - If patient needs extraction their INR must be below 4 and checked no more than 72 hours prior to treatment. Keep treatments as atraumatic as poss. Use local measures like haemostatic packing material and sutures
Avoid prescription of meds such as Metronidazole and azole antifungals as they can increase INR and risk of internal bleeding
Advise patient to take paracetamol for pain relief as NSAIDs can increase bleeding risk
What are oral antiplatelets?
Types - Aspirin, Clopidogrel, Dipyridamole, Prasugrel, Ticagrelor
What - Reduces ability of blood clots to form
How - Antiplatelet act on various sites on platelets inhibiting platelet aggression and therefore thrombus formation
When - Given to pt who have previously had Myocardial infarction to help prevent another occurring. May also be prescribed in patients that have had stroke or stent fitted or pt diagnosed with peripheral vascular disease
Warnings - pt on dual antiplatelet (most common aspirin and Clopidogrel) have higher risk of prolonged bleeding compared to on single antiplatelet drug. Treat pt without interruption to their antiplatelet meds. Stopping antiplatelets prior to surgical procedure may increase risk of thrombo-embolic event.
Implement local haemostatic measures. Don’t advise NSAIDs as they increase bleeding risk.
Do not prescribe drugs such as Erythromycin, Clarithromycin, Carbamazepine and Fluconazole to these patients as they may increase bleeding risk.
What are Bisphosphonates and RANK-L Inhibitors?
Types: Alendronic acid, Risedronate, Denusomab.
What: slows down bone loss.
How: reduces osteoclast activity, thereby slowing bone turnover. They also help to preserve bone density and strength.
When: prescribed to patients with osteoporosis or osteopenia.
Warnings: Assess the risk level of medication related osteonecrosis of the jaw (MRONJ) for each patient taking bisphosphonates or RANK-L inhibitors.
Manage patients of lower risk in primary care with straight forward extractions and don’t prescribe antiseptic prophylaxis.
For those patients that are of higher risk, explore all alternative treatment options to extraction and simple extractions in primary care should be that last resort.
What are Azoles antifungals?
Examples: Fluconazole, Miconazole.
Mechanism of action: azoles target ergosterol synthesis. Inhibition of the enzyme, which synthesises ergosterol leads to depletion of ergosterol resulting in the formation of a cell membrane with altered structure and function
Uses: fluconazole is usually the first line of treatment for oral fungal infections, followed by miconazole.
Contraindications: do not prescribe azole antifungals to a patient taking warfarin or statins as this increases their effects.
What are Polyenes antifungals?
Examples: Amphotericin B (systemic), Nystatin (topical).
Mechanism of action: polyenes are a type of broad-spectrum antifungals that work by disrupting the cell membrane of the fungus. They do this by binding to ergosterol, a steroid in the cell membrane, which leads to depolarisation of the membrane and an increase in K+ and Na+ permeability. This ultimately results in cell death.
Uses: Nystatin is commonly prescribed for patients where azole antifungals are contraindicated.
Contraindications: no contraindications listed in the BNF.
What to do when patient has oral fungal infection?
- Attempt to resolve infection with local measures first then prescribe
- Chronic hyperplastic candidosis aka candida leukoplakia is potentially premalignant and should be referred to specialist
What to do if patient has Pseudomembranous Candidosis or Erythematous Candidosis?
Local measures
- If using corticosteroid inhaler advise patient to rinse mouth with water or brush teeth after use.
Prescribing
- Fluconazole capsules
50mg, one daily for seven days.
- Miconazole Oromucosal Gel
80g tube, pea-sized amount, four times daily after food
Continue use for seven days after lesions have healed.
What to do if patient has denture stomatitis?
Local measures
- Clean dentures thoroughly
- Leave dentures out at night
- Check to see if dentures are the cause of the infection
Prescribing
- Nystatin Oral suspension, 100,000 units/ml
30ml, 1ml, four times daily after food
