Drug Prescribing Flashcards
What is the initial management for dental abscesses?
local measures
- if pus present in a dental abscess, drain by extraction of the tooth or through the root canals
- if pus present in any soft tissue, attempt to drain by incision
What is the first-line antibiotics for dental abscess?
Phenoxymethylpenicillin Tablets, 250mg
2 tablets four times daily
for 5 days
Swallowed with water, at least 30 minutes before food.
For severe infections in adults, double the dose.
C/I: penicillin allergy
or
Amoxicillin Capsules, 500mg
1 capsule three time daily
for 5 days
For severe infections in adults, double the dose.
C/I: penicillin allergy
What is the first-line antibiotics for dental abscess for a patient allergic to penicillin?
Metronidazole tablets, 200mg
1 tablet three times daily
for 5 days
For severe infection in adults (and 12-17yo), double the dose.
Avoid drinking alcohol.
C/I: warfarin
What is the use of broad-sprectrum antibiotics associated with?
(bacteria)
Increase in Clostridium difficile
How to manage a patient who has not responded to first-line antibiotic therapy?
- check diagnosis
- refer the patient or consider speaking to a specialist befor prescribing second-line antibiotics
What is a serious adverse effect of especially Clindamycin?
antibiotic-associated colitis
In what cases would you consider second-line antibiotics?
- no response to first-line antibiotics
- severe infection with spreading cellulitis
What is the second-line antibiotics for dental abscess?
Clindamycin Capsules, 150mg
1 capsule four times daily, swallowed with water
for 5 days
C/I: patients with diarrhoea
Advise to discontinue immeidatedly if diarrhoea or colitis develops as clindamycin can cause the side-effect of antibiotic-associated colitis
or
Co-amoxiclav 250/125 Tablets
1 tablet three times daily
for 5 days
Co-amoxiclav: amoxicillinn 250mg (trihydrate) + clavulanic acid 125mg (potassium salt)
C/I: penicillin allergy, hepatic dysfunction, co-amoxiclav-associated or penicillin-associated jaundice
or
Clarithromycine Tablets, 250mg
1 tablet two times daily
for 7 days
C/I: electroylte disturbances (QT interval prolongation), hepatic or renal impairment, pregnant or nursing mothers, warfarin or statins
What is the initial management for Necrotising Ulcerative Gingivitis?
local measures
- supra-gingival and sub-gingival PMPR
- oral hygiene advice
What is the initial management for pericoronitis?
local measures
- irrigation
- debridement
What is the first-line antibiotics for necrotising ulcerative gingivitis and pericoronitis?
Metronidazole Tablets, 400mg
1 tablet three times daily
for 3 days
Avoid alcohol
C/I: warfarin
or
Amoxicillin Capsules, 500mg
1 capsule three times daily
For severe infections in adults, double the dose
C/I: penicillin allergy
What is the initial management for sinusitis?
local measures
self-limiting condition (2.5 weeks), so advise patiennt to use steam inhalation (not for children)
What is the antibiotic treatment when sinusitis is accompanied with purulent discharge lasting at least 7 days or when symptoms are persistent/severe?
Phenoxymethylpenicillin Tablets, 250mg
2 tablets four times daily
for 5 days
For severe infections in adults, double the dose
C/I: penicillin allergy
For penicillin allergy:
Doxycycline Capsules, 100mg
2 capsules on the first day, followed by 1 capsule daily for 7 days
Swallowed with water during meals.
For severe infection in adults, double the dose.
Caution with hepatic impairment or those receiving potentially hepatotoxic drugs.
C/I: pregnant or nursing mothers, warfarin.
Can cause staining (binds to calcium and deposits on growing bone an teeth) and dental hypoplasia.
Can cause nausea, vomiting, diarrhoea, dysphagia, oeseophageal irritation and photosensitivity.
If drug treatment is required for sinusitis, what can be prescribed other than antibiotics?
Ephedrine Nasal Drops, 0.5%
1 drop into each nostril up to three times daily when required
Maximum 7 days
C/I: high blood pressure
What is the initial management for pseudomembranous candidosis and erythematous candidosis?
Advise patients who use a corticosteroid inhaler to rinse their mouth with water or brush their teeth immediately after using the inhaler.
What drug treatment can be provided for Pseudomembranous candidosis, erythematous candidosis and denture stomatitis?
Fluconazole Capsules, 50mg
1 capsule daily
for 7 days
Can be prescribed for 14 days max for oropharyngeal candidosis.
C/I: warfarin, statins
or
Miconazole Oromucosal Gel 20mg/g
Apply a pea-sized amount after food four times daily
Discontinue use for 7 days after lesions have healed.
C/I: warfarin, statins
Patient on warfarin/statins, or fluconazole/miconazole are cotnraindicated:
Nystatin Oral Suspension 100,000 units/ml
1ml after food four times daily
for 7 days
Rinse suspension around mouth and then retain suspension near lesion for 5 minutes before swallowing.
Continue use for 48 hours after lesions have healed.
What is the initial management for denture stomatitis?
CHX mouthwash
Denture hygiene instructions:
* brush palate daily
* clean dentures thoroguhly (by soaking in CHX mouthwash or sodium hypochlorite (acrylic) for 15 mins twice daily)
* leave dentures out as often as possible during treatment period
If dentures are the problem, ensure dentures are adjusted or make new dentures.
What microorganism causes angular cheilitis in denture-wearing patients?
Candida spp.
What microorganism causes angular cheilitis in non denture-wearing patients?
Streptococcus spp.
Staphylococcus spp.
What drug treatment can be prescribed for angular cheilitis that is caused by Candida?
Miconazole Cream, 2%
Apply to angles of mouth twice daily
Continue use for 10 days after lesions have healed.
C/I: Warfarin, statins
If unresponsive:
Miconazole (2%) and Hydrocortisone (1%) Cream
Apple to angles of mouth twice daily
Continue use for a maximum of 7 days
C/I: Warfarin, statins
or
Miconazole (2%) and Hydrocortisone (1%) Ointment
Apply to angles of mouth twice daily
Continue use for a maximum of 7 days
C/I: Warfarin, statins
Creams for wet surfaces whereas ointments for dry surfaces
What drug treatment can be prescribed for angular cheilitis that is caused by Streptococcus spp. or Staphylococcus spp.?
Sodium Fusidate Ointment, 2%
Apple to angles of mouth four times daily
Do not prescribe for longer than 10 days.
or
Miconazole Cream, 2%
Apply to angles of mouth twice daily
Continue use for 10 days after lesions have healed.
C/I: Warfarin, statins
If unresponsive:
Miconazole (2%) and Hydrocortisone (1%) Cream
Apple to angles of mouth twice daily
Continue use for a maximum of 7 days
C/I: Warfarin, statins
or
Miconazole (2%) and Hydrocortisone (1%) Ointment
Apply to angles of mouth twice daily
Continue use for a maximum of 7 days
C/I: Warfarin, statins
What is the initial management of primary herpetic gingivostomatitis (mild inffection/not immunocompromised)?
herples simplex infection
Advise patient to avoid dehydration and alter their diet (to include soft food and adequate fluids) and use analgesics and an antimicrobial mouthwash:
Chlorhexidine Mouthwash 0.2%
Rinse mouth for 1 minute with 10ml twice daily
Spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.
Leave interval of 30 minute between using CHX mouthwash and toothpaste.
or
Hydrogen Peroxide Mouthwash, 6%
Rinse mouth for 2 minutes withh 15ml diluted in half a tumbler of warm water three times daily
Spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.
What is is the drug treatment of primary herpetic gingivostomatitis in immunocompromised patients and severe infections in non-immunicompromised patients?
Aciclovir Tablets, 200mg
1 tablet fives times daily
for 5 days
What can be prescribed to treat herpes labialis?
Aciclovir Cream 5%
Apple to lesion every 4 hours (5 times daily)
for 5 days
Administer at the prodromal stage of a herpes labialis lesion.
Can be applied for up to 10 days, if required.
