Medicines and Therapeutics in Oral Medicine Flashcards
antimicrobials ‘licenced’ for use in oral diseases
anti-viral
anti-fungal
antibiotics
mouthwash licenced for topical tx of oral med lesions
benzadamine mouthwash
topical steroids used for oral med lesions
not licenced for use
inhaled steroids
steroid mouthwash
systemic ‘medical’ tx licenced for use in oral med lesions
cabamazepine
3 classical classes of medicines used for oral med lesions
anti-microbial
topical steroids
dry mouth medication
and others
classification of medicines
5
General Sales (OTC anywhere)
Pharmacy Medicines (OTC from pharmacists only)
Prescription only Medicines
Controlled Drugs
Medical Devices
licenced medicines definition
medicines and healthcare products regulatory agency
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
Usually clinical trial data provided by the manufacturer
Post licence surveillance via MHRA (yellow card scheme, reporting side effects, duty of prescribers)
unlicenced medicines definition
Medicines that have not had evidence of efficacy submitted for the condition under treatment
* Will be ‘licenced medicines’ – but for another condition
* ‘off-licence’ or ‘off-label’ use is at the discretion of the treating physician - Cost of new clinical trials for the new conditions too much for manufacturer to justify
* Patient must be informed that medicine is being used ‘off-licence’
* Patient must be given PIL specific to the condition under treatment
* Drug manufacturer supplied PIL will be for the licenced condition, Prescriber responsible for explaining risks and giving information to pt and ensuring pt safety for the use
common antiviral used for oral med lesions
aciclovir
aciclovir used to tx
3
primary herpetic gingivostomatitis
recurrent herpetic lesions
shingles (recurrent herpes zoster)
antiviral
3 common antifungals used to tx oral med lesions
miconazole
fluconazole
nystatin
antifungals used to tx what oral med lesions
commonly
acute pseudomembranous candidiasis
acute erythematous candidiasis
2 topical steroids commonly used for oral med lesions
betamethasone mouthwash (soluble tablets)
beclomethasone metered dose inhaler
topical steroids used for oral med lesions are to tx what commonly
2
aphthous ulcers
lichen planus
‘medical device’ definition
means any instrument, apparatus, implement, machine, appliance, implant, reagent for in vitro use, software, material or other similar or related article, intended by the manufacturer to be used, alone or in combination, for human beings, for one or more of the specific medical purpose(s) of:
* diagnosis, prevention, monitoring,** treatment or alleviation of disease,**
* diagnosis, monitoring, treatment, alleviation of or compensation for an injury,
* investigation, replacement, modification, or support of the anatomy or of a** physiological process,**
* supporting or sustaining life,
* control of conception,
* disinfection of medical devices
* providing information by means of in vitro examination of specimens derived from the human body;
and does not achieve its primary intended action by pharmacological, immunological or metabolic means, in or on the human body, but which may be assisted in its intended function by such means.
inc dry mouth tx
examples of medical devices used for ‘dry mouth’ tx
5
Salivix pastilles
Saliva orthana
Biotene Oral Balance
Artificial Saliva DPF
Glandosane
not providing a pharmacological input, only lubricant
For full list of saliva substitutes prescribable by NHS dentists see https://www.sps.nhs.uk/wp-content/uploads/2020/02/UKMI_QA_Saliva-Subsitutes_update_June-2019-1.pdf
6 other medicines that can be used by oral med department
not antimicrobial, topical steroid or dry mouth use
- Tricyclic Antidepressants
- Gabapentin/Pregabalin
- Azathioprine
- Mycophenolate
- Hydroxycholoroquine
- Colchicine
6 considerations when prescribing a drug for oral med lesions
- Clinical indication
- Licenced or unlicensed for this use
- Dose and route of administration
- Important warnings for the patient
- Drug interactions and cautions
- Treatment duration and monitoring
what to include on prescription
- Patient’s name, Address, Age (under 18)
- Patient identifier – DoB, CHI Number
- Number of Days treatment
- Drug to be prescribed
- Drug formulation and Dosage
- Instructions on quantity to be dispensed
- Instructions to be given to the patient
- Signed – identifier of Prescriber
Key Patient information MUST be legible
AVOID abbreviations – write full instructions in INK
Only legal requirement is for dentist to SIGN prescription – this confirms all the other information is correct and has been checked.
Essentially the SAME information for Private – GDC number usually added.
prescription validity
duration
no. items
repetition
Six months from date issued
More than one item on a script
More than one repeated dispensing occasion
advantages of written instructions
4
Stressed patient may not remember instructions
Language issues may prevent proper understanding
* Multilingual options, large print options
Contact number for Patient Issues with the medicine
Legal protection if post-treatment course questioned
additional advice to give pts when prescribing meds
4
- Take drugs at correct time and finish the course
- Unexpected reactions: STOP! and contact prescriber
- Known side-effects should be discussed e.g. Metronidazole and alcohol
- Keep medicines safe: especially from children
