Medicines And Therapeutics In Oral Medicine Flashcards

1
Q

What 3 main types of medication are used on oral med?

A

Antimicrobials
- antifungal, viral, biotics

Topical steroids
- mouthwash or inhaled

Dry mouth medication

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2
Q

What is a licensed medicine?

A

Medicine that’s proven in evidence to have efficacy and safety at defined doses when treating specified medical conditions

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3
Q

What is an unlicensed medicine? What must be done when using them?

A

Medicine not had evidence of efficacy submitted for the condition being treated

Typically a licensed medicine but for another condition

Patient must be informed its off license and given PIL

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4
Q

Give two unlicensed topical steroids and their uses

A

Betamethasone mouthwash

Beclomethasone metered dose inhaler

  • treating aphthous ulcers
  • treating lichen planus
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5
Q

What is a ‘medical device’? in relevance to dentistry and oral med

A

Instrument, apparatus, implement etc… used for

  • Treatment or alleviation of disease
  • replacement to support the anatomy or physiological process
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6
Q

Give an example of a medical device

A

Dry mouth treatments

  • salivix pastilles
  • biotene oral balance
  • glandosane
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7
Q

What are the main antiviral, antifungal and topical steroids used?

A

Aciclovir

Nystatin, fluconazole, miconazole

Betamethasone mouthwash, beclamethasone inhaler

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8
Q

What needs to be considered when giving someone a drug?

A

Clinical use

Licensed or unlicensed for use

Dose and route of admin

Important warnings that must be given

Interactions and cautions with drug

Treatment duration and monitoring

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9
Q

How would you write a prescription?

A

Pt name, address and age
Patient identifier
Number of days of treatment
Drug to be prescribed
Dose of drug and its formulation
Instructions on quantity to be dispensed
Instructions for patient
Signed

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10
Q

What makes a prescription invalid?

A

> 6months after date issued

More than 1 item on prescription

More than one repeated dispensing occasion

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11
Q

What advice should be discussed with patients regarding prescription?

A

Take drugs correct time and finish course

Stop immediately if any unexpected reactions

Discuss known side FX e.g. metronidazole and alcohol

Keep medicines safe, especially from children

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12
Q

What are some non steroidal, topical treatments for oral mucosal lesions?

A

Chlorhexadine

Benzdamine mouthwash or spray
- useful for topical anaesthetic

OTC such as igloo or bonjela

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13
Q

Give some steroid based topical treatments of oral mucosal lesions

A

Hydrocortisone mucoadhesive pellet
- allow to dissolve over the ulcer

Betamethasone mouthwash

Beclomethasone metered dose inhaler

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14
Q

What is Betamethasone mouthwash?
What is it used to treat?
What instructions should be given?

A

Used to treat aphthous ulceration and recurrent ulceration

Is a topical steroid

Unlicensed product

2 tablets with 2 teaspoons of water(10ml), rinse 2 mins, twice daily

Refrain from eating and drinking within 30 mins after

Do not swallow and do not rinse after use

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15
Q

What should be included on the PIL for betamethasone MW?

A

Licensed for other medical conditions

Dose range and frequency of dose

Safe to use as directed without standard steroid risk such as diabetes, osteoporosis etc

Small oral candida risk

Special instructions
- Must spit out to avoid systemic steroid side fx risk

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16
Q

How should a patient use their Beclomethasone MDI? Dose?

A

50 mcg/puff

Position device with vent directly over lesion
2 puffs, 2-4 times daily
Don’t rinse after use

Must be a pressurised device, not breath activated

17
Q

What should be on the PIL for Beclomethasone MDI?

A

Accepted and proven treatment

Licensed for other medical conditions such as COPD and asthma

Discard manufacturer PIL

Dose and frequency of use, along with technique for oral lesions

Known side fx - small oral candida risk

Special instructions
- do not rinse after!!

18
Q

What systemic treatment can be given? (Specialist only)

A

Disease modulators
- colchicine

Steroids
- prednisolone
- intermittent troublesome ulcers
- high dose and short duration for 5 days

19
Q

What are the risks of systemic steroid use? How may these be mitigated?

A

Prolonged courses of steroids, or repeated short courses over many months

  • adrenal suppression and steroid dependancy. Don’t suddenly stop steroids, taper the dose.
  • osteoporosis risk. Calcium supplements and bisphosphonates should be given.
  • peptic ulcer risk. PPIs should be given as prophylaxis
  • mood / sleep alteration and also depression risk.
20
Q

What needs done, in prep, before a patient is given systemic immunomodulatory treatments?

A

BBV screen

FBC

Electrolyte count

Liver function tests

TPMT test

Zoster antibody screen - activate shingles

EBV

Chest x ray to check for evidence of active or previous TB - reactivate TB

Cervical smear

Pregnancy test

21
Q

What immune modulating treatments can be given?

A

Immune suppressants
- azathiopriine

Immunotherapy
- adalimumab

22
Q

Risks of systemic immune modulators?

When is risk reduced?

What must inform pt of?

A

Risk of infection

Risk of cancer development

Risk of adverse drug reactions

Pt must be well informed and contraception given to women who have capability for pregnancy

23
Q

Dose of azathioprine, mechanism? Side fx?

A

1-3mg per kg per day

Mechanism includes
- inhibits DNA replication in immune cells
- impede function of immune cells
- reduces production of inflammatory cells such as cytokines

Side fx
- GIT issues such as nausea or vomiting
- increased risk of cancers and infection
- anaemia / thrombocytopenia

24
Q

What is Prednisolone? What is its method of action?

A

Glucocorticoid that has anti-inflammatory and immunosuppressive effects

These glucocorticoids bind to glucocorticoid receptor - mediating gene expression within the cell and inhibiting pro inflammatory signals, and up regulating anti-inflammatory signals

25
Q

Side fx of Prednisolone?

A

Weight gain due to alteration in glucose tolerance - leading to raised appetite

Adrenal suppression

Cushing’s syndrome

Osteoporosis

Sleep disorder

Anxiety