Medicines And Therapeutics In Oral Medicine Flashcards
What 3 main types of medication are used on oral med?
Antimicrobials
- antifungal, viral, biotics
Topical steroids
- mouthwash or inhaled
Dry mouth medication
What is a licensed medicine?
Medicine that’s proven in evidence to have efficacy and safety at defined doses when treating specified medical conditions
What is an unlicensed medicine? What must be done when using them?
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
Give two unlicensed topical steroids and their uses
Betamethasone mouthwash
Beclomethasone metered dose inhaler
- treating aphthous ulcers
- treating lichen planus
What is a ‘medical device’? in relevance to dentistry and oral med
Instrument, apparatus, implement etc… used for
- Treatment or alleviation of disease
- replacement to support the anatomy or physiological process
Give an example of a medical device
Dry mouth treatments
- salivix pastilles
- biotene oral balance
- glandosane
What are the main antiviral, antifungal and topical steroids used?
Aciclovir
Nystatin, fluconazole, miconazole
Betamethasone mouthwash, beclamethasone inhaler
What needs to be considered when giving someone a drug?
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
How would you write a prescription?
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
What makes a prescription invalid?
> 6months after date issued
More than 1 item on prescription
More than one repeated dispensing occasion
What advice should be discussed with patients regarding prescription?
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
What are some non steroidal, topical treatments for oral mucosal lesions?
Chlorhexadine
Benzdamine mouthwash or spray
- useful for topical anaesthetic
OTC such as igloo or bonjela
Give some steroid based topical treatments of oral mucosal lesions
Hydrocortisone mucoadhesive pellet
- allow to dissolve over the ulcer
Betamethasone mouthwash
Beclomethasone metered dose inhaler
What is Betamethasone mouthwash?
What is it used to treat?
What instructions should be given?
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
What should be included on the PIL for betamethasone MW?
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
How should a patient use their Beclomethasone MDI? Dose?
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
What should be on the PIL for Beclomethasone MDI?
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!!
What systemic treatment can be given? (Specialist only)
Disease modulators
- colchicine
Steroids
- prednisolone
- intermittent troublesome ulcers
- high dose and short duration for 5 days
What are the risks of systemic steroid use? How may these be mitigated?
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.
What needs done, in prep, before a patient is given systemic immunomodulatory treatments?
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
What immune modulating treatments can be given?
Immune suppressants
- azathiopriine
Immunotherapy
- adalimumab
Risks of systemic immune modulators?
When is risk reduced?
What must inform pt of?
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
Dose of azathioprine, mechanism? Side fx?
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
What is Prednisolone? What is its method of action?
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
