Medicines and Therapeutics in Oral Medicine Flashcards
What are the main medicines used in Oral Med?
- Anti-microbial
- Topical steroids
- Dry mouth medications
- Others like immunosuppresive
What types of Antimicrobials can be used in the Oral medicine?
- Anti-viral
- Anti-fungal
- Antibiotics
What Topical steroids can be used in Oral med?
- Inhaled steroids
- Steroid mouthwash
What other medicines can be used in oral med, not antimicrobials or Topical steroids?
- Benzdamine mouthwash
- Carbamazepine
What are the 5 classifications of Medicines?
- General sales
- Pharmacy medicines
- Controlled drugs
- Medical devices
What is meant by medical devices in oral med?
- i.e. saliva substitute
- Not technically a medicine but used to aid txt
What is the definition of Licenced Medicines?
- A medicine that has been proven in evidence to MHRA to have efficacy and safety at defined doses in a child and/or adult population when treating specified medical conditions
- Clinical trial data provided by the manufacturer
- Post licence surveillance via MHRA is also done to ensure truth in the data
What are some conditions that Unlicensed Medicines have to meet before pt can take them?
- ‘Off licence’ or ‘off-label’ use is at discretion of treating physician
- Pt must be informed it is off-licence
- Pt must be given PIL (patient information leaflet) specific to condition under txt
What is the Antiviral Aciclovir used to treat?
- Primary herpetic gingivostomatitis
- Recurrent herpetic lesions
- Shingles (recurrent herpes zoster)
What are the Antifungals Miconazole, Fluconazole and Nystatin used to treat?
- Acute pseudomembranous candidiasis
- Acute erythematous candidiasis
What are some Unlicensed topical steroids and what are they used for?
- Betamethasone mouthwash
- Beclomethasone metered dose inhaler
- Both used to treat aphthous ulcers and Lichen planus
What should be on the specific Inhaled steroid PIL for metered dose inhaler (MDI) when used for oral ulcers?
- What the condition is
- What are the causes
- Is it hereditary
- Symptoms
- What does it look like
- How is it diagnosed
- Can it be cured
- Is it life threatening
- How can be treated
- How do i use the inhlaer
- How often and what tiime of day
- Can i eat or drink after it
- Potential risks and side effects
What are some medical devices that can be used to txt ‘Dry mouth’?
- Salivix pastilles
- Saliva orthana
- Biotene oral balance
- Artificial saliva DPF
- Glandosane
What are some medicines that can be prescribed by an Oral Medicine Specialist in a practice, not a primary care dentist?
- Tricyclic antidepressants to reduce pain transmission for orofacial pain
- Gabapentin/Pregabalin for neuropathic pain
- Azathioprine *
- Mycophenolate *
- Hydroxychloroquine *
- Colchicine - *used to treat inflammatory mucosal conditions where other simple txt have failed
What information is required when filling out pt Prescription?
- Pt name, address, Age if under 18
- Pt identifier - DoB or CHI no.
- Number of days of txt
- Drug to be prescribed
- Drug formulation and dosage
- Instructions on quantity to be dispensed
- Instructions to be given to pt
- Signed - identifier of prescriber
How long is a prescription validity?
- Six months from date issued
- Useful if more than one item on script
- Useful if more than one repeated dispensing occasion e.g. recurrent herpetic lesions
What are the requirements when writing prescriptions?
- Must be legible
- AVOID abbreviations - write full instructions in INK
- Only legal requirement is for dentist to sign the prescription - confirms all info is correct
What are some advantages for written instructions for the pt?
- Stressed pt may not remember instructions
- Language issues may prevent proper understanding (multilingual options available, large print options)
- Contact numbers for pt issues
- Legal protection if post-txt course questioned
What are some advice for pt when prescribing meds?
- Take drugs at correct time and finish course
- Unexpected reactions - stop and contact prescriber
- Known side-effects should be discussed e.g. metronidazole and alcohol
- Keep medicines stored safely, esp from children
What are some non-steroidal topical txt of Oral Mucosal Lesions?
- Chlorhexidine mouthwash (dilute 50% with water if needed)
- Benzdamine mouthwash or spray (useful topical anaesthetic/pain relief)
- OTC remedies such as Igloo, Listerine, Bonjela
What are some Steroid based topical txt or oral mucosal lesions?
- Hydrocortusone mucoadhesive pellet
- Betamethasone mouthwash
- Beclomethasone Metered Dose inhaler (MDI/puffer)
- CFC-free preparations e.g. Clenil modulite
What is the Tailored info leaflet for Betamethasone mouthwash for treating mouth ulcers (unlicensed)?
- Use Betnesol tabs 0.5mg
- 1mg 2 tablets
- 10mls water (2 teaspoons)
- 2 mins rinsing
- twice daily
- Refrain from eating/drinking for 30 min after use
- Do not swallow (avoids systemic steroid effects like diabetes, osteoporosis, adrenal suppression)
- Do not rinse after use
What is the tailored PIL for Beclomethasone MDI?
- This is an accepted and proven effective txt for oral condition
- Licensed for other medical conditions like asthma and COPD
- Dental prescribing 50cmg/puff device
- Position device correctly - exit vent directly over ulcer area
- 2 puffs
- 2-4 times daily
- Dont rinse after use or effect will be lost
- Must be a pressurised device not a breath activated device
- Small oral candida risk
