Medicines & Therapeutics

Question 1

What can medicines be classified into based on their sales

Answer 1

• general sales (OTC)
• pharmacy medicines
• prescription only medicines
• controlled drugs
• medical devices

Question 2

What are licenced medicines

Answer 2

• medicines that have 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

Question 3

What is required from a manufacturer so a medicine is licensed

Answer 3

It requires clinical trials, usually at the expense of the manufacturer

Once the drug is licensed, it has to go through post licence surveillance by MHRA and any adverse effects must be reported via the yellow card scheme unless it is a recognized common side effect (this is the duty of every prescriber)

Question 4

What are unlicensed medications

Answer 4

Medicines that have not evidence of efficacy submitted for the condition under treatment

This does not mean it doesn’t have efficacy, but it has not been proven under rigorous clinical trials and presented to MHRA

It will be licensed for another condition

Question 5

What are some of the common medications used in oral medicine

Answer 5

• antiviral
• antifungals
• antibiotics
• topical steroids
• benzdamine mouthwash
• carbamazepine
• dry mouth medication

Question 6

How long are prescriptions valid for

Answer 6

6 months from date

Question 7

What should be written on a prescription

Answer 7

• drug name
• strength of drug
• dose and frequency
• quantity

Question 8

What may CHX mouthwash be prescribed for

Answer 8

where pain limits OH e.g primary herpetic gingivostomatitis
helps with oral mucosal infections
useful where secondary inefction risk is present

Question 9

What is the prescirption for CHX

Answer 9

0.2% chlorhexidine mouthwash
300ml
rinse mouth w/ 10ml 2 times daily

Question 10

What precautions should patients take when using CHX mouthwash

Answer 10

• may be incompatible with some toothpaste ingredients: leave 30 mins between
• if taste is bothersome, dilute 1:1, doesnt effect efficacy
• can increase staining - aim to not eat for a while after rinsing

Question 11

What is benzydamine used for

Answer 11

pain relief - topical anaesthesia

Question 12

What are the preparations for benzydamine

Answer 12

mouthwash
spray

Question 13

What is the prescription for benzydamine moutwash

Answer 13

0.15%
300ml
rinse or gargle using 15ml every 1.5 hours as required

Question 14

What is the prescription for benzydamine spray

Answer 14

0.15%
30ml
4 sprays onto affected area every 1.5 hrs
up to 8 sprays at one time

Question 15

What is the advice for benzydamine

Answer 15

dilute if stingy
dont use mouthwash > 7 days

Question 16

What is the prescription for lidocaine spray

Answer 16

10% lidocaine spray 50ml

Question 17

What is the prescription for lidocaine ointment

Answer 17

15mg lidocaine ointment
5%

Question 18

What are the preparations of lidocaine

Answer 18

spray
ointment

Question 19

What are the 3 possible topical steroid treatment for ulcers

Answer 19

• hydrocortisone mucoadhesive pellet
• betamethasone soluble tablets
• beclometasone pressurised inhaler

Question 20

What is the prescription for hydrocortisone mucoadhesive pellet

Answer 20

2.5mg
20 tablets
1 tablet dissolved next to lesion 4 times daily

Question 21

What is the prescription for betamethasone soluble tablets

Answer 21

500mg
100 tablets
1 tablet dissolved in 10ml water and use as mouthwash 4 times daily

Question 22

What is the prescription for beclomethasone pressurised inhaler

Answer 22

50mg
1 200 dose unit
1-2 puff onto ulcer 2 times daily

Question 23

What age can pressurised inhalers be given

Answer 23

> 12

Question 24

What is important that px do when using beclometasone inhaler

Answer 24

spit it out to avoid systemic effects

Question 25

What is the risk with beclometasone inhaler

Answer 25

oral candida

Question 26

When is steroid mouthwash preferred over inhaler

Answer 26

when widespread lesions present

Question 27

What are systemic disease steroids may a specialist give for ulceration

Answer 27

• prednisolone
• usually 30mg 5 days
• generally shouldnt be used too frequently, no more than once a month

Question 28

What are the risks of systemic steroid

Answer 28

• adrenal suppression
• steroid dependancy
• osteoporosis risk
• peptic ulcer risk
• mood/sleep alteration adn mania/depression risk

Question 29

What are immune suppressants that may be used for systemic treatment (specialist only)

Answer 29

hydroxychloroquine (lichen planus mainly)

Question 30

How should a patient be prepared for systemic immunomodulatory treatments

Answer 30

• want to ensure that immunosuppression will not harm the px

Question 31

What tests will be done prior to systemic immunomodulatory treatment

Answer 31

• BBV screen
• FBC
• electrolytes
• LFT
• TPMT - azathioprine only
• zoster antibody screen
• ebv
• chest xray - TB?
• cervical smear up to date
• pregnancy test

Question 32

What information should px be given about risks of immunomodulatory treatment

Answer 32

short term risk
long term risk
effective contraception used to prevent unplanned pregnancy

Question 33

What is the short term risk of immunomodulatory treatment

Answer 33

acute drug reaction

Question 34

What is the long term risk of immunomodulatory treatment

Answer 34

cancer risk increased
especially azathioprine and skin cancer risk