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My BDS4 > OM - Therapeutic Medications > Flashcards

OM - Therapeutic Medications Flashcards

1
Q

What are licensed medications?

A

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

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2
Q

Who has responsibility for the safety of licensed medication use?

A

the manufacturer

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3
Q

What are unlicensed medications?

A

Medicines that have not had evidence of efficacy submitted to the MRHA for the condition under treatment
(doesn’t mean that the drug has no efficacy just means that the efficacy has not been proven to MRHA)

  • Unlicenced meds shouldn’t be used if there is a licensed option available – not often the case in mucosal diseases in OM.
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4
Q

Who has responsibility for the safety of unlicensed medication use?

A

The prescriber

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5
Q

What must the prescriber provide alongside an unlicensed medicine?

A

PIL (safety measures and instructions) specifically for its use to treat the unlicensed condition - cannot use the one provided by the manufacturer

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6
Q

What LICENSED medications are used to treat oral medicine conditions? (4)

A
  • Anti-microbials
  • Anti-viral
  • Anti-fungal
  • Antibiotics
  • Benzdamine mouthwash
  • Carbamazepine (trigeminal neuralgia)
  • Dry mouth medication – medical devices
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7
Q

What medications are unlicensed for use in treating oral medicine conditions however are still used?

A
  • Topical Steroids
  • Inhaled steroids
  • Steroid mouthwash
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8
Q

What are antivirals e.g. Acyclovir used to treat in OM? (3)

A
  • primary herpetic gingivostomatitis
  • recurrent herpetic lesions
  • shingles (recurrent herpes zoster)
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9
Q

Name examples of antifungals used in OM. (3)

A

Miconazole, Fluconazole, Nystatin

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10
Q

What are antifungals used to treat in OM? (2)

A

Acute pseudomembranous candidiasis
acute erythematous candidiasis

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11
Q

What are topical steroids used to treat in OM? (2)

A
  • aphthous ulcers
  • Lichen planus
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12
Q

Name examples of topical steroids used in OM. (2)

A

Betamethasone mouthwash (soluble tablets to make a mouthwash)

Beclomethasone Metered Dose Inhaler

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13
Q

What are medical devices? Provide a relevant example to OM.

A

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) 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.

e.g. dry mouth treatments – used to replace saliva (not a pharmacological input but a lubricant impute)

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14
Q

List dry mouth treatments regarded as medical devices (5)

A
  • Salivix pastilles
  • Saliva orthana
  • Biotene Oral Balance
  • Artificial Saliva DPF
  • Glandosane
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15
Q

List more advanced drugs used in OM and examples of what they are used for. (6)

A
  • Tricyclic Antidepressants
  • Gabapentin/Pregabalin (management of chronic pain)
  • Azathioprine (immunosuppression for lichen planus, apthus ulcers etc )
  • Mycophenolate (immunosuppression for lichen planus, apthus ulcers etc)
  • Hydroxycholoroquine (used for lichen planus, apthus ulcers)
  • Colchicine (used for lichen planus, apthus ulcers)
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16
Q

What must be considered before prescribing therapeutic medicines? (6)

A
  • Clinical indication – is it appropriate to use this medication in this setting?
  • Licenced or unlicensed for this use
  • Dose and route of administration
  • Important warnings for the patient
  • Drug interactions and cautions
  • Treatment duration and monitoring
17
Q

What details are required on a prescription? (8)

A
  • 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 (better to provide written instructions)
  • Signed – identifier of Prescriber
18
Q

What are the advantages of written patient instructions for medications? (5)

A
  • If px is stressed, they may not remember instructions
  • Language issues may prevent proper understanding
  • Multilingual options and large print options
  • Contact number can be provided if Patient has Issues with the medicine
  • Legal protection if post-treatment course questioned
19
Q

How long are prescriptions valid?

A

6 months

20
Q

What advice do we give to patients regarding the use of medications? (5)

A
  • Take drugs at correct time
  • 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
21
Q

List non-steroidal topical therapy used in OM. (4)

A
  • Chlorhexidene mouthwash - management of oralmucosal infections/conditions where secondary infection can be a problem.
  • Benzdamine mouthwash or spray
  • OTC remedies such as Igloo, Listerine, Bonjela
  • Anything else the patient finds helpful (Check that it is not harmful though – bleach, aspirin)
22
Q

List steroid topical therapy used in OM. (4)

A
  • Hydrocortisone mucoadhesive pellet
  • Betamethasone mouthwash
  • Beclomethasone Metered Dose Inhaler (MDI/Puffer)
  • CFC-free preparations, e.g. ‘Clenil Modulite’
23
Q

For what conditions are topical steroids used fr in OM?

A

disabling immunologically driven lesions

24
Q

What is the action of the Hydrocortisone mucoadhesive pellets?

A

dissolve over the ulcer and adheres to the ulcer via a gel

25
Q

What are Betamethasone mouthwashes used to treat? (2)

A

Oral mucosal immunological ulceration;
Apthous ulcers - generalised around the mouth
Lichen planus

26
Q

Describe the patient instructions for betnesol tabs (Betamethasone mouthwash) (6)

A
  • use 1mg = 2 tablets in 10mls water = 2 teaspoons water
  • 2 mins rinsing
  • Twice daily
  • Refrain from eating/drinking for 30 min after use
  • DO NOT SWALLOW
  • Do not rinse after use
27
Q

What is the advantage of betamethasone mouthwashes?

A

can alter the concentration and frequency of use

28
Q

What are the risks of exceeding the standard dosages and/or swallowing betamethasone mouthwashes?

A

If swallowed the drug will be absorbed systemically
= standard steroid side effects risk: diabetes, osteoporosis, adrenal suppression, etc

29
Q

When is a beclomethasone MDI used instead of a betamethasone mouthwash?

A

When there are isolated lesions present (use mouthwash for full mouth)

30
Q

Describe the patient instructions for the use of beclomethasone MDI’s. (7)

A

Explain technique used for oral lesions – different from use for lung conditions;
1. Place puffer directly on the mucosa above where the lesion is present
2. Activated twice = powder applied directly to the mucosa, sticks and is absorbed.

  • 50mcg/puff device
  • Position device correctly: exit vent directly over ulcer area
  • 2 puffs
  • 2-4 times daily
  • Don’t rinse after use
31
Q

List the risks of systemic steroid use (5)

A
  • Adrenal suppression – steroid dependency – don’t stop suddenly – taper dose
  • Cushingoid features
  • Osteoporosis risk – bone prophylaxis – Calcium supps and bisphosphonates required.
  • Peptic ulcer risk – Proton Pump Inhibitor prophylaxis
  • Mood/Sleep alteration and mania/depression risk – can be very quick in onset
32
Q

What are the risks of systemic immunomodulation? (3)

A

increased
infection risks
cancer risks (esp Azathioprine and skin cancer) and adverse drug reactions risks

33
Q

What systemic immunomodulator increases the risk of skin cancer?

A

Azathioprine

34
Q

List an example of a systemic disease modulator use to treat mucosal diseases.

A

Colchicine

35
Q

List an example of a systemic steroid use to treat mucosal diseases.

A

prednisolone

36
Q

List examples of systemic immune suppressants use to treat mucosal diseases. (3)

A
  • Hydroxychloroquine – mainly for Lichen Planus
  • Azathioprine
  • Mycophenolate
37
Q

List examples of systemic biologically based immunotherapy use to treat mucosal diseases. (2)

A
  • Adalimumab
  • Enterecept
38
Q

Describe the patient preparations that are required before systemic immunomodulatory treatments. (11)

A

We must ensure that immunosuppression will not harm the patient’s pre-existing medical conditions if they are not yet detected therefore we assess;

  • Blood borne virus: Hep B, Hep C, HIV (these can become more aggressive if px suppressed)
  • FBC
  • Electrolytes
  • Liver Function tests
  • Thiopurine Methyltransferase (TPMT) Only for Azathioprine use
  • Zoster antibody screen
  • EBV

Also assess;
* Chest X-Ray - Evidence of previous/active TB
* Cervical Smear up to date
* Pregnancy test
* If patient will metabolize the drug safely

My BDS4 (57 decks)

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