OM- Therapeutic medications Flashcards
What are licensed medications?
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
Who has responsibility for the safety of licensed medication use?
the manufacturer
What are unlicensed medications?
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.
Who has responsibility for the safety of unlicensed medication use?
The prescriber
What must the prescriber provide alongside an unlicensed medicine?
PIL (safety measures and instructions) specifically for its use to treat the unlicensed condition - cannot use the one provided by the manufacturer
What LICENSED medications are used to treat oral medicine conditions? (4)
acylovir (anti-viral)
Nystatin/miconazole/fluconazole (anti-fungal)
Antibiotics
Benzdamine mouthwash
Carbamazepine.
What medications are unlicensed for use in treating oral medicine conditions however are still used?
- Topical Steroids
- Inhaled steroids
- Steroid mouthwash
What are antivirals e.g. Acyclovir used to treat in OM? (3)
- primary herpetic gingivostomatitis
- recurrent herpetic lesions
- shingles (recurrent herpes zoster)
Name examples of antifungals used in OM. (3)
Miconazole, Fluconazole, Nystatin
What are antifungals used to treat in OM? (2)
Acute pseudomembranous candidiasis
acute erythematous candidiasis
What are topical steroids used to treat in OM? (2)
- aphthous ulcers
- Lichen planus
Name examples of topical steroids used in OM. (2)
Betamethasone mouthwash (soluble tablets to make a mouthwash)
Beclomethasone Metered Dose Inhaler
What are medical devices? Provide a relevant example to OM.
Anything used to treat a disease without pharmacological/ metabolic means e.g. dry mouth treatment- not pharmalogical but a lubricant.
List dry mouth treatments regarded as medical devices (5)
- Salivix pastilles
- Saliva orthana
- Biotene Oral Balance
- Artificial Saliva DPF
- Glandosane
List more advanced drugs used in OM and examples of what they are used for. (6)
- 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)
What must be considered before prescribing therapeutic medicines? (6)
- 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
What details are required on a prescription? (8)
- 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
What are the advantages of written patient instructions for medications? (5)
- 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
How long are prescriptions valid?
6 months
What advice do we give to patients regarding the use of medications? (5)
- 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
List non-steroidal topical therapy used in OM. (4)
- 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)
List steroid topical therapy used in OM. (4)
- Hydrocortisone mucoadhesive pellet
- Betamethasone mouthwash
- Beclomethasone Metered Dose Inhaler (MDI/Puffer)
- CFC-free preparations, e.g. ‘Clenil Modulite’
For what conditions are topical steroids used fr in OM?
disabling immunologically driven lesions
What is the action of the Hydrocortisone mucoadhesive pellets?
dissolve over the ulcer and adheres to the ulcer via a gel