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DENT 319 - Pharmacology > Pharmacological Management of Selected Oral Conditions > Flashcards

Pharmacological Management of Selected Oral Conditions Flashcards

1
Q

7 possible factors contributing to the development of angular cheilitis

A
  • Anatomic (skin folds, loss of vertical dimension)
  • Chronic fungal infection
  • Chronic bacterial infection
  • Mixed infection
  • Contact reaction - toothpaste
  • Nutritional - anemia, vit B12
  • Eczema
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2
Q

Treatment for angular cheilitis if chronic fungal infection is suspected

A

Have pt clean areas with SPECTROGEL h/s

  • Rx. Clotrimazole 1%-Betamethasone dipropionate .05% (LOTRIDERM) cream
  • Disp. 15g. tube
  • Sig: Thin coat BID x 2 weeks
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3
Q

Treatment for angular cheilitis if no response to initial therapy when suspecting fungal infection

A

ADD:

  • Rx Polymyxin B / Bacitracin (POLYSPORIN) ung. 10,000u/500u/g
  • Disp 15 g tube
  • Sig apply to affected areas after meals and bedtime
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4
Q

Treatment for angular cheilitis if bacterial infection is suspected

A
  • Have patient clean areas with SPECTROGEL h/s
  • Fucidin H cream
    • Fusidic acid 2% - hydrocortisone acetate 1%
      • Topical antibiotic - corticosteroid
    • Disp: 30g tube
    • Sig: BID x 2 weeks
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5
Q

Treatment for angular cheilitis if no response to initial therapy when bacterial source is suspected

A

ADD:

  • Rx Polymyxin B/ Bacitracin (POLYSPORIN) ung. 10,000u/500u/g
  • Disp. 15g tube
  • Sig. apply to affected areas after meals and bedtime
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6
Q

Define solar cheilitis

A

Premalignant epithelial changes of the lower lip related to chronic sun damage

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7
Q

Treatment for solar cheilitis

A
  • OMBRELLE LIP BALM
  • Disp. 4.4g stick
  • Sig. Apply 30 min before sun exposure and reapply every 1-2 hrs prn

NOTE: Prevention is key. Better to write prescription even if OTC

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8
Q

Treatment for herpes labialis or recurrent intraoral herpes simplex virus infections

A
  • VALTREX 1000mg
  • Disp: 4 tabs
  • Sig: 2 tabs at earliest symptom and then 2 tabs 12 hr later
  • Therapy should be initiated at earliest symptom of cold sore (i.e. tingling, itching, or burning)
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9
Q

Treatment of recurrent herpes labialis for pts who do not want to take a PO med

A
  • Acyclovir cream 5% (ZOVARIX CREAM)
  • Apply liberally to the affected area 4 to 6 times daily for up to 10 days
  • Therapy should be initiated ASAP following onset
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10
Q

Treatment for recurrent herpes labialis for pts who do not want to take a PO OTC med

A
  • ABREVA (docosanol cream 10%)
  • Disp: 2g tube or 2g pump
  • Applied topically 5x/day and continue until lesion is healed up to max 10 days
  • Begin treatment preferably at prodrome or erythema stage
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11
Q

3 characteristics of primary (acute) herpetic gingivostomatitis

A
  • Pt does not have protective antibodies
  • Fever, malaise, vesicular eruption which ulcerates
  • Negative hx for herpes labialis
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12
Q

Treatment for acute herpetic gingivostomatitis

A
  • VALTREX 1000 mg
  • Disp: 20 tabs
  • Sig: 1 tab BID x 10 days

Most effective within 48 hrs of onset

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13
Q

Treatment of herpes zoster

A
  • FAMVIR (500 mg)
  • Disp: 21 tabs
  • Sig: 1 tab TID x 7 days

Initiate within 72 hrs of onset of rash

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14
Q

Condition to rule out for symptomatic geographic tongue

A

Vitamin B12 deficiency

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15
Q

3 possible treatments for symptomatic geographic tongue

A
  1. Alcohol free pediatric Benadryl elixir
    • Disp: 100 mL bottle
    • Sig: Rinse hold 5 mL in mouth for 2 min then spit out QID prn
  2. Flucinonide Gel 0.05% (LYDERM GEL)
    • Disp: 15g tube
    • Sig: Thin coat BID prn
    • NOTE: No more than 1 week
  3. Dexamethasone (PMS-Dexamethasone) elixir 0.5mg/5mL
    • Disp 100 ml bottle
    • Sig: Rinse/hold 5mL in mouth for 2 min then spit out BID prn
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16
Q

Condition to rule out in symptomatic lichen planus

A

Hepatitis C

17
Q

First line treatments (2) for symptomatic lichen planus

A
  • LYDERM GEL
    • Disp: 15g TUBE
    • Sig: Thin coat BID x 2 weeks then BID prn
  • DEXAMETHASONE ELIXIR 0.5mg/5mL
    • Disp: 100mL bottle
    • Sig: Rinse hold 5mL in mouth for 2 min then spit out BID x 2 weeks then BID prn
18
Q

Second line treatment for symptomatic lichen planus

A
  • Clobetasol cream 0.05% (DERMOVATE)
  • Disp: 15g tube
  • Sig; Thin coat BID prn
19
Q

Third line treatment for symptomatic lichen planus

A
  • Clobetasol in aq. Solution 0.1% with nystatin 100000U/mL
  • Disp: 300 mL
  • Sig: Rinse and hold 5mL in mouth for 2 min then spit out, BID x 2 weeks
20
Q

3 possible treatments for lichen planus with secondary candidiasis

A
  1. LOTRIDERM cream
    • Disp 15g tube
    • Sig: Thin coat BID x 2 weeks, then BID prn
  2. Nystatin Oral Suspension 100000U/mL
    • Disp: 200mL
    • Sig: Rinse hold 5mL in mouth for 2 min then spit out QID x 10 days
  3. Fluconazole 100 mg
    • Disp: 7 tabs
    • Sig: 1 tab daily x 7 days
21
Q

General management of recurrent aphthous ulcers

A
  • Aoid any triggers if possible (foods, trauma)
  • Trial of Sodium Lauryl Sulfate free toothpaste
    • Biotene or Proenamel
22
Q

2 possible treatments for recurrent aphthous minor when few ulcers in accessible areas

A
  • Alcohol free Chlorexidine 0.12% mouth rinse (GUM-PAROEX)
    • Disp: 473mL bottle
    • Sig: Rinse with 10 mL BID x 5 days
  • Flucinonide Gel 0.05% (LYDERM GEL)
    • Disp: 15 g tube
    • Sig: Thin coat QID prn x 5 days
23
Q

Treatment of recurrent aphthous minor when multiple ulcers

A
  • DEXAMETHASONE ELIXIR 0.5mg/5mL
  • Disp: 100 mL bottle
  • Sig: Rinse hold 5 mL in mouth for 2 min then spit out QID x 5 days
24
Q

Treatment for traumatic ulcer

A
  • Triamcinolone acetonide (ORACORT) 0.1%
  • Disp: 7.5 g tube
  • Sig: Apply a thin film after meals and medtime x 7 days

NOTE: Sticky goo containing gelatin, pectin and sodium carbocymethylcellulose in a polytethylene and mineral oil gel base. Only topical steroid formulated for intraoral use

25
Q

Treatment for radiation or chemotherapy associated mucositis

A

Magic Mouth Rinse (over 20 different recipes, which may contain topical anesthetic, weak topical corticosteroid, antifungal and antibacterial agent)

26
Q

4 Magic Mouth Rinses to treat mucositis

A
  1. 2% Viscous xylocaine
    1. Disp: 100 mL bottle
    2. Sig: Rinse with 5-10 mL q4h prn pain
    3. NOTE: 5-10 mL = 100-200 mg lidocaine. No more than 6 doses in 24 hrs
  2. Dr Chauvin’s Magic Mouth rinse
    1. Mix in equal volumes:
      1. 2% Viscous Xylocaine 100mL
      2. Dexamethasone Elixir 0.5mg/5mL 100mL
      3. Nystatin Oral Suspension 100000U/mL 100mL
    2. Disp: 300mL
    3. Sig: Rinse and spit with 5-10mL q4-6hrs prn
  3. Palliative Mouth Rinse
    1. Mix with equal volumes:
      1. Pediatric Benadryl elixir 100mL
      2. Kaopectate 100 mL
    2. Disp: 200 mL
    3. Sig: Rinse with 5-10 mL q4-6 hrs prn
  4. Benzydamine 0.15% Oral rinse (Pharixia)
    1. Solution containing 10% ethanol, benzydamine 0.15%
    2. 100 mL or 250 mL bottles
27
Q

General management of denture stomatitis

A
  • Improve denture hygiene
  • Ask pt not to sleep w/ denture in place
  • Clean denture w/ denture brush and liquid dish soap
  • Consider soft denture reline
28
Q

2 possible treatments for denture stomatitis related to Candida

A
  • Nystatin (NYADERM) cream 100,000u/g
    • Disp: 30 g tube
    • Sig: apply thin coat to inner surface of denture QID x 2 weeks
  • LOTRIDERM Cream (Clotrimazole 1%-Betamethasone dipropionate 0.05% cream)
    • Disp: 15 g tube
    • Sig: Thin coat to inner aspect of denture BID x 2 weeks
29
Q

2 treatments for dry mouth with salivary gland dysfunction

A
  • Pilocarpine (SALAGEN) 5 mg
    • Disp: 90 tabs
    • Sig: one tab TID before meals
  • Prevident Booster Toothpaste 1.1% NaF
    • Disp: 100mL
    • Sig: Use once daily h/s, do not rinse after use
30
Q

Treatment for caries prevention of pts with xerostomia

A
  • Alcohol free Chlorhexidine 0.12% mouth rinse
  • Disp: 473 ml bottle
  • Sig: Rinse with 10-15 mL BID x 1 week
31
Q

How to manage idiopathic burning mouth disorder

A
  • Give suggestions for symptomatic relief of xerostomia if associated
  • Manage dysgeusia (abnormal taste)
    • Zinc 25 mg
    • Disp: 60 tabs
    • Sig: one tab daily x 6 months
32
Q

Treatment for neuropathic pain associated with idiopathic burning mouth disorder

A
  • Pregabalin (LYRICA) 50 mg
  • Disp: 60 tabs
  • Sig: one tab daily x 1 weeks then one tab BID x 1 week, then one tab TID

NOTE: May require up to 300 mg daily to control pain

DENT 319 - Pharmacology (7 decks)

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