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Prescription Treatments Flashcards

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1
Q

What is the recommended dosage of Clotrimazole troches for mild candidiasis?

A

10 mg 5 times daily

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2
Q

What alternative treatment for mild candidiasis is preferred if a patient has dry mouth?

A

Nystatin

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3
Q

What is the dosage and frequency for Miconazole mucoadhesive buccal tablet for mild candidiasis?

A

50 mg once daily for 7-14 days

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4
Q

What is the recommended dosage for Nystatin suspension in mild candidiasis?

A

4-6 mL swished for >1 min then swallow 4x daily

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5
Q

True or False: Nystatin suspension is absorbed systemically.

A

False, <5% is absorbed systemically

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6
Q

What is a concern regarding the high sucrose content in Nystatin suspension?

A

Careful of caries

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7
Q

What is the recommended oral fluconazole dosage for moderate to severe candidiasis?

A

100–200 mg daily for 7–14 days

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8
Q

When is fluconazole particularly recommended?

A

When a patient has taken an antibiotic or steroid that caused pseudomembranous candidiasis

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9
Q

Name two medications for which fluconazole may be contraindicated.

A
  • Citalopram
  • Erythromycin
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10
Q

What are some common adverse effects of fluconazole?

A
  • Headache
  • Dizziness
  • Rash
  • Nausea
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Dysgeusia
  • Dyspepsia
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11
Q

What hepatic effects can fluconazole cause?

A
  • Hepatitis
  • Increased serum alkaline phosphatase
  • Increased serum ALT & AST
  • Jaundice
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12
Q

What is the recommended dosage for Itraconazole suspension in fluconazole-refractory disease?

A

200 mg once daily for up to 28 days.

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13
Q

What is the dosage schedule for posaconazole suspension?

A

400 mg twice daily for 3 days then 400 mg once daily, for up to 28 days

Posaconazole is the second option after Itraconazole for Fluconazole-Refractory Disease!

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14
Q

When is chronic suppressive therapy usually unnecessary in treatment of candidiasis?

A

In immunocompetent patients.

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15
Q

What is recommended for HIV-infected patients to reduce recurrent candidiasis infections?

A

Antiretroviral therapy.

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16
Q

What is the recommended dosage of fluconazole for suppressive therapy? (in uncontrolled HIV pts)

A

100 mg 3 times weekly.

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17
Q

What antifungal can be used for denture stomatitis?

A

Nystatin.

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18
Q

Name management strategies for denture stomatitis.

A
  • Diluted Bleach
  • Polident
    *Denture Brush
    *Removing denture at night
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19
Q

Which topical antifungal agents are used for angular cheilitis? What is the non-pharmacological treatment?

A
  • Clotrimazole cream 1%
  • Nystatin-Triamcinolone Acetonide ointment or cream.
  • Denture reline or remake
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20
Q

What is the recommended dispensing amount for Nystatin-Triamcinolone Acetonide and what should the label say?

A

Dispense: 15 g tube
Label: Apply to the angles of mouth after mealtimes and before bedtime.

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21
Q

What is the treatment for primary HSV in immunocompromised patients?

A

Oral acyclovir suspension (Zovirax)
15mg/kg up to adult dose of 200mg
Rinse and swallow 5x/day for 5-7 days

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22
Q

What supportive treatments should be included in primary HSV treatment?

A
  • Fluid
  • Nutrition
  • Rest.
  • Topical Anesthetics (lidocaine gel or benzocaine)
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23
Q

What Rx anesthetic can be used for primary HSV?

A

Viscous Lidocaine 2%.
Disp: 100ml
Label: Rinse with 10ml for 2 minutes then expectorate

*do not give this to kids, careful selection of pt to use this tx

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24
Q

What is another Primary HSV Tx composed of and what is the Rx?

A

Magic Mouthwash
* 1 part Diphenhydramine/Benadryl 12.5 mg/5 mL elixir (reduce inflammation)
* 1 part Lidocaine (pain relief)
* 1 part Magnesium hydroxide/Maalox (mucosal coating agent)

Disp: 4oz bottle
Label: Rinse with 5mL every 2 hours for 30 seconds and spit out

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25
What analgesics are recommended for primary HSV treatment?
* Acetaminophen * Ibuprofen.
26
Who should receive antiviral treatment for primary HSV?
Immunosuppressed or dehydrated patients.
27
What is the regimen for dental induced recurrent HSV-1 suppression?
2-day prophylactic course of valacyclovir.
28
What is the dosage schedule for valacyclovir as a prophylactic treatment for dental induced recurrent HSV?
RX: Valacyclovir 1g tablets Disp: 6 Tablets Label: * 2g (2 tabs) taken 1 hour before dental * 2g (2 tabs) taken the same evening * 1g (1 tab) taken bid (2x a day) the next day.
29
What can reduce the duration of symptoms for recurrent herpes labialis? What type of treatment is this?
Taking an oral antiviral during prodrome. This is Abortive/Eposodic Tx.
30
What is the recommended daily prevention/suppression dosage of valacyclovir?
1g daily.
31
What is the other episodic/abortive treatment for recurrent herpes labialis? What is the Rx?
Famciclovir 500 mg tablets. Disp: 3 tablets Label: Take 3 tablets stat PO.
32
How should famciclovir be taken at the onset of prodrome of Recurrent Herpes Labialis?
Take 3 tablets stat PO.
33
What are some topical treatments for recurrent herpes labialis?
34
What is the purpose of abortive treatment for RAS?
To reduce healing time
35
What type of mouth rinse may reduce the severity and pain of ulcerations in RAS?
Chlorhexidine mouth rinses
36
What is the effect of topical corticosteroids on RAS?
May reduce the number of new ulcers, reduce pain, and increase healing
37
What is the Rx of Triamcinolone acetonide used for RAS?
Triamcinolone Acetonide 0.1% paste in Orabase Disp: 5g tube Label: Apply a thin film over ulcer after meals and bedtime *Do not use for more than 2 weeks
38
What is the Rx of Fluocinonide for RAS treatment?
Fluocinonice 0.05% gel or ointment Disp: 15g tube Label: apply a thin layer over ulcer after meals and at bedtime *do not use for more than 2 weeks
39
What is the Rx of Clobetasol for RAS treatment?
Clobetasol 0.05% ointment Disp: 15g tube Label: apply a thin film over ulcer BID * do not use for more than 2 weeks
40
What is the purpose of RX Prednisone in the treatment of RAS?
For fastest resolution of current episode. Used to consolidate severe outbreaks
41
What is the Rx of Dexamethasone used for RAS? What type of treatment is this?
Dexamethasone 0.5mg/5ml elixir or solution Dispense: 600ml Label: Swish with 5-10ml for 5 minutes up to 4x/day and expectorate. * this is suppressive tx for select pts with close surveillance bc they can develop steroid-related problem with longterm usage.
42
What should be monitored when using Dexamethasone as suppressive treatment?
Close surveillance for steroid-related long term problems
43
What is the first-line treatment for Oral Lichen Planus?
TOPICAL CORTICOSTEROIDS ## Footnote Topical corticosteroids are used to manage symptoms and inflammation associated with Oral Lichen Planus.
44
What is the intermediate potency corticosteroid mentioned for Oral Lichen Planus?
0.5 mg/0.5 mL Dexamethasone Elixir oral solution ## Footnote This solution is indicated for multiple, widespread, or difficult-to-reach lesions.
45
How should Dexamethasone Elixir be administered?
Swish and spit with 5-10 mL for 5 minutes up to 4x a day ## Footnote Patients are advised to expectorate after swishing.
46
What is the indication for ultrapotent corticosteroids in Oral Lichen Planus treatment?
Areas that are refractory to the intermediate potency steroids ## Footnote Ultrapotent corticosteroids are used when the initial treatment is ineffective.
47
Name a specific ultrapotent corticosteroid used for Oral Lichen Planus.
0.5% Clobetasol Propionate or Halobetasol gel or ointment ## Footnote These are used for localized severe lesions.
48
What is the maximum duration for using ultrapotent corticosteroids?
Do not use more than 2 weeks ## Footnote This limitation helps minimize adverse effects.
49
What are the potential adverse effects of long-term use of topical corticosteroids?
Candidiasis and other complications ## Footnote Long-term use can lead to opportunistic infections and other side effects.
50
What is the second-line treatment for Oral Lichen Planus?
Tacrolimus and Cyclosporine (Topical Calcineurin inhibitors) ## Footnote These are considered when corticosteroids are ineffective.
51
What concentration of Tacrolimus ointment is used for Oral Lichen Planus?
0.03 or 0.1% ## Footnote Tacrolimus is an immunosuppressive agent that prevents T-cell activation.
52
What is the Tacrolimus Rx?
Tacrolimus ointment (0.03 or 0.1%) Disp: 30g tube Label: Blot-dry area, rub in a thin film over affected areas 3x/day ## Footnote It should also not be used for more than 2 weeks.
53
What is the systemic treatment option for Oral Lichen Planus?
Prednisone +/- steroid sparing agents ## Footnote Systemic treatment is not recommended for long-term use.
54
Tacrolimus is only for patients who ________.
do not get good response to topical corticosteroids ## Footnote This ensures that it is used in appropriate cases where other treatments have failed.
55
# Managing Xerostomia If no measurable salivary hypofunction with no or few oral signs:
* Normal flow has variability and there may be compositional abnormalities * Perception of dry mouth may have a neurological component * Salivary stimulation (OTC) * Salivary lubrication * Humidification * Hydration/prevent dehydration (ie avoid alcohol, caffeine) * Monitor closely to rule out emerging disease
56
# Managing Xerostomia With low USFR and some oral signs, but responds to stimulation (but may not necessarily return to “normal”):
* Look for possible causes * Restore chewing function * Reduce medication-induced salivary hypofunction * Salivary stimulation OTC, Rx medications, others * Salivary lubrication * Humidification * Hydration/prevent dehydration (ie avoid alcohol, caffeine) * Treat oral consequences
57
# Managing Xerostomia What prescription medications are used?
Pilocarpine and Cevimeline | These are Muscarinic Agonists
58
# Managing Xerostomia What is the typical dosage for Pilocarpine?
5-7.5mg tid & qhs (can go as high as 10mg qid)
59
# Managing Xerostomia What is the typical dosage for Cevimeline?
30mg tid (can go as high as 60mg tid)
60
# Managing Xerostomia What are the contraindications for muscarinic agonists?
* Significant cardiovascular diseases * Significant hepatic diseases * Significant renal diseases * Significant respiratory diseases * Narrow angle glaucoma
61
# Managing Xerostomia What are common adverse effects of muscarinic agonists?
* Sweating * Flushing * Rhinitis * Increased urination * Weakness * Shakes
62
# Managing Xerostomia With low USFR and oral signs, but does NOT respond to stimulation:
If dehydrated: rehydrate or treat underlying condition (eg DM) * Salivary substitutes * Minimizing damage to salivary glands * Prevention and treatment of oral complications * Future directions
63
# Managing Xerostomia What is done in the case of Medication-Induced Salivary Hypofunction?
* Coordinate with prescribing physician * Reduce drugs with strong anticholinergic side effects * Reduce redundant drugs (e.g., multiple drugs for same indications) * Change to less xerogenic medication * Alter dose * Reduce qhs dosages * Alter administration time
64
# Managing Xerostomia What are the prevention strategies and treatments of oral complications related to xerostomia?
* Close surveillance, regular recalls * Optimal oral/denture hygiene * Smooth off rough/sharp teeth/prostheses * Restore dentition * Avoidance of foods/beverages which exacerbate mucosal pain * For Caries -> Fluoride therapy and restore * For Candidiasis -> Institute antifungals (be aware of sugar content in nystatin suspension)
65
# Managing Xerostomia What is the instruction for Prevident 5000+ usage?
Prevident 5000+ Brush BID, do not rinse for 30min

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