SDCEP Drug Prescribing Flashcards
common drug interaction that have serious consequences (3)
- interaction of NSAIDs, carbamazepine, azole antifungals, metronidazole and macrolide ABs with warfarin
- incidence of myopathy after prescribing azoles & clarithromycin in those taking statins
- asthma symptoms exacerbated following use of NSAIDs
when not to prescribe ABs for dental abscess
when infection is localised to peri-radicular tissues as this indicates infection is being adequately managed by immune system
in these cases abscess is mostly isolated from circulation resulting in very little antibiotic penetration
aim is to tx using local measures to achieve drainage with removal of cause where possible
when to prescribe ABs for dental abscess
if immediate drainage not achieved using local measures or in cases of spreading infection (swelling, cellulitis, lymph node involvement) or systemic involvement (fever, malaise) which suggest immune system alone is not able to adequately manage the infection
what are local measures for dental abscess tx (2)
- if pus is present in dental abscess drain by XLA of tooth or through root canals
- if pus is present in any soft tissue attempt to drain by incision
AB regime for dental abscess
- amoxicillin 500mg 1 x3 daily for 5 days
- phenoxymethylpenicillin (pen V) 250mg 2 x 4 daily for 5 days
do mot prescribe penicillin to pt with hx of anaphylaxis, urticaria or rash immediately after penicillin administration
if pt allergic to penicillin what do you prescribe for dental abscess
metronidazole 200mg 1 x 3 daily for 5 days
advise to avoid alcohol
do not prescribe to those on warfarin
2nd line antibiotics for dental abscess (3)
- clindamycin
- coamoxiclav
- clarithromycin
when to use 2nd line antibiotics in dental abscess
if pt has not responded to 1st line tx, check diagnosis, refer or speak to specialist before prescribing 2nd line
as the use of these broad spectrum antibiotics can result in c.diff the should be restricted to 2nd line tx of severe infection only
clindamycin regime for abscess
active against gram + cocci inc streptococci & penicillin resistan staphylococci
150mg 1 x 4 daily for 5 days
side effect of antibiotic associated colitis
coamoxiclav regim for dental abscess
active against beta lactamase producing bacteria that are resistant to amoxicillin & can be used to tx severe dental infection with spreading cellulitis or that has not responded to 1st line tx
250/125mg 1 x 3 daily for 5 days
clarithromycin regime for dental abscess
active against beta lactamase producing bacteria
250mg 1 x 2 daily for 7 days
local measures to tx ANUG / pericoronitis
- remove supra and sub gingival deposits along with OHI
- due to pain associated with ANUG pt may only be able to tolerate limited debridement in acute phase
- in case of pericoronitis carry out irrigation & debridement
if drug tx required for ANUG / pericoronitis what is an appropriate regime (2)
- metronidazole 200mg 1 x 3 for 3 days
- amoxicillin 500mg 1 x 3 for 3 days
local measures for tx of sinusitis
advise steam inhalation
when to use drug therapy for ANUG / pericoronitis
systemic involvement
persistent swelling despite local measures
when to use drug therapy for sinusitis
generally self limiting with av duration of 2.5wks
only if persistent symptoms and/or purulent discharge lasting at least 7 days or if symptoms severe
appropriate drug regime for tx of sinusitis
ephedrine nasal drops 0.5% 10ml 1 drop into each nostril up to x3 daily when required
if AB required:
amoxicillin 500mg 1 x 3 daily for 7 days
doxycycline 100mg 2 on day 1 followed by x1 daily for 7 days
what pt groups are predisposed to pseudomembranous candidosis & erythematous candidosis
- on inhaled corticosteroids / cytotoxics / broad spectrum antibacterials
- diabetic pts
- nutritional deficiency
- serious systemic disease associated with reduced immunity i.e. leukaemia & other malignancies & HIV infection
local measures against candidiasis
advice pt with corticosteroid inhaler to rinse mouth with water or brush their teeth immediately after using inhaler
drug regime for candidiasis
- fluconazole 50mg 1 x 1 daily for 7 days - do not prescribe to those on warfarin / statins
- miconazole oromucosal gel 20mg/g - 80g tube apply pea sized amount after food x4 daily for 7 days - do not prescribe to those on warfarin / statins
if the above is contraindicated then prescribe: - nystatin oral suspension 100,000 units/ml 30ml - 1ml after food x4 daily for 7 days (use for 48hrs after lesions have healed)
local measures to tx denture stomatitis
- brush palate daily to tx condition
- clean dentures thoroughly (by soaking in CHX / NaOCl (only for acrylic dentures) for 15mins x 2 daily
- leave denture out for as long as possible during tx period
drug tx of denture stomatitis
same as for candidiasis
angular cheilitis in denture wearing v non denture wearing pts
denture wearing - caused by infection wit candida spp & often associated denture stomatitis
non denture wearing - infection with streptococcus spp or staphylococcus spp
difference in cream & ointment
cream used on wet surfaces while ointments normally used on dry surfaces
drug regime for tx of angular cheilitis
if denture causing the problem - adjust / remake
1. miconazole cream 2% 20g tube apply 2x daily - do not prescribe to those on warfarin / statin - effective against both candida & gram + cocci
2. sodium fusidate ointment 2% 15g tube apply 4x daily
if UNRESPONSIVE CASES:
1. miconazole 2% & hydrocortisone 1% cream 30g tube apply x2 daily
2. miconazole 2% & hydrocortisone 1% ointment 30g tube apply x2 daily
local measures for herpes simplex infections
PHG as a result of HSV best managed by symptomatic relief
avoid dehydration, alter diet to inc soft food, adequate liquid, bed rest, analgesics, antimicrobial MW i.e. CHX / H2O2
why prescribe MW for herpes simplex infections
controls plaque accumulation if toothbrushing is painful & helps to control 2ndary infection in general
what MW to prescribe for herpes simplex infections
- CHX 0.2% 300ml rinse for 1min with 10ml x2 daily until lesions resolved
- H2O2 6% 300ml rinse for 2 mins with 15ml diluted in 1/2 tumbler of warm water x3 daily until lesions resolved
if pt immunocompromised / non compromised & severe infection with herpes simplex infection appropriate drug regime is
aciclovir 200mg 1 x 5 tablets daily for 5 days
tx of herpes labialis (mild infection)
mild infection of lips (cold sores) in non immunocompromised pts is tx with topical antiviral drug:
aciclovir cream 5% 2g apply to lesion ever 4hrs (5x daily) for 5 days
in pt with varicella-zoster infection
i.e. shingles
systemic antiviral agents reduce pain & reduce incidence of post herpetic neuralgia & viral shedding
aciclovir is the drug of choice
drug regime for tx of varicella zoster infection
aciclovir 800mg 1 x5 daily for 7 days
what to prescribe for odontogenic pain & why
paracetamol - useful for dental & post op pain but not anti-inflammatory activity
ibuprofen - NSAID so has anti-inflammatory activity
caution with prescribing NSAIDs
- history of hypersensitivity to NSAID
- causes gastrointestinal irritation so caution in pt with previous / active peptic ulcer disease (can be prescribed with PPI to combat this)
- elderly
- pregnant
- on oral anticoagulants i.e. warfarin
- inherited bleeding disorder
- can impair renal function so caution in those with renal/hepatic/cardiac impairment
drug regime for odontogenic pain
- paracetamol 500mg 2 x4 daily for 5 days
- ibuprofen 400mg 1 x 4 daily for 5 days (preferably after food)
drug regime for odontogenic pain in pt with hx of previous or active peptic ulcer disease
prescribe PPI in conjunction with NSAID:
1. lansoprazole 15mg 1x5 daily for 5 days
2. gastro resistant omeprazole 20mg 1x 5 daily for 5 days
if pt presents with trigeminal neuralgia what is the drug regime
carbamazepine 100mg 1 x 2 daily for 10 days
a positive response to this confirms diagnosis; make referral to specialist / GMP
if pt has TMD - what do you do
local measures first i.e. reassurance, local therapy, soft diet, avoid chewing gum, occlusal splint
analgesics next
then diazepam as a muscle relaxant
diazepam 2mg 1 x 3 daily for 5 days
egs of antimicrobial MW
can reduce 2ndary infection & useful when pain limits other OH measures:
CHX MW 0.2% 300ml rinse for 1min with 10ml x2 daily
H2O2 MW 6% 300ml rinse for 2mins with 15ml diluted in 1/2 glass of warm water x3 daily
if pt with recurrent aphthous stomatitis what can be useful
doxycycline ( a tetracycline MW ) 100mg; 1 tablet to be dissolved in water & rinsed around mouth for 2mind 4x daily for 3 days at onset of ulceration
for major aphthae / ulcers causing severe pain what drug regime
- benzydamine MW 0.15% 300ml rinse 15ml every 1.5hrs as required
- benzydamine oromucosal spray 0.15% 30ml 4 sprays onto affected area every 1.5hrs
- lidocaine ointment 5% 15g rub sparingly on affected area
- lidocaine spray 10% 50ml apply as necessary with a cotton bud
topical steroids used to treat ulceration & inflammation drug regime
- beclomethasone MDI one 200-dose unit 1-2 puffs directed onto ulcers x 2 daily
- betamethasone tablets 500mcg 1 tablet dissolved in 10ml water x 4 daily use as MW
- hydrocortisone oromucosal tablets 2.5mg 1 tablet dissolved next to lesion x4 daily
local measures for xerostomia
frequent sips of cold water
suck pieces of ice or sugar free fruit pastilles
sugar free chewing gum
artificial saliva replacement options
- saliva orthana oral spray - 50ml spray x3 onto oral mucosa as required
- bioxtra gel - 40ml apply as required
- glandosane aerosol spray - 50ml spray onto oral & pharyngeal mucosa as required
- saliva stimulating tablets - 1 tablet as required
- saliveze oral spray - 50ml 1 spray on mucosa as required
2, 3, 5 (only for use in sicca syndrome / associated with radiotherapy)
4 only for impaired salivary gland function & patent salivary ducts
drug regime for fluoride preparations
1.NaF TP 2800ppmF / 0.619%
2. NaF TP 5000ppmF / 1.1%
3. NaF MW 0.05%
