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FINALS - Guidance Documents > SDCEP - Drug Prescribing > Flashcards

SDCEP - Drug Prescribing Flashcards

(Excluding emergency drugs)

1
Q

If a patient presents with a suspected dental abscess, what treatment should be done?

Note: There is no sign of systemic involvement or spreading infection.

A

If pus is present in dental abscesses, drain by extraction of the tooth or through the root canals.

If pus is present in any soft tissue, attempt to drain by incision.

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2
Q

If a patient presents with a suspected dental abscess, what treatment should be done?

Note: There is cellulitis and suspected systemic involvement. Drainage has been unsuccessful

A

First line antibioitcs indicated:

Pen-V 250mg (2 taken four times daily)
OR
Amox 500mg (1 taken three times daily)

Both for 5 days.

Amox may be indicated in patients with poor compliance to pen-v regime.

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3
Q

If a patient presents with a suspected dental abscess, what treatment should be done?

Note: Patient has not responded to inital course of amox.

A

Check diagnosis
Consider referal
Speak to specialist before considering second line antibiotics such as:

Clindamycin 150mg (1 taken four times daily)
OR
Co-amoxiclav 250/125 tablets (1 taken three times daily)
OR
Clarithromycin 250mg (1 taken two times daily)

Each a five day course.

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4
Q

What local measures can be taken in a patient with suspected NUG?

A

In the case of necrotising ulcerative gingivitis, carry out scaling and provide oral hygiene advice

After first instance, consider anti-biotics and referal.

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5
Q

What anti-biotics can be prescribed to a patient with suspected NUG?

A

Metronidazole Tablets, 400 mg
Send: 9 tablets
Label: 1 tablet three times daily

OR

Amoxicillin Capsules, 500 mg
Send: 9 capsules
Label: 1 capsule three times daily

Three day courses

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6
Q

What are the contraindications for prescribing metronidazole?

A

Advise patient to avoid alcohol (metronidazole has a disulfiram-like reaction with alcohol).

Do not prescribe metronidazole for patients taking warfarin.

Metronidazole is not licensed for use in children under 1 year.

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7
Q

What are the contraindications for prescribing amoxaclillin?

A

Penicillins can result in hypersensitivity reactions, including rashes and anaphylaxis, and can cause diarrhoea.

Do not prescribe amoxicillin to patients with a history of this immediately after penicillin administration as these individuals are at risk of immediate hypersensitivity.

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8
Q

What local measures can be taken in a patient with sinusitis?

A

Advise the patient to use steam inhalation

Do not recomend boiling water for children

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9
Q

When should anti-biotics be prescribed for sinusitis?

A

Persistant symptoms present
Purulent discharge lasting seven days
Severe symptoms

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10
Q

What anti-biotics can be prescribed for sinusitis?

A

Phenoxymethylpenicillin Tablets, 250 mg
Send: 40 tablets
Label: 2 tablets four times daily

OR

Doxycycline Capsules, 100 mg
Send: 8 capsules
Label: 2 capsules on the first day, followed by 1 capsule daily

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11
Q

What are the contraindications for doxycycline?

A

Do not prescribe to the following patients:
- Herpatic dysunction
- Taking herpatotoxic drugs
- Pregnant women
- Taking warfarin
- Children under 12

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12
Q

What is the guidance when prescribing doxycycline capsules to pregnant women?

A

Do not prescribe for pregnant women, nursing mothers or children under 12 years, as it can deposit on growing bone and teeth (by binding to calcium) and cause staining and, occasionally, dental hypoplasia.

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13
Q

What considerations should be taken when prescribing diazepam to patients?

A

It is highly addictive
Ask for minimal dose possible
Half the dose for elderly/debilitated patients
All patients require escort and should not drive

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14
Q

What is an appropriate regimine for prescribing diazepam to manage anxiety?

A

Diazepam Tablets, 5 mg
Send: 1 tablet
Label: 1 tablet 2 hours before procedure

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15
Q

Why is compliance poor with nystatin?

A

Unpleasant taste

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16
Q

What are the implications of prescribing fluconazole?

A

Systemic drug
A lot of interactions including warfarin and statins.

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17
Q

What are the implications of prescribing fluconazole?

A

Fluconazole can be absorbed when given topically, and has simialr interactons to miconazole.

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18
Q

What type of patients are pre-disposed to candidosis?

A

Patients taking:
- Corticosteroids
- Cytotoxics
- Broad-spectrum antibacterials

Diabetic patients

Patients with nutritional deficiencies

Patients with serious systemic disease associated with reduced immunity

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19
Q

What should you do if a patient with candidosis does not respond to local measures or a course of drug tratment?

A

Refer to a specialist or GP for further investigation.

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20
Q

How should you treat a patient with a fungal infection who is immunocompromised with systemic disease?

A

They are likely to need IV systemic treatment, therefore refer to specialist or GP.

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21
Q

What local measures can be taken for patients with pseudomembranous candidosis or erythematous candidosis, who are taking corticosteroid inhalers?

A

Advise patients to rinse mouth after use of inhaler with water.

Advise to brush teeth immediately after using inhaler.

Consider spacer device.

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21
Q

What notable drug interactions does fluconazole have?

A

Many interactions, including warfarin and statins.

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22
Q

What dosage of fluconazole should be used in patient with candidosis?

A

Fluconazole capsules 50mg
Send 7 capsules
Take 1 capsule daily

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23
Q

What notable interactions does miconazole have?

A

Warfarin and statins, but many others.

Note that even the gel can interact as it is absorbed through topical use.

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24
Q

What prescription of miconazole should be sent for a patient with candidosis?

A

Miconazole Oromucosal Gel*, 20 mg/g

Send: 80 g tube

Label: Apply a pea-sized amount after food four times daily

Advise patient to continue use for 7 days after lesions have healed.

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25
Q

What prescription of nystatin should be sent for a patient with candidosis?

A

Nystatin Oral Suspension, 100,000 units/ml
Send: 30 ml
Label: 1 ml after food four times daily for 7 days

Advise patient to rinse suspension around mouth, then retain near lesion for 5 minutes before swallowing.

Advise patient to continue use for 48 hours after lesions have healed.

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26
Q

What local measures should be taken for a patient with denture stomatitis?

A

Chlorhexidine mouthwash
Denture hygiene
Ensure denture fit / construct new dentures
Anti-fungal agents

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27
Q

Describe what you would tell the patient if instructing them on oral hygiene for denture stomatitis?

A

Brush the palate daily to treat the condition

Clean the dentures thoroughly, soaking them in chlorhexidine mouthwash or sodium hypochlorite for 15 minutes daily (only use hypochlorite for acrylic dentures).

Leave dentures out as often as possible during the treatment period.

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28
Q

What may indicate if angular cheilitis is caused by a fungal or a bacterial infection?

A

If there is a denture with an associated stomatitis, it is more likely to fungal.

If there is no denture, then the infection is more likely to be bacterial.

This is due to the denture acting as a resevoir for fungal microbes.

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29
Q

What type of medication can be prescribed for bacterial OR fungal angular cheilitis?

A

Miconazole Cream, 2%
Send: 20 g tube
Label: Apply to angles of mouth twice daily

Advise to continue for at least 10 days after the lesions have healed.

**IF UNRESPONSIVE: **

Miconazole (2%) and Hydrocortisone (1%) Cream
Send: 30 g tube
Label: Apply to angles of mouth twice daily
Advise patient to continue use for a maximum of 7 days.

Note ointment can prescribed for dry surfaces, cream is used for wet.

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30
Q

What type of medication can be prescribed for bacterial angular cheilitis?

A

Sodium Fusidate Ointment, 2%
Send: 15 g tube
Label: Apply to angles of mouth four times daily

Do not prescribe for longer than 10 days to avoid development of resistance.

31
Q

Outline the main management principles of herpes simplex infections.

A

These infections are best managed by symptomatic relief:

-Nutritious diet, plenty of fluids, bed rest
- Analgesics
- Antimicrobial mouthwashes
- Systemic aciclovir in immunocompromised patients, or patients with severe disease.
- Severe disease in immunocompromised patients should be refered to hospital.

32
Q

What orofacial condition is sometimes associated with herpes simplex infection?

A

Bells palsy

Refere to specialist or GP if this is the case

33
Q

What dosage of chlorhexidine mouthwash should be prescribed to a patient with a herpetic infection?

A

Chlorhexidine Mouthwash, 0.2%
Send: 300 ml
Label: Rinse mouth for 1 minute with
10 ml twice daily

Advise patient to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.

Chlorhexidine gluconate might be incompatible with some ingredients in toothpaste; advise patient to leave an interval of at least 30 minutes between using mouthwash and toothpaste.

Also advise patient that chlorhexidine mouthwash can be diluted 1:1 with water with no loss in efficacy.

34
Q

What dosage of hydrogen peroxide mouthwash should be sent to a patient with a herpetic infection?

A

Hydrogen Peroxide Mouthwash, 6%
Send: 300 ml
Label: Rinse mouth for 2 minutes with 15 ml diluted in half a tumbler of warm water three times daily

Advise patient to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.

Hydrogen peroxide mouthwash can be used as a rinse for up to 3 minutes, if required.

35
Q

What dose of systemic aciclovir could be prescribed to patient with a herpetic infection?

A

Aciclovir Tablets, 200 mg
Send: 25 tablets
Label: 1 tablet five times daily

36
Q

Outline the management of herpes labialis.

A

Common cold sores.

Anti-viral creams for non-immunocompromised patients:
Aciclovir Cream, 5%

Send: 2 g
Label: Apply to lesion every 4 hours (five times daily) for 5 days

NB: Aciclovir cream can be applied for up to 10 days, if required.

There is limited absorption from topical aciclovir preparations.

37
Q

What management should be done in a patient with varicella zoster virus?

A

Singles

Systemic antiviral agents reduce pain, and reduce the incidence of post-herpetic neuralgia and viral shedding - aciclovir is the drug of choice.

Start treatment ideally at diagnosis or within 72 hours of the onset of the rash; even after this point antiviral treatment can reduce the severity of post-herpetic neuralgia.

Refer all patients with herpes zoster to a specialist or their general medical practitioner.

38
Q

What are the main management principles for odontogenic pain?

A

Most can be relieved with NSAIDs (Ibuprofen, aspirin, diclofenac).

Paracetamol can also be used, though has no demonstrated anti-inflamatory activity.

A PPI should also be considered when prescribing NSAIDs in patients with previous history of peptic ulcer disease.

Analgesia is a temporary issue, until the underlying disease can be managed.

If regimines are ineffective, refer to GP.

39
Q

Why is dihydrocodeine not recomended for use against dental pain?

A

Relatively ineffective against dental pain.

Can cause nausea, constipation, and opiate dependancy/abuse.

40
Q

What dosage of paracetamol can be prescribed to a patient to manage pain?

A

Paracetamol Tablets, 500 mg
Send: 40 tablets
Label: 2 tablets four times daily

Advise to take at 4 hourly intervals.

Note that a patient who ingests a therapeutic excess (defined as more than the recommended daily dose [8 x 500 mg tablets for adults] AND more than or equal to 75 mg/kg in any 24 hour period) should be referred for assessment in an emergency department.

Avoid alcohol

41
Q

What are some contraindications for prescribing paracetamol?

A

Previous allergic reaction
Liver or kidney issues
Regularly drinks (<14 units per week)

42
Q

What dosage of ibuprofen should you prescribe to a patient with odontogenic pain?

A

Ibuprofen Tablets, 400 mg
Send: 20 tablets
Label: 1 tablet four times daily, preferably after food

43
Q

When is ibuprofen contraindicated?

A

Patients who have hypersensitivity to aspirin or any other NSAID.

Patients taking low dose daily aspirin.

Patients with peptic ulcer disease unless a PPI is also prescribed.

Use with caution in the following patients:
- Allergic disorders
- Pregnant women
- Nursing mothers
- Taking oral anti-coagulents
- Bleeding disorders
- Renal/herpetic/cardiac impariment

Limit use to 5 days in patients taking anti-hypertensive drugs.

44
Q

What dosage of diclofenac tablets should be prescribed to patients for odontogenic pain?

A

Diclofenac Sodium Tablets, 50 mg
Send: 15 tablets
Label: 1 tablet three times daily

45
Q

What are the contraindications of diclofenac?

A
  • Ischaemic heart disease
  • Cerebrovascular disease
  • Peripheral arterial disease
  • Heart failure
  • Ventricular disfunction
  • Hypersensitivity to any other NSAID
  • Taking daily aspirin
  • Pregnant patients
  • Peptic ulcer disease (unless PPI prescribed)
  • Coagulation medication/issues
  • Not licensed for children
46
Q

What prescription of omeprazole should be prescribed, and when is it indicated?

A

Gastro-resistant Omeprazole Capsules, 20 mg
Send: 5 capsules
Label: 1 capsule once daily

Caution in patients with liver disease, pregnancy, and breastfeeding

Prescribe when giving an NSAID to a patient with previous/current peptic ulcer disease.

47
Q

What prescription of lansoprazole should be prescribed, and when is it indicated?

A

Lansoprazole Capsules, 15 mg
Send: 5 capsules
Label: 1 capsule once daily

NB: Use with caution in patients with liver disease, in pregnancy and in patients who are breast-feeding.

Prescribe when giving an NSAID in patients with previous/current peptic ulcer disease.

48
Q

Outline the management for trigeminal neuralgia.

A

If a patient with trigeminal neuralgia presents in primary care, control quickly by treatment with carbamazepine.

A positive response confirms the diagnosis.

Make an urgent referral to a specialist or the patient’s general medical practitioner for a full blood count and liver function tests.

49
Q

What presription of carbamazapine should be prescribed for suspected trigeminal neuralgia?

A

Carbamazepine Tablets, 100 mg
Send: 20 tablets
Label: 1 tablet twice daily

NB: Advise patient to space out doses as much as possible throughout the day.

Carbamazepine has the potential to react with multiple other medicines; check BNF for interactions.

Carbamazepine can cause reversible blurring of vision, dizziness and unsteadiness (dose-related).

50
Q

Outline the management for TMD in practice.

A

Temporomandibular dysfunction usually responds to reassurance and local therapy.

Advise the patient to have a soft diet and avoid chewing gum.

Consider making an occlusal splint for the patient.

Acute temporomandibular dysfunction might respond to analgesics such as ibuprofen or a short course of diazepam as a muscle relaxant.

If no response, then refer to specialist or GP.

51
Q

How should chronic neuropathic pain be managed in practice?

A

Chronic neuropathic facial pain and oral dysaethesia might require management with neuropathic painkillers; refer to a specialist or the patient’s general medical practitioner.

52
Q

What dosage of diazepam should be prescribed for TMD?

A

Diazepam Tablets, 2 mg
Send: 15 tablets
Label: 1 tablet three times daily

Benzodiazepines are addictive and susceptible to abuse therefore only the minimum number of tablets required should be prescribed.

NB: The dose can be increased if necessary to 15 mg daily.

Halve the adult dose for elderly or debilitated patients.

Advise all patients that they should not drive.

53
Q

Outline the management of ulceration and inflammation.

A

Can occur due to several different conditions, a diagnosis is required as specific therapy is indciated in addition to topical measures.

Temporary relief can be obtained using local measures, mouthwashes, local analgesics, and topical corticosteroids.

If the lesions persist, specialist referal is indicated.

An ulcer that persists for more than three weeks must be refered for biopsy.

54
Q

What local measures can be taken for mucosal ulceration/inflammation?

A

Advise the patient to rinse their mouth with a salt solution prepared by dissolving half a teaspoon of salt in a glass of warm water to relieve pain and swelling.

55
Q

What prescibed mouthwashes can be offered to patients with ulceration/inflamation?

A

Simple:
HSMW (at home)
Sodium chloride mouthwash (prescribed)

Anti-microbial:
Chlorhexidine
Hydrogen peroxide
Doxycycline mouthwash

56
Q

What presciption of sodium chloride mouthwash should be given to a patient with ulceration?

A

Sodium Chloride Mouthwash, Compound
Send: 300 ml
Label: Dilute with an equal volume of warm water

NB: Advise patient to spit out mouthwash after rinsing.

57
Q

What presciption of chlorhexidine mouthwash should be given to a patient with ulceration?

A

Chlorhexidine Mouthwash, 0.2%
Send: 300 ml
Label: Rinse mouth for 1 minute with 10 ml twice daily

NB: Advise patient to spit out mouthwash after rinsing and use until lesions have resolved and patient can carry out good oral hygiene.

Can reduce dose with 1:1 water without loss in efficacy.

May be incompatable with some ingredients of toothpaste, leave 30 mins between brushing.

58
Q

What presciption of hydrogen peroxide mouthwash should be given to a patient with ulceration?

A

Hydrogen Peroxide Mouthwash, 6%
Send: 300 ml
Label: Rinse mouth for 2 minutes with 15 ml diluted in half a glass of warm water three times daily

NB: Advise patient to spit out mouthwash after rinsing, and use until lesions have resolved and patient can carry out good oral hygiene.

Hydrogen peroxide mouthwash can be used as a rinse for up to 3 minutes, if required.

59
Q

What presciption of doxycycline mouthwash should be given to a patient with ulceration?

A

Doxycycline Dispersible Tablets, 100 mg

Send: 48 tablets

Label: 1 tablet to be dissolved in water and rinsed around the mouth for 2 minutes four times daily for three days at the onset of ulceration

NB: Advise patient to spit out mouthwash after rinsing, and warn of staining/dental hypoplasia.

60
Q

What are the contraindications of doxycline mouthwash?

A
  • Herpative impariment
  • Patients on herpatotoxic drugs
  • Pregnant women
  • Nursing mothers
  • Anticogulents (effect can be enhanced)
  • Not licensed for children under 12
61
Q

What local analgesia is available for oral ulceration/inflammation?

A

Benzydamine mouthwash
Benzydamine spray
Lidocaine ointment
Lidocaine spray

62
Q

What prescription of benztdamine mouthwash should be prescribed for oral ulceration?

A

Benzydamine Mouthwash, 0.15%
Send: 300 ml
Label: Rinse or gargle using 15 ml every 1½ hours as required

Advise patient to spit out mouthwash after rinsing

63
Q

What prescriptions of benztdamine oromucosal spray can be prescribed for patients with oral ulceration?

A

Benzydamine Oromucosal Spray, 0.15%
Send: 30 ml
Label: 4 sprays onto affected area every 1½ hours

64
Q

What prescription of lidocaine ointment can be prescribed for oral ulceration.

A

Lidocaine Ointment, 5%
Send: 15 g
Label: Rub sparingly and gently on affected areas

NB: Advise patient to take care with the application to avoid producing anaesthesia of the pharynx before meals as this might lead to choking.

65
Q

What prescription of lidocaine spray can be given to a patient with oral ulceration?

A

Lidocaine Spray, 10%
Send: 50 ml
Label: Apply as necessary with a cotton bud

NB: Advise patient to take care with the application to avoid producing anaesthesia of the pharynx before meals as this might lead to choking.

This is off label usage, as its not licensed for oral ulceration.

66
Q

What considerations are there when prescribing systemic corticosteroids to treat mucosal ulceration?

A

Chronic systemic use may lead to bruising, muscle weakness, weight gain, skin changes, sleep disturbances, cataracts, and pathologic fractures.

Adrenal insufficiency syndrome if on them for more than three weeks.

Impact on the immune system.

67
Q

What prescription of steroid inhaler should be given to a patient with oral ulceration?

A

Beclomethasone 50 micrograms/ metered inhalation

Send: One 200-dose unit

Label: 1-2 puffs directed onto ulcers twice daily

68
Q

What prescription of steroid mouthwash can be given to a patient with oral ulceration?

A

Betamethasone Soluble Tablets‡, 500 micrograms

Send: 100 tablets

Label: 1 tablet dissolved in 10 ml water as a mouthwash four times daily

Advise to put out after mouthwash - off label use.

69
Q

What local measures can be taken for a patient experiencing xerostomia?

A

Advise patient:
- To take frequent sips of cool drinks
- Suck pieces of ice or sugar free pastels
- Chew sugar free gum

70
Q
A
71
Q

Give five examples of salivary replacement.

A

Artificial saliva gel
Artificial salivary spray
Artificial pastilles
BioXtra gel
Glandosane Aerosol Spray

72
Q

What should you consider before prescribing a patient high strength toothpaste?

A

Before prescribing, take into account whether the patient lives in an area where water is fluoridated, whether fluoride varnish has been applied and whether the patient uses fluoride rinses.

73
Q

What medium strength toothpaste could you prescribe for a patient who is high caries risk?

A

Sodium Fluoride Toothpaste, 0.619% (2800 ppm)
Send: 75 ml
Label: Brush teeth for 1 minute after meals using 1 cm, before spitting out, twice daily

Note not suitable for children under 10 years old.

74
Q

What high strength tooth paste can you prescribe for a patient who is high caries risk?

A

Sodium Fluoride Toothpaste, 1.1% (5000 ppm)
Send: 51 g
Label: Brush teeth for 3 minutes after meals using 2 cm, before spitting out, three times daily

Not suitable for children under 16 years old.

75
Q

What prescription of fluoride mouthwash can you provide a high caries risk patient with?

A

Sodium Fluoride Mouthwash, 0.05%
Send: 250 ml
Label: Rinse mouth once daily with 10 ml for 1 minute and spit out (preferably at a different time from brushing)

FINALS - Guidance Documents (2 decks)

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