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Oral Path > Smoking Cessations & medications Kerr! > Flashcards

Smoking Cessations & medications Kerr! Flashcards

1
Q

For Smoking Cessations

List the Nicotinic Drugs

(memorize Generic Names)

A

Nicotine Patch Generic Name

-Nicodern CQ/Habitrol

Nicotine Gum Generic Name

-Nicorette

Nicotine lozenge

  • Commit

Nicotine Inhaler

-Nicotrol lnholer

Nicotine Nasal Spray

  • Nicotrol NS

Combination NRT therapy is : NICTOINE Patch + Nictoine (gum,, or spray, or lozenge)

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2
Q

For Smoking Cessations

List Non-Nicotinic Drugs

(memorize the generic names)

A
  • Buprorpion Sustained release (Buprorpion SR)

Can be used
w/NRT

Start 1-2 weeks
before quit date.

  • Varenicline

Tartrate

Start 1 week
before quit date

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3
Q

give simple prescription for FDA approved

nicotone drug

(easier to memorize 1 for the exam)

A

Nicotine Nasal Spray

Max dosage: 40 spray for a day

Duration: 6 months, tapers 6 week

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4
Q

give simple prescription for FDA approved

Non-nicotone drug

(easier to memorize 1 for the exam)

A

Varencline (tablet)

First 3 days: 0.5 mg a day (QD)

Next 4 days: 0.5 mg twice a day (TID)

after 7 days: 1 mg a day twice a day (TID)

Duration: No tapering needed, can take up to 6 months

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5
Q

What are the adverse effects of Nicotine Inhaler?

A
  • Mouth and throat irritation
  • Cough

• Side effem generally caused by
inappropriate use

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6
Q

What are the adverse effects of Nicotine Nasal
Spray?

A
  • Nasal irrttation
  • Sneezing
  • Cough
  • Teary eyes
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7
Q

What are the adverse effects of Nicotine Patch?

A
  • local skin irritation
  • insomonia
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8
Q

What are the adverse effects of Nicotine Gum?

A
  • hiccups
  • Dyspepsia
  • mouth sorness
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9
Q

What are the adverse effects of Nicotine lozenge?

A
  • Dyspepsia
  • local irrttation mouth & throat
  • Rarely causes coughing & hiccups
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10
Q

What are the adverse effects of Sustained release
bupropion (Zyban or Wellbutrin)?

A
  • Insomnia
  • Dry mouth
  • Anxiety
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11
Q

What are the adverse effects of Varencline
tartrate Chontix ?

A
  • Nausea
  • Insomnia
  • Abnormal dreams
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12
Q

Nicotine inhaler

Precautions/Contraindications

A

Reactive Airway Disease

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13
Q

Nictotine Nasal Spray

Precautions

A

Reactive Ariway diseases

Not recomended for pts with Chronic Nasal diseases ( nasal polyps & sinusitis)

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14
Q

Sustained Release Bupropion

Contraindications

A
  • Seizure disorders
  • Current use of bullrin or MAO inhibitor
  • Eating disorder (bulimia, anorexia)
  • Alcohol
  • Head trauma

Moniter Blood presssure

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15
Q

Varenicline Tartlrate

Precaustions

A
  • women breasfeeding should avoid
  • pt with kidney problems -adjust dose
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16
Q

Nictoine Patch

Precutions

A
  • Caution with 6 months of MI
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17
Q

Nictotine Gum

Precuations

A
  • poor dentition
  • maybe inappropriate for use for pts with compelete or partial denture (hard for them to chew)
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18
Q

Nictotine Lozenge

Precautions

A
  • Xerostomia
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19
Q

TREATING TOBACCO DEPENDENCE:
A 2-PART PROBLEM

20
Q

Why is it so hard to quit: Nicotine addiction?

21
Q

What are the symptoms of Nicotine Withdrawal?

A

■Irritability/frustration/anger

■Anxiety

■Difficulty concentrating

■Restlessness/impatience

■Depressed mood/depression

■Insomnia

■Impaired performance

■Increased appetite/weight gain

■Cravings

22
Q

WHAT WORKS (5A’s)

A
  • Ask about tobacco use and secondhand smoke exposure
  • Advise to quit
  • Assess interest in quitting
  • Assist in quit attempt (referral and or pharmacotherapy)
  • Arrange for a follow-up
23
Q

Is Treating Tobacco is within the
Scope of Practice of dentists?

A

Yes

•New York State Education Department has deemed that treating tobacco use is part of the scope of practice for dentistry, this includes prescribing smoking cessation products.

24
Q

Nicotine replacement therapy (NRT)

&

FDA labeling

Is it Safe?

A
  • NO safety concerns association with using more than one NRT
  • NO significant safety concerns association with using NRT at the same time as a cigarettes
  • Use for longer than 12 weeks is safe
25
Q

Assist-Prescribe FDA-Approved Medications

26
Q

First Line Pharmacotherapy

in combatting smoking?

A
  • Combination long- and-short acting Nicotine Replacement Therapy (NRT) (e.g., patch and gum, patch and inhaler)
  • Varenicline alone
  • Bupropion SR with NRT (long- or short-acting)
27
Q

•What is NRT at the POC?

•Rationale for NRT at the POC

•Who will hand the patient NRT?

•What kind of NRT will be on stock?

•How to distribute NRT at POC?

A

•What is NRT at the POC?

–Distribution of a free starter pack of NRT to all smokers by clinic staff during the clinic visit

•Rationale for NRT at the POC

–NRT doubles the success rate of patients’ quit attempts

–Inconvenience of purchasing RNT or filling a prescription creates barriers

–The clinic is an opportune time to intervene

•Who will hand the patient NRT?

–Dental Students

•What kind of NRT will be on stock?

•Nicotine Patch, Gum, and Lozenge

•How to distribute NRT at POC?

–Take faculty-approved NRT request form to dispensary, where NRT is stored.

28
Q

What is the The most effective treatment for
smoking cessation

A

a combination
of pharmacotherapy and counseling

29
Q

PRIMARY HERPETIC GINGIOSTOMATITIS

medication

A
  • OTC Magic Mouthwash
  • OTC Analgesic Acetaminophen or Ibuprofen
  • Rx Topical Anesthetic: Viscous 2% Lidocaine Solution
  • Rx Antivirals: Acyclovir suspension
30
Q

RECURRENT HERPES LABIALIS [PRODROME PHASE] – TOPICAL

A
  • OTC Docosanol Cream
  • Rx Acyclovir cream 5%
  • Rx Penciclovir cream 1%
  • Rx Acyclovir 5%/Hydrocortisone 1% cream
  • Rx Acyclovir Buccal Tablets
31
Q

RECURRENT HERPES LABIALIS [PRODROME PHASE] – SYSTEMIC

A

Rx Valacyclovir 1g tablets,

Rx Famiciclovir 500mg tablets

32
Q

RECURRENT HERPES LABIALIS [VESICLE/CRUSTED PHASE]

A

Nothing you can do! Antivirals do not help at this stage

Helpful agents: Ice, Dessicants, L-lysine

33
Q

RECURRENT INTRAORAL HERPES

A

Rx Topical Anesthetic: Viscous 2% Lidocaine Solution

34
Q

MILD CANDIDIASIS

A
  • Clotrimazole Troches
  • Miconazole mucoadhesive buccal 50mg tablet to mucosal surface over Canine Fossa
  • Nystatin suspension [100,000 u/mL] 4-6mL swish for >1 minute then swallowed, 4x/day - High sucrose content  Caries risk
35
Q

MODERATE-SEVERE CANDIDIASIS

A
  • Fluconazole 100-200mg 1x/day for 7-14 days
  • Itraconazole suspension 200mg 1x/day
  • Posaconazole suspension
36
Q

DENTURE STOMATITIS

A
  • Nystatin on intaglio surface of denture when pt wears it
  • Remove & clean denture at night
    • Bleach 1:10
    • Polident
    • Microwave
  • Reline denture/refit it
37
Q

ANGULAR CHEILITIS

A
  • Rx Clotrimazole cream 1%
  • Rx Nystatin-Triamcinolone Acetonide Ointment/Cream, 15g tube, Apply to angles of mouth after meals & before bedtime
  • Denture adjustment, reline, remake
38
Q

CANDIDIASIS –IMMUNOCOMPROMISED, RECURRENT INFECTION

CHRONIC SUPPRESSIVE THERAPY

A

Fluconazole 100mg 3x/week

Clotrimazole 10mg troches 1 week/1 month

39
Q

RECURRENT APHTHOUS STOMATITIS –ABORTIVE THERAPY: TOPICAL CORTICOSTEROIDS

DO NOT USE MORE THAN 2+ WEEKS

A

Clobetasol Ointment 0.05% (ultra potent)

Fluocinonide Gel/Ointment 0.05% (potent)

Triamcinolone Acetonide in Orabase 0.1% (intermediate)

40
Q

RECURRENT APHTHOUS STOMATITIS – ABORTIVE/SUPPRESSIVE THERAPY: CORTICOSTEROID RINSE

A
  • Dexamethasone Elixir [EtOH base]
    • 0.5mg/5mL, 600 mL, Swish and spit with 5-10mL for 5 minutes (up to)4x/day
  • Dexamethasone Solution [H2O base]
    • 0.5mg/5mL, Swish and spit with 5-10mL for 5 minutes (up to) 4x/day
41
Q

RECURRENT APHTHOUS STOMATITIS – SYSTEMIC CORTICOSTEROIDS [NOTE: SHORT-TERM USE ONLY TO GAIN CONTROL OF SEVERE DISEASE]

A
  • Prednisone [Glucocorticoid & Immunosuppressant] 0.5mg/kg 1x/day for 1 week
42
Q

ORAL LICHEN PLANUS – 1st LINE TOPICAL CORTICOSTEROIDS [NOTE: DO NOT USE 2+ WEEKS | A/E: Candidiasis]

A

Dexamethasone Elixir [EtOH base]

Dexamethasone Solution [H2O base]

Clobetasol 0.05%, 15g tube

Halobetasol Ointment 0.05%

43
Q

ORAL LICHEN PLANUS – CALCINEURIN INHIBITORS [NOTE: DO NOT USE 2+ WEEKS | *BLACK BOX WARNING: CANCER]

A
  • Tacrolimus Ointment 0.03% or 0.1%, 30g tube, Blot area dry, rub in thin film over areas 3x/day after meals & at bedtime
  • Tacrolimus Solution 0.5mg/5mL
44
Q

PEMPHIGUS VULGARIS

A

STAGE 1 TREATMENT: CONTROL

Systemic Corticosteroids

STAGE 2 TREATMENT: CONSOLIDATION

Immunosuppressants – i.e. CellCept [Mycophenolate mofetil] is steroid sparing - Must have no new lesions for 2+ weeks & 80% of lesions healed to get into “remission” stage - Can begin tapering steroids

STAGE 3 TREATMENT: REMISSION/MAINTENANCE

Rituximab

45
Q

MUCOUS MEMBRANE PEMPHIGOID

A

Local Therapy [Local corticosteroids]

Dapsone, Tetracycline + Nicotinamide [NOT IMMUNOSUPPRESSIVE]

Low Risk: Oral mucosa only – Topical corticosteroid Clobetsol

High Risk: Ocular, Esophageal involvement – Systemic Corticosteroids Prednisone 1mg/kg

46
Q

XEROSTOMIA/SJOGREN’S SYNDROME

A

Artificial Saliva

Biotene toothpaste & rinse

Orabalance gel

Pilocarpine 5-7.5mg 3x/day (tabletss)

Cevimeline 30mg 3x/day (tablets)

Oral Path (23 decks)

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