Therapeutic Drugs in Oral Medicine

Question 1

What are the different types of drugs used in Oral Medicine ?

Answer 1

Anti-microbial- anti-viral/fungal/biotics

Topical Steroids (most common)- inhaled, mouthwashes

Dry mouth medication

Other- Carbamezepine, Benzdamine

Question 2

What are the different classifications of medicines?

Answer 2

General Sales- OTC

Pharmacy Medicines

Prescription only Medicines

Controlled Drugs- specialists only

Medical Devices

Question 3

What is a licensed drug?

Answer 3

A medicine that has been proven in evidence to the MHRA to have efficacy and safety (in trials) at defined doses in a child and/or adult population when treating specified medical conditions
-> undergoes surveillance

Question 4

What is an unlicensed drug?

Answer 4

Medicines that have not had evidence of efficacy submitted for the condition under treatment

-> Will be ‘licenced medicines’ – but for another condition
-> ‘off-licence’ or ‘off-label’ use is at the discretion of the treating physician

Question 5

When should an off-license drug never be used?

Answer 5

If there is a licensed drug for that specific condition

Question 6

What is different about the patient information leaflet for off-license meds?

Answer 6

Patient information leaflets by manufacturer is only for licensed condition
-> prescriber must give directions on other use via leaflet (patient must be aware the drug is off-licence)

Question 7

Which antiviral is licensed for use in dentistry? What is it used to treat?

Answer 7

Acyclovir

Used to treat: primary herpetic gingivostomatitis, recurrent herpetic lesions, shingles (recurrent herpes zoster)

Question 8

Which antifungals are licensed for use in dentistry? What are they used to treat?

Answer 8

Miconazole, Fluconazole, Nystatin

Used to treat: Acute pseudomembranous candidiasis/acute erythematous candidiasis

Question 9

What can carbamezipine be used for?

Answer 9

Epilepsy and trigeminal neuralgia
-> licensed for both

Question 10

What are topical steroids used for in OM?

Answer 10

Treating aphthous ulcers and Lichen planus

Question 11

What topical steroids are used in OM?

Answer 11

Betamethasone mouthwash- water soluble tablets

Beclamethasone MDI

-> Both have own specific PIL by British and Irish Oral medicine society

Question 12

What are medical devices?

Answer 12

Devices used to treat or alleviate disease but do not achieve by function pharmacological, immunological or metabolic means

Question 13

What are examples of reasons for use of medical devices?

Answer 13

Diagnosis, prevention, monitoring, treatment or alleviation of disease

Diagnosis, monitoring, treatment, alleviation of or compensation for an injury

Investigation, replacement, modification, or support of the anatomy or of a physiological process

Supporting or sustaining life

Control of conception

Disinfection of medical devices

Providing information by means of in vitro examination of specimens derived from the human body

Question 14

What medical devices are used in dentistry?

Answer 14

Salivix pastilles
Saliva orthana
Biotene Oral Balance
Artificial Saliva DPF
Glandosane

-> lubricant function as opposed to medical

Question 15

What are examples of other medicines which may be used by specialists in OM?

Answer 15

Tricyclic Antidepressants

Gabapentin/Pregabalin- chronic pain

Azathioprine/Mycophenolate- lichen planus, ulcers, vesiculobullous conditions

Hydroxycholoroquine- ulcers

Colchicine

Question 16

What must be considered when prescribing a drug for a patient?

Answer 16

Clinical indication

Is it licenced or unlicensed for this use

Dose and route of administration

Important warnings for the patient

Drug interactions and cautions

Treatment duration and monitoring

Question 17

What must be included in a prescription?

Answer 17

Patient’s name, Address, Age (under 18)

Patient identifier – DoB, CHI Number

Number of Days treatment

Drug to be prescribed

Drug formulation and Dosage

Instructions on quantity to be dispensed

Instructions to be given to the patient

Signed – identifier of Prescriber

Question 18

Why should only one item be included per script?

Answer 18

Risk of reduced legibility

->Typed is better- can include more than one item more easily (but not in dentistry)

Question 19

How long are prescriptions valid?

Answer 19

6 months from issue

-> repeat prescriptions can last up to 6 months

Question 20

How should instructions to the patient about medicines be provided?

Answer 20

Verbal and Written

-> different language, larger print options if required

Question 21

What advice should be given to patients about their medicines that you have prescribed?

Answer 21

How to use

Frequency and dosage- remind them to finish course

What to expect- normal and abnormal affects

Drug interactions

Known side effects

Safety instructions- keep away from children