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BDS4 Oral Medicine > therapeutic drugs in oral medicine > Flashcards

therapeutic drugs in oral medicine Flashcards

1
Q

when would you give non-steroid topical therapy

A

for inconvenient lesions with discomfort

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2
Q

when would you give steroid topical therapy

A

for disabling immunologically driven lesions

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3
Q

what are the options for non-steroid topical treatment of oral mucosal lesions

A

chlorohexidine mouthwash
benzdamine mouthwash or spray
OTC remedies = Bonjela, Igloo

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4
Q

what must you warn pt about when giving Chlorohexdine moutwash

A

can cause dental staining if use before foods with high pigment
should be advised to use last thing at night

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5
Q

what is benzdamine mouthwash

A

NSAID
good for painful mucosal conditions
useful topical anaesthetic/ain relief = especially before mealtimes

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6
Q

what are options of steroid based topical treatment

A

hydrocortisone mucoadhesvie tablet
betamethasone mouthwash
beclomethasone MDI

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7
Q

how does hydrocortisone tablet work

A

requires prolonged contact with mucosa to work
allow tablet to dissolve over the ulcer
as they dissolve they would adhere through formation of a gel which protects ulcer and gives some relief from discomfort but also hold drug in contact

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8
Q

how does betamethasone mouthwash work

A

give betnesol tablets 0.5mg and dissolve in 10mls water and rinse for 2 mins daily

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9
Q

problem with betamethasone mouthwash

A

not licensed for the use of treating oral mucosal lesions
need to supply pt with a tailored pt information leaflet instead

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10
Q

advantages of betamethasone mouthwash

A

can increase concentration by adding more tablets
can rinse more often daily for better effect

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11
Q

what does MDI stand for

A

meter dose inhaler

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12
Q

how does beclomethasone inhaler work

A

puffer applied directly onto the mucosa above where lesion is present and activated twice which allows puffer to be sprayed directly onto mucosa
sticks and is absorbed
used 2-4 x day

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13
Q

what type of lesions is beclomethasone good for

A

isolated lesions, not for widespread lesions

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14
Q

what type of lesions is betamethsone mouthwash good for

A

widespread lesions, not as good for isolated lesions

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15
Q

what is the problem with beclomethasone being used for mucosal lesions

A

not licensed for this use, need to provide pt with tailored information leaflet

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16
Q

what type of puffer device must be used

A

pressure device not a breath activated one

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17
Q

why must a pressure inhaler device be used and not puffer

A

because cannot such the steroid from the device onto mucosa as it will just go into airways

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18
Q

what are the systemic treatment options

A

disease modulators
steroid inflammatory reducers
immune suppressants
immunotherapy

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19
Q

example of disease modulators

A

colchicine

20
Q

systemic steroid inflammatory reducers example

A

prednisolone

21
Q

how is prednisolone used

A

high dose/short duration = 30mg for 5 days
used for intermittent troublesome ulcers
very good at reducing immunological problems quickly but if used for too long will get standard steroid side effects

22
Q

what are the risks of systemic steroids

A
  • adrenal suppression
  • cushingoid features
  • osteoporosis risk
  • peptic ulcer risk
  • mood /sleep alteration
  • mania/depression risk
23
Q

how can you get adrenal suppression from systemic steroids

A

steroid dependancy
means you can’t stop them suddenly, need to taper them off

24
Q

how can we minimise osteoporosis risk from systemic steroids

A

bone prophylaxis
calcium supplements and Bisphosphonates

25
Q

examples of immunosuppressants

A

hydroxychloroquine
azathioprine, mycophenolate

26
Q

examples of immunotherapy medications

A

adalimumab, intercept

27
Q

what checks need to be carried out on pt prior to starting systemic immunomodulatory treatment

A

must ensure no pre-existing medical conditions that have not yet been detected
blood borne virus screen = Hep B, Hep C, HIV
tuberculosis risk
FBC
electrolyes
LFC
thiopurine methytransferase (TPMT) = only for azathioprine
zoster AB screen
EBV
chest x-ray
cervical smear up to date
pregnancy test

28
Q

what medicines are used in oral medicien

A

antimicrobials
topical steroids
dry mouth medication
mouthwash topical treatments
systemic medical treatments

29
Q

what is meant by a licensed medication

A

a medicine that has been proven in evidence to the MHRA to have efficacy and safety at defined doses in a child and/or adult population when treating specified medical conditions

30
Q

what must you do if a medicine causes an adverse effect that is not recognised as a common side effect

A

yellow-card scheme

31
Q

what does unlicensed medication mean

A

medicines that have not had evidence of efficacy submitted for the condition under treatment
does not mean medicine has no efficacy it just means there is no evidence of that efficacy from the MHRA
will be ‘licensed medicines’ but for another condition

32
Q

if giving a pt an unlicensed medicine what must you do

A

gives them a patient information leaflet specific to the condition under treatment (the manufacturers PIL will be for the condition the medication is licensed for)

33
Q

example of antiviral medication used in oral med

A

acyclovir

34
Q

what is acylovir used for

A

treat primary herpetic gingivostomatitis
treat recurrent herpetic lesions
treat shingles = recurrent herpes zoster

35
Q

examples of antifungals

A

miconazole, fluconazole, nystatin

36
Q

what are antifungals used to treat in oral med

A

acute pseudomembranous candidiasis
acute erythematous candidiasis
oral mucosal infectons

37
Q

what are beclomethasone MDI puffer and betamethasone mouthwash used for

A

treating aphthous ulcers
treating lichen planus

38
Q

other than betamethasone mouthwash what other mouthwash can be used for oral med

A

benzydamine hydrochloride mouthwash

39
Q

what is carbamazepine used for now, and what did it used to be for

A

trigeminal neuralgia now
used to be for epilepsy

40
Q

what is a ‘medical device’

A

something used to treat or alleviate disease, but don’t achieve action by pharmacological, metabolic or immunological means

41
Q

examples of dry mouth treatment

A

salivax pastilles
saliva orthana
biotene orla balance
artificial salive DPF
glandosane

42
Q

why are dry mouth treatments referred to as medical devices

A

they are not providing any pharmacological input, just a lubricant

43
Q

what medicines are used in oral med specialist practice

A

tricyclic antidepressants
gabapentine/pregablin = chronic pain management
azathioprine
mycophenolate
hydroxychloroquine
colchicine

44
Q

what must be included on a prescription

A

pts naem, address, age
pt idenitifier = CHI, DOB
number of days of treatment
drug to be prescribed
drug formulation and dosage
instructions on quantity to be dispensed
instructions to be given to pt
signed = identifier of prescriber

45
Q

how long is a prescription valid

A

6 months from date of issue

46
Q

advantages of written pt instructions

A

stressed pt may not remember instructions
language issues may prevent proper understanding
contact number for pt with issues
legal protection if post-treatment course questioned
drug interactions included

BDS4 Oral Medicine (3 decks)

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