therapeutic drugs in oral medicine Flashcards
when would you give non-steroid topical therapy
for inconvenient lesions with discomfort
when would you give steroid topical therapy
for disabling immunologically driven lesions
what are the options for non-steroid topical treatment of oral mucosal lesions
chlorohexidine mouthwash
benzdamine mouthwash or spray
OTC remedies = Bonjela, Igloo
what must you warn pt about when giving Chlorohexdine moutwash
can cause dental staining if use before foods with high pigment
should be advised to use last thing at night
what is benzdamine mouthwash
NSAID
good for painful mucosal conditions
useful topical anaesthetic/ain relief = especially before mealtimes
what are options of steroid based topical treatment
hydrocortisone mucoadhesvie tablet
betamethasone mouthwash
beclomethasone MDI
how does hydrocortisone tablet work
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
how does betamethasone mouthwash work
give betnesol tablets 0.5mg and dissolve in 10mls water and rinse for 2 mins daily
problem with betamethasone mouthwash
not licensed for the use of treating oral mucosal lesions
need to supply pt with a tailored pt information leaflet instead
advantages of betamethasone mouthwash
can increase concentration by adding more tablets
can rinse more often daily for better effect
what does MDI stand for
meter dose inhaler
how does beclomethasone inhaler work
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
what type of lesions is beclomethasone good for
isolated lesions, not for widespread lesions
what type of lesions is betamethsone mouthwash good for
widespread lesions, not as good for isolated lesions
what is the problem with beclomethasone being used for mucosal lesions
not licensed for this use, need to provide pt with tailored information leaflet
what type of puffer device must be used
pressure device not a breath activated one
why must a pressure inhaler device be used and not puffer
because cannot such the steroid from the device onto mucosa as it will just go into airways
what are the systemic treatment options
disease modulators
steroid inflammatory reducers
immune suppressants
immunotherapy
example of disease modulators
colchicine
systemic steroid inflammatory reducers example
prednisolone
how is prednisolone used
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
what are the risks of systemic steroids
- adrenal suppression
- cushingoid features
- osteoporosis risk
- peptic ulcer risk
- mood /sleep alteration
- mania/depression risk
how can you get adrenal suppression from systemic steroids
steroid dependancy
means you can’t stop them suddenly, need to taper them off
how can we minimise osteoporosis risk from systemic steroids
bone prophylaxis
calcium supplements and Bisphosphonates
examples of immunosuppressants
hydroxychloroquine
azathioprine, mycophenolate
examples of immunotherapy medications
adalimumab, intercept
what checks need to be carried out on pt prior to starting systemic immunomodulatory treatment
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
what medicines are used in oral medicien
antimicrobials
topical steroids
dry mouth medication
mouthwash topical treatments
systemic medical treatments
what is meant by a licensed medication
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
what must you do if a medicine causes an adverse effect that is not recognised as a common side effect
yellow-card scheme
what does unlicensed medication mean
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
if giving a pt an unlicensed medicine what must you do
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)
example of antiviral medication used in oral med
acyclovir
what is acylovir used for
treat primary herpetic gingivostomatitis
treat recurrent herpetic lesions
treat shingles = recurrent herpes zoster
examples of antifungals
miconazole, fluconazole, nystatin
what are antifungals used to treat in oral med
acute pseudomembranous candidiasis
acute erythematous candidiasis
oral mucosal infectons
what are beclomethasone MDI puffer and betamethasone mouthwash used for
treating aphthous ulcers
treating lichen planus
other than betamethasone mouthwash what other mouthwash can be used for oral med
benzydamine hydrochloride mouthwash
what is carbamazepine used for now, and what did it used to be for
trigeminal neuralgia now
used to be for epilepsy
what is a ‘medical device’
something used to treat or alleviate disease, but don’t achieve action by pharmacological, metabolic or immunological means
examples of dry mouth treatment
salivax pastilles
saliva orthana
biotene orla balance
artificial salive DPF
glandosane
why are dry mouth treatments referred to as medical devices
they are not providing any pharmacological input, just a lubricant
what medicines are used in oral med specialist practice
tricyclic antidepressants
gabapentine/pregablin = chronic pain management
azathioprine
mycophenolate
hydroxychloroquine
colchicine
what must be included on a prescription
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
how long is a prescription valid
6 months from date of issue
advantages of written pt instructions
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
