TOK prescribing and pharmacology Flashcards
Routine management of patients at increased risk but who
do not require antibiotic prophylaxis to prevent infective
endocarditis should include:
Ensuring the patient and/ or carer is aware of the risk of developing infective endocarditis. Oral hygiene instruction.
Antibiotic prophylaxis should be given to appropriate
patients when
Placing stainless steel crowns Performing subgingival scaling Preparing subgingival margin for a non-precious shell crown
Which of the following are appropriate short term
interventions for painful oral ulceration?
Use of a benzydamine mouthwash using 15mL every hour and a half in an adult. Use of benzydamine oromucosal spray, 4 sprays onto affected area every hour and half in an adult.
Which two of these antibiotics are most suitable for a 50
year old male taking methotrexate 25mg orally once per week
Erythromycin Metronidazole
According to the SDCEP guidelines:
The correct dose of varnish containing 22,600ppm Fluoride is 0.25mL for a child between 2 and 5 years. If a child is at increased risk of dental caries they should have 5% Sodium Fluoride varnish application 4x/year.
The following measures are recommended to minimise the
risk of osteonecrosis in patients who take bisphosphonate
drugs undergoing invasive dental procedures:
None of the above
In patients having daily injections of Tinzaparin Sodium for
prophylaxis of deep vein thrombosis who require surgical
extraction
The patient can be treated without any adjustment to the frequency of injections Stage extensive or complex procedures Pack and suture
Which of the following is true when prescribing Antibiotic
prophylaxis against Infective Endocarditis for dental
treatment:
Antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures
The subgroup of patients requiring ‘’special consideration’’ who are at increased risk of infective endocarditis include
Patients who have a prosthetic valve replacement Patients who have had previous infective endocarditis Patients with cyanotic congenital heart disease
Which of the following cardiac conditions are included in
the subgroup requiring special consideration when
prescribing antibiotic prophylaxis against Infective
Endocarditis
Previous Endocarditis Cyanotic congenital heart disease Prosthetic valve replacemen
An adult patient presents with denture stomatitis and drug
treatment is required. Which of the following may be
appropriate drug regimes?Prescription of..
Miconazole oromucosal gel (20mg/ml), pea sized amount after food four times daily Fluconazole capsules (50mg), 1 capsule daily for 7 days
The incidence of MRONJ
In patients with osteoporosis given a once yearly IV infusion of bisphosphonates appears to be no greater than that in patients taking the drug orally. Is 0-10 cases per 10 000 in osteoporosis patients treated with anti-resorptive drug. Is thought to be increased in patients taking anti-resorptive or anti-angiogenic drugs with prostate cancer and multiple myeloma
Which of the following statements are true regarding
patients that take direct oral anticoagulants (DOACs) such
as apixiban
High risk procedures to be carried out early in the day with missed morning dose Low risk procedures can be carried out without alteration to dose
You decide to prescribe a steroid mouthwash for a patient
with recurrent apthous ulceration. What would be an
appropriate regime?
Hydrocortisone oro-mucosal tablets 250mg. 1 tablet dissolved in 10ml of water as a mouthwash four times daily spitting out after rinsing.
A prescription for chlorhexidine can…
Be written by a dental nurse and signed by a dental surgeon.
When writing an NHS Dental Prescription for an adult a
dentist must include which of the following?
The patients full name The dose of the medicine prescribed The dentists signature in ink The patients full address
In relation to giving advice to a patient taking oral
bisphosphonates, before the commencement of your
treatment which of the four statements is false?
Explain to the patient that they should have drug holidays during dental treatment
If drug treatment is required for acute necrotizing
ulcerative gingivitis, which of the following is the drug
regimen of choice for non-severe infection in adult
patients?
Metronidazole tablets (400mg), 1 tablet three times daily for 3 days.
A 45 year old patient presents to your practice with a
spreading infection from a PA abscess. The patient is an
alcoholic who is allergic to penicillin. He is taking Atenolol
and Simvastatin. An appropriate antibiotic regime would
be:
Clindamycin Capsules 150mg, 1 capsule four times daily for 5 days.
The antibiotic most frequently associated with the adverse
effect of antibiotic associated colitis is…?
Clindamycin
The use of which of the following should be avoided for a
seven-year-old patient?
Aspirin
You are prescribing Artificial Saliva Pastilles to a patient
with dry mouth. Which of the following abbreviations
should the prescription be endorsed with:
ACBS (stands for Advisory Committee on Borderline Substances)
Which of the following is true when assessing if a patient is
at risk of MRONJ:
Anti-angiogenic drugs are not thought to remain in the body for extended periods of time.
Patients taking Zoledronic acid for treatment of cancer are at higher risk. There is no evidence that MRONJ risk will be reduced if the patient permanently stops taking bisphosphonate drugs prior to invasive dental procedures.
If the patient is currently taking Denosumab they are at increased risk
A patient taking aflibercept requires an essential
extraction
Perform regular reviews with essential review at week 8 Advise the patient they are at risk of developing MRONJ Focus on minimising periodontal/dental infection or disease
Dental Prescribing within the National Health Service…?
Is restricted to drugs within ‘’The List of Dental Preparations’’ found in the ‘’British National Formulary’’. Caries no charge to the patient by the issuing pharmacy in Scotland.
A 65 year old female patient presents with angular
cheilitis. She takes Bendroflumethiazide for high blood
pressure. You prescribed Miconazole cream 2 weeks ago,
but it remains unresponsive. An appropriate alternative
regime would be:
Miconazole (2%) and Hydrocortisone (1%) Ointment. Apply to angles of mouth twice daily for a maximum of 7 days.
Which of the following is/ are true of patients taking
Rivaroxaban?
Inferior dental blocks are unlikely to cause bleeding.
Which of the following treatments are not considered
essential in a patient taking bisphosphonates?
Undertake tooth whitening.
Which of the following MUST be included in an NHS
prescription?:
Patients full name Patients address Dentists stamp Date prescription was written Duration of course of medication Patients age if under 12 years old
With regard to the emergency supply of prescription only
medicine, the prescriber must undertake to furnish a
prescription within what period of time?
72 hours
A patient arrives at the practice requiring a prescription.
The patient is registered with another dentist at the
practice who is on holiday for 2 weeks. How should you
proceed?
Write an appropriate NHS prescription for the patient.
A 62 year old patient requires antibiotic prophylaxis for a
tooth extraction. They are allergic to penicillin and unable
to swallow capsules. An appropriate antibiotic would be:
Azithromycin Oral Suspension 200mg/5ml, 12.5mls 1 hour before treatment
A nine year old child presents at your practice with pain
and localised swelling from a dental abscess. The child is
not amenable to local anaesthesia and you wish to refer.
The child is also allergic to penicillin. Which of the
following regimens is recommended?
Metronidazole 100mg. One to be taken 3 times a day for 5 days.
Which of the following are appropriate medications for
treatment of trigeminal neuralgia?
Carbamazepine
A patient presents to your practice with what you think is
undiagnosed trigeminal neuragia. Which of the following
is/are true:
carbamazepine tablets 100mg can be prescribed to otherwise healthy adult patients without consulting a Oral Medicine Consultant. The patients current medication should be inspected prior to prescribing Carbamazepine
Patients prescribed Carbamazepine should be referred for a full blood count and liver function tests
Which of the following is an appropriate antifungal
medication for a patient taking Warfarin?
Nystatin
Which drugs listed below is/are not associated with an
increased bleeding risk?
Amoxicillin, Cetirizine
Which of the following drugs are associated with increased
bleeding risk:
Carbamazepine, Methotrexate, Apixaban, Naproxen, Gold
An adult patient presents with denture stomatitis in the
upper arch. The local measure to be used in the first
instance include:
Advise patient to clean dentures thoroughly by soaking in chlorhexidine mouthwash. Advise patient to brush the palate daily. Advise patient to leave denture out as often as possible during the treatment period.
If patients are taking oral bisphosphonates
Straight forward extractions should be performed in primary care.
Patients who are taking the novel oral anticoagulant
Dabigatran:
Should miss their morning dose if having a biopsy
When a patient requires Antibiotic prophylaxis against
infective endocarditis
The prescription should include a note that the antibiotic is being prescribed for prophylaxis For patients who require sequential invasion treatments over a short time period, the same antibiotic can be prescribed for the purpose of prophylaxis for each treatment episode In a patient who isn’t allergic to penicillin, the correct dose is 3g (1 sachet) 60 mins before the procedur
NICE guidelines state that for individuals at risk of infective
endocarditis:
Any episodes of infection in people at risk of infective endocarditis should be investigated and treated promptly to reduce the risk of endocarditis developing Chlorhexidine mouthwash should not be offered as prophylaxis
According to the BNF, which of the following are not
known to be harmful during pregnancy?
Paracetamol Amoxicillin
If drug treatment is required for ANUG, which of the
following is the drug regime of choice for non-severe
infection in adult patients?
Metronidazole tablets (400mg), 1 tablet 3x/day x3days
Doxycycline dispersible tablets
Can enhance the anticoagulant effect of warfarin Can be prescribed to a 12 year old patient
Which of the following is true regarding paracetamol?
Dosage should be no greater than 4g per day in a healthy adult Sugar-free paediatric suspensions are available
It is appropriate to prescribe Gladosane Aerosol Spray to
patients with a dry mouth:
In patients with sicca syndrome
A dental extraction should be postponed if:
The patient’s INR is 4.1 The patient has an unstable INR which was measured at 1.8 two days ago
When carrying out root surface instrumentation on a
patient taking Warfarin, which of the following statements
are true?
If the patients’ INR is 4 or above, delay treatment until their INR has been reduced Ensure that the patients’ INR has been checked, ideally no more than 24 hours before the procedure
A warfarinised, pain free, patient requires an extraction
and can attend any day and at any time. The patient has a
stable INR reading 3.8. Best management would be to
treat this patient:
In the early part of the day and early in the working week within 72 hours of having their INR checked.
For a patient taking Aspirin and Clopidogril following a TIA
Bleeding can be prolonged up to 1 hour
You are carrying out root surface instrumentation on a
patient with BPEs of 4 in all sextants and the patient is
taking Aspirin, which of the following should you consider
Carry out treatment in a staged manner Limiting the initial treatment area Use local haemostatic measures to achieve haemostasis
Which of the following are not drugs associated with
Medication-related Osteonecrosis of the jaw?
Acetic Acid Ascortic Acid
Which patients would be at higher risk of MRONJ?
Patients with a previous diagnosis on MRONJ Patients being treated with anti-resorptive or anti-angiogenic drugs (or both) as part of the management of cancer
A patient is at high risk of MRONJ following tooth
extraction if:
If the patient is taking Apixaban and Alendronic Acid If the patient is taking Denosumab and hydrocortisone
If a patient is at higher risk of developing MRONJ
TRY The patient should contact the practice if they have altered sensation in a socket following an extraction
