Medication Safety and Adverse Drug Events
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Questions and Answers

What is the definition of an adverse drug reaction (ADR) according to the WHO (1972)?

  • A response to a drug that is noxious and unintended and occurs at doses normally used in humans. (correct)
  • A response to a drug that is therapeutic and occurs at high doses in humans.
  • A response to a drug that is beneficial and intended and occurs at doses normally used in humans.
  • A response to a drug that is prophylactic and occurs at low doses in humans.

    • What is the primary source to check for details of medicines according to the text?

  • MIMS
  • WHO website
  • Australian Drug Information (Aus DI) site
  • Australian Medicines Handbook (correct)

    • What is a potential issue with documenting Adverse Drug Reactions (ADRs)?

  • Identifying the contaminated herbal medications.
  • Recording only severe reactions.
  • Determining the severity of the noxious response. (correct)
  • Documenting only therapeutic effects.

    • What is the name of the handbook recommended as the first source for checking medicine details?

    <p>Australian Medicines Handbook</p> Signup and view all the answers

    What is the name of the website recommended as a secondary source for checking medicine details?

    <p>Australian Drug Information (Aus DI) site</p> Signup and view all the answers

    What is the CRICOS code mentioned in the text?

    <p>00025B</p> Signup and view all the answers

    Who is acknowledged in the text for their contribution?

    <p>Prof Laurence J Walsh and Dr Claudia Lopez-Silva</p> Signup and view all the answers

    What is the year mentioned in the text as the definition of Adverse Drug Reaction (ADR) was stated?

    <p>1972</p> Signup and view all the answers

    What percentage of patients in general practice in Australia experience adverse drug events?

    <p>Approximately 10%</p> Signup and view all the answers

    What is the main mechanism of anti-platelet medication?

    <p>Inhibiting platelet aggregation</p> Signup and view all the answers

    Which of the following medications is least likely to cause hyposalivation?

    <p>Anti-pruritics</p> Signup and view all the answers

    What is the purpose of the Australian Commission on Safety and Quality in Health Care?

    <p>To conduct research on medication safety</p> Signup and view all the answers

    Which of the following is NOT a direct factor Xa inhibitor?

    <p>Warfarin</p> Signup and view all the answers

    What is the typical route of administration for Heparin?

    <p>Intravenous</p> Signup and view all the answers

    What is the primary focus of the International Journal for Quality in Health Care?

    <p>Publishing research on healthcare quality improvement</p> Signup and view all the answers

    Which medication has the shortest half-life?

    <p>Heparin</p> Signup and view all the answers

    Which of the following is not a type of medication that can cause hyposalivation?

    <p>Vitamins</p> Signup and view all the answers

    What is the reversal agent for Dabigatran?

    <p>Idarucizumab</p> Signup and view all the answers

    What is the name of the study published in the Medical Journal of Australia in 2006?

    <p>Adverse drug events in general practice patients in Australia</p> Signup and view all the answers

    Which of the following is a common side effect of the medications listed?

    <p>Xerostomia</p> Signup and view all the answers

    What is the primary mechanism of action of Warfarin?

    <p>Vitamin K antagonist</p> Signup and view all the answers

    What is the CRICOS code mentioned in the text?

    <p>00025B</p> Signup and view all the answers

    What is the main difference between anti-coagulant and anti-platelet medications?

    <p>Mechanism of action</p> Signup and view all the answers

    Which medication is metabolized primarily by the liver?

    <p>Warfarin</p> Signup and view all the answers

    What is the mechanism of warfarin in the body?

    <p>Inhibits Vitamin K, affecting Factors II, VII, IX, and X</p> Signup and view all the answers

    What is the primary advantage of NOAC therapy over traditional anticoagulants?

    <p>Higher compliance and lower side effect profile</p> Signup and view all the answers

    What is the reversal agent for dabigatran?

    <p>Idarucizumab</p> Signup and view all the answers

    What is the primary disadvantage of factor Xa inhibitors?

    <p>No antidote for emergency situations</p> Signup and view all the answers

    In what year was warfarin first used as a rodenticide in the USA?

    <p>1952</p> Signup and view all the answers

    What is the name of the foundation that synthesised warfarin in 1948?

    <p>Wisconsin Alumni Research Foundation</p> Signup and view all the answers

    What is the mechanism of NOACs in the body?

    <p>Selectively inhibit Coagulation Factor Inhibition</p> Signup and view all the answers

    What is the half-life of NOACs?

    <p>Short half-life</p> Signup and view all the answers

    Which of the following foods is not typically associated with blood thinning effects?

    <p>Avocado</p> Signup and view all the answers

    What is the primary purpose of documenting an Adverse Drug Reaction (ADR) from a dental point of view?

    <p>To identify the offending medication</p> Signup and view all the answers

    Which of the following researchers is not associated with a new approach to classifying adverse drug reactions?

    <p>J. Smith</p> Signup and view all the answers

    What is a common factor that can contribute to an Adverse Drug Reaction (ADR)?

    <p>Other medications involved</p> Signup and view all the answers

    Which of the following supplements is not typically associated with encouraging clotting?

    <p>Ginkgo</p> Signup and view all the answers

    Why is it important to separate an Adverse Drug Reaction (ADR) from an allergy?

    <p>To ensure accurate treatment and management</p> Signup and view all the answers

    What is the primary purpose of documenting the reaction description and severity in an Adverse Drug Reaction (ADR)?

    <p>To record the severity of the reaction</p> Signup and view all the answers

    Which of the following is not a factor that can contribute to an individual's susceptibility to an Adverse Drug Reaction (ADR)?

    <p>Diet</p> Signup and view all the answers

    What is a critical consideration for dentists when dealing with patients who have neurological disorders or cognitive impairment?

    <p>Determining if the patient can provide informed consent</p> Signup and view all the answers

    What is the primary concern when dealing with patients who have cognitive impairment?

    <p>Determining if the patient can provide informed consent</p> Signup and view all the answers

    Which of the following is a key aspect of risk assessment in dental care?

    <p>Assessing the patient's lifestyle factors</p> Signup and view all the answers

    What is the primary goal of medical history and risk assessment in dentistry?

    <p>Evaluating the patient's overall health</p> Signup and view all the answers

    Which of the following is a critical aspect of evaluating a patient's capacity to provide informed consent?

    <p>Evaluating the patient's cognitive function</p> Signup and view all the answers

    What is a key consideration when evaluating the medical history of a patient?

    <p>Reviewing the patient's medical history</p> Signup and view all the answers

    What is the primary purpose of evaluating a patient's capacity to understand and provide informed consent?

    <p>To ensure the patient understands the treatment plan</p> Signup and view all the answers

    Which of the following is a critical aspect of medical history and risk assessment in dentistry?

    <p>Reviewing the patient's medical history</p> Signup and view all the answers

    What is the primary focus of the treatment planning phases?

    <p>Understanding medical history and tailoring treatment</p> Signup and view all the answers

    What is the significance of understanding medical history in dental treatment?

    <p>All of the above</p> Signup and view all the answers

    What is the relationship between medical history and treatment planning?

    <p>Medical history informs treatment planning</p> Signup and view all the answers

    What is the outcome of integrating medical history into treatment planning?

    <p>It makes the dentist a better clinician</p> Signup and view all the answers

    What is the primary purpose of treatment planning phases?

    <p>To tailor treatment to patient's needs</p> Signup and view all the answers

    What is the significance of the systemic phase in treatment planning?

    <p>It is the initial phase of treatment</p> Signup and view all the answers

    What is the relationship between the treatment planning phases?

    <p>The phases are sequential and interdependent</p> Signup and view all the answers

    What is the outcome of a thorough medical history in treatment planning?

    <p>Increased understanding of patient needs</p> Signup and view all the answers

    What is the stage of the patient's Chronic Kidney Disease?

    <p>Stage IIIA</p> Signup and view all the answers

    What is the dosage of Insulin Aspart Protamine Suspension for the patient?

    <p>16 units BD</p> Signup and view all the answers

    What is the name of the medication taken by the patient for Prostamegaly?

    <p>Baclofen (Gablofen)</p> Signup and view all the answers

    What is the current status of the patient's Multiple Myeloma?

    <p>In remission</p> Signup and view all the answers

    What is the dosage of Atorvastatin (Lipitor) taken by the patient?

    <p>40mg NOCTE</p> Signup and view all the answers

    What is the reason for the patient's Gastric Oesophageal Reflux Disease (GORD)?

    <p>Secondary effect to Multiple Myeloma treatment</p> Signup and view all the answers

    What is the dosage of Vitamin D + Calcium (Ostevit-D) taken by the patient?

    <p>1000 IU MANE</p> Signup and view all the answers

    What is the primary concern for dentistry related to the patient's Type 2 Diabetes Mellitus?

    <p>High</p> Signup and view all the answers

    What is the primary mechanism of action of Venlafaxine?

    <p>Increasing the levels of serotonin and norepinephrine in the brain</p> Signup and view all the answers

    What is the primary use of Spironolactone?

    <p>Treating fluid buildup due to heart failure, liver scarring, or kidney disease</p> Signup and view all the answers

    What is the active ingredient in Lipex?

    <p>Simvastatin</p> Signup and view all the answers

    What is the brand name of Lithicarb?

    <p>Lithicarb</p> Signup and view all the answers

    What is the primary use of Atenolol?

    <p>Treating angina and hypertension</p> Signup and view all the answers

    What is the primary mechanism of action of Atenolol?

    <p>Affecting the heart and circulation</p> Signup and view all the answers

    What is the primary use of Venlafaxine?

    <p>Treating depression</p> Signup and view all the answers

    What is the brand name of Spironolactone?

    <p>Aldactone</p> Signup and view all the answers

    What is the trade name of the bisphosphonate drug used for osteoporosis and other bone diseases?

    <p>Fosamax</p> Signup and view all the answers

    What is the purpose of dental clinicians screening patients prior to the use of anti-resorptive and anti-angiogenic medications?

    <p>To prevent medication-related osteonecrosis of the jaw (MRONJ)</p> Signup and view all the answers

    What is the percentage of decrease in incidence of MRONJ with patients undergoing preventive dentistry?

    <p>3-fold</p> Signup and view all the answers

    What is the name of the journal that published the study on medication-related osteonecrosis of the jaw in patients with cancer?

    <p>The Journal of Clinical Endocrinology &amp; Metabolism</p> Signup and view all the answers

    What is the purpose of discussing the risks of MRONJ with patients prior to drug therapies?

    <p>To ensure patients understand the importance of good oral hygiene</p> Signup and view all the answers

    Which of the following is a risk factor for MRONJ?

    <p>Use of anti-angiogenic medications</p> Signup and view all the answers

    What is the name of the organization that published a position paper on medication-related osteonecrosis of the jaw?

    <p>American Association of Oral and Maxillofacial Surgeons</p> Signup and view all the answers

    How many patients were included in the study on reduction in MRONJ incidence for cancer patients with IV bisphosphonates?

    <p>1,243</p> Signup and view all the answers

    What is the primary goal of medical history and risk assessment in dentistry?

    <p>To tailor treatment towards the patient's needs and goals</p> Signup and view all the answers

    What is the significance of understanding medical history in dental treatment?

    <p>It reduces the risk of adverse reactions and improves patient outcomes</p> Signup and view all the answers

    What is the primary focus of the treatment planning phases?

    <p>To develop a systematic approach to patient care</p> Signup and view all the answers

    What is the primary concern when dealing with patients who have cognitive impairment?

    <p>Their ability to provide informed consent</p> Signup and view all the answers

    What is a critical aspect of evaluating a patient's capacity to provide informed consent?

    <p>Their ability to provide informed consent</p> Signup and view all the answers

    What is a key consideration when evaluating the medical history of a patient?

    <p>Their medical history and risk assessment</p> Signup and view all the answers

    What is a critical aspect of risk assessment in dental care?

    <p>Identifying potential medical issues</p> Signup and view all the answers

    What is the primary advantage of understanding medical history and performing risk assessments?

    <p>It reduces the risk of adverse reactions and improves patient outcomes</p> Signup and view all the answers

    What percentage of women may have some degree of thyroid deficiency?

    <p>Up to 10%</p> Signup and view all the answers

    What is the name of the medication that is a selective type 1 beta blocker?

    <p>Atenolol</p> Signup and view all the answers

    In 2008, the National Institute for Health and Clinical Excellence (NICE) recommended the cessation of antibiotic prophylaxis for which group of patients?

    <p>Patients at risk of Infective Endocarditis (IE) for any invasive dental procedure</p> Signup and view all the answers

    What is the name of the medication that is a calcium channel blocker?

    <p>Lercanidipine</p> Signup and view all the answers

    What is the name of the medication that is a statin?

    <p>Atorvastatin</p> Signup and view all the answers

    What is the name of the medication that is an ACE inhibitor?

    <p>Perindopril arginine</p> Signup and view all the answers

    What is the term for the condition characterized by low energy, depression, fatigue, and elevated TSH?

    <p>Hypothyroidism</p> Signup and view all the answers

    What is the name of the medication that is a thyroid supplement?

    <p>Oroxine</p> Signup and view all the answers

    What is the current status of the patient's Multiple Myeloma (MM) condition?

    <p>In remission</p> Signup and view all the answers

    What is the dosage of Insulin Aspart Protamine Suspension taken by the patient for Type 2 Diabetes Mellitus?

    <p>16 units BD</p> Signup and view all the answers

    What is the stage of the patient's Chronic Kidney Disease (CKD)?

    <p>Stage IIIA</p> Signup and view all the answers

    What is the dosage of Vitamin D + Calcium (Ostevit-D) taken by the patient for Osteoporosis?

    <p>1000 IU MANE</p> Signup and view all the answers

    What is the impact of the patient's Multiple Myeloma (MM) on dentistry?

    <p>High</p> Signup and view all the answers

    What is the dosage of Metoprolol (Minax) taken by the patient for Hypertension?

    <p>50mg BD</p> Signup and view all the answers

    What is the impact of the patient's Gastric Oesophageal Reflux Disease (GORD) on dentistry?

    <p>Low</p> Signup and view all the answers

    What is the dosage of Baclofen (Gablofen) taken by the patient for Prostamegaly?

    <p>10mg MANE</p> Signup and view all the answers

    What is the name of the drug used to treat osteoporosis, osteogenesis imperfecta, and other bone diseases?

    <p>Alendronic acid</p> Signup and view all the answers

    What is the primary purpose of dental clinicians screening patients prior to the use of anti-resorptive and anti-angiogenic medications?

    <p>To prevent MRONJ</p> Signup and view all the answers

    What is the effect of preventive dentistry on the incidence of MRONJ?

    <p>It decreases the incidence of MRONJ by up to 3-fold</p> Signup and view all the answers

    What type of reaction occurs within 1 day and involves Ab IgE?

    <p>Type I</p> Signup and view all the answers

    Which publication updated the position paper on Medication-Related Osteonecrosis of the Jaw in 2014?

    <p>American Association of Oral and Maxillofacial Surgeons</p> Signup and view all the answers

    What is the primary use of Spironolactone?

    <p>Treating fluid build-up due to heart failure, liver scarring, or kidney disease</p> Signup and view all the answers

    What is the name of the study that found a decline in the incidence of MRONJ in patients with cancer?

    <p>Sim et al. (2015)</p> Signup and view all the answers

    What is the name of the journal that published the study by Ruggiero et al. in 2014?

    <p>Journal of Oral and Maxillofacial Surgery</p> Signup and view all the answers

    What is the name of the medication that contains simvastatin?

    <p>Lipex</p> Signup and view all the answers

    What is the class of antidepressant that Venlafaxine belongs to?

    <p>Selective serotonin-norepinephrine reuptake inhibitor</p> Signup and view all the answers

    What is the purpose of discussing the risks of MRONJ with patients prior to drug therapy?

    <p>To ensure patients understand the importance of good oral hygiene</p> Signup and view all the answers

    What is the primary difference between Type I and Type IV reactions?

    <p>Time of occurrence</p> Signup and view all the answers

    What is the benefit of preventive dentistry in reducing the incidence of MRONJ?

    <p>It reduces the incidence of MRONJ by up to 3-fold</p> Signup and view all the answers

    What is the brand name of the medication that is primarily used to treat angina and hypertension?

    <p>Tenormin</p> Signup and view all the answers

    What is the primary use of Lithicarb?

    <p>Treating mania, manic depressive (bipolar) illness and recurrent endogenous (unipolar) depressive illness</p> Signup and view all the answers

    What type of reaction occurs after 2-3 days and involves T cells?

    <p>Type IV</p> Signup and view all the answers

    What is the primary focus of the treatment planning phases?

    <p>MDT and rehabilitation</p> Signup and view all the answers

    What is the role of the dentist in cancer treatment?

    <p>Support through treatment and post-treatment maintenance</p> Signup and view all the answers

    What is a primary goal of dental pre-assessment in patients undergoing cancer therapy?

    <p>Minimise interruption of cancer treatment from acute dental concerns</p> Signup and view all the answers

    What is the significance of the TNM staging system?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of 3D simulation in surgical planning?

    <p>Improving surgical accuracy</p> Signup and view all the answers

    What is a long-term oral side effect of radiation therapy?

    <p>Hyposalivation</p> Signup and view all the answers

    What is the significance of neck dissection in cancer treatment?

    <p>Addressing lymph node involvement</p> Signup and view all the answers

    What is a dental complication that can arise from radiation therapy?

    <p>Osteoradionecrosis</p> Signup and view all the answers

    What percentage of oral SCC is attributable to tobacco and alcohol?

    <p>75%</p> Signup and view all the answers

    Why is it essential to remove teeth with poor prognosis before cancer therapy?

    <p>To reduce the risk of dental emergencies during cancer therapy</p> Signup and view all the answers

    What is the role of immunotherapy in cancer treatment?

    <p>Enhancing immune response</p> Signup and view all the answers

    What is the primary goal of dental pre-assessment in cancer treatment?

    <p>Minimise interruption of cancer treatment</p> Signup and view all the answers

    What is the significance of early detection in oral cancer screening?

    <p>Improving survival rates</p> Signup and view all the answers

    What is a short-term oral side effect of radiation therapy?

    <p>Mouth ulcers</p> Signup and view all the answers

    What is a common side effect of chemotherapy?

    <p>Mucositis</p> Signup and view all the answers

    What is the primary focus of dental treatment planning for patients undergoing cancer therapy?

    <p>Minimising interruption of cancer treatment from acute dental concerns</p> Signup and view all the answers

    What is the primary focus of the dentist's role in cancer treatment?

    <p>Supporting patients through treatment</p> Signup and view all the answers

    What is the dentist's role in cancer treatment?

    <p>Provide support through treatment</p> Signup and view all the answers

    What is the purpose of stabilising periodontal disease in patients undergoing cancer therapy?

    <p>To reduce the risk of dental emergencies during cancer therapy</p> Signup and view all the answers

    What is a potential complication of oncology treatment?

    <p>Osteoradionecrosis</p> Signup and view all the answers

    Why is it essential to develop an appropriate preventive regime for patients undergoing cancer therapy?

    <p>To counter the increased challenge to oral structures from oncology treatment</p> Signup and view all the answers

    What is a goal of dental pre-assessment in cancer treatment?

    <p>Minimise interruption of cancer treatment</p> Signup and view all the answers

    What is a side effect of chemotherapy?

    <p>All of the above</p> Signup and view all the answers

    What is the significance of dental pre-assessment in cancer treatment?

    <p>Prepare patients for cancer therapy</p> Signup and view all the answers

    What is the primary goal of developing a preventive regime for a cancer patient?

    <p>Prevent future complications</p> Signup and view all the answers

    Why is it essential to consider the need for prophylactic extractions in a cancer patient's dental treatment plan?

    <p>To prevent ORN with future extractions</p> Signup and view all the answers

    What is the benefit of using a baking soda mouthrinse in a cancer patient's preventive regime?

    <p>Relieves dry mouth</p> Signup and view all the answers

    Why is it important to advice a cancer patient on denture use as part of their dental treatment plan?

    <p>To prevent mucositis</p> Signup and view all the answers

    What is the recommended frequency of toothbrushing in a cancer patient's preventive regime?

    <p>Twice daily</p> Signup and view all the answers

    What is the purpose of using a remineralising agent in a cancer patient's preventive regime?

    <p>To remineralise teeth</p> Signup and view all the answers

    Why is a low sugar diet recommended as part of a cancer patient's preventive regime?

    <p>To prevent tooth decay</p> Signup and view all the answers

    What is the recommended daily water intake for a cancer patient to relieve dry mouth?

    <p>1.5-2 liters per day</p> Signup and view all the answers

    What is the primary role of a dentist in supporting a patient undergoing cancer treatment?

    <p>To monitor for oral mucositis and provide pain management</p> Signup and view all the answers

    What is the main concern when performing extractions post-head and neck radiation therapy?

    <p>Risk of osteoradionecrosis</p> Signup and view all the answers

    What is the purpose of regular dental reviews for patients who have undergone radiation therapy?

    <p>To prevent dental disease and promote oral health</p> Signup and view all the answers

    What is the classification system used to describe osteoradionecrosis of the mandible?

    <p>Notani's classification</p> Signup and view all the answers

    What is the primary goal of supportive care during cancer treatment?

    <p>To manage symptoms and promote oral health</p> Signup and view all the answers

    What is the role of the multidisciplinary team (MDT) in cancer treatment?

    <p>To diagnose and treat cancer</p> Signup and view all the answers

    What is the main focus of post-treatment maintenance for patients who have undergone radiation therapy?

    <p>Preventing dental disease and promoting oral health</p> Signup and view all the answers

    What is the purpose of assessing the risk of osteoradionecrosis when performing extractions?

    <p>To prevent osteoradionecrosis</p> Signup and view all the answers

    Study Notes

    Adverse Drug Reactions (ADRs)

    • An ADR is a response to a drug that is noxious and unintended and occurs at doses normally used in humans for prophylaxis, diagnosis or therapy of disease, or for modification of physiological function (WHO 1972)

    Medication History

    • Check the Australian Medicines Handbook (www.amh.net.au) as the first source, then use the Australian Drug Information (Aus DI) site if needed

    More Drugs – More ADRs

    • The more drugs a patient takes, the higher the risk of ADRs

    Medications with Hyposalivatory Effects

    • Anti-hypertensives
    • Narcotic analgesics
    • Anti-spasmodics
    • Anti-convulsants
    • Systemic bronchodilators
    • Anti-emetics
    • Anti-nauseants
    • Skeletal muscle relaxants
    • Anti-Parkinsonian agents
    • Anxiolytics
    • Anti-depressants (TCA)
    • Expectorants
    • Decongestants
    • Tranquillisers
    • Sedatives
    • Anti-neoplastic agents

    Anti-Coagulant vs Anti-Platelet Medication

    • Anti-platelet medication inhibits platelet aggregation through various methods
    • Anti-coagulant medication affects coagulation factors to impede thrombosis/coagulation cascade after initial platelet aggregation

    Common Anti-Coagulant Pharmacokinetics

    • Warfarin (Coumadin/Marevan)
      • Route: Oral
      • Frequency: Daily
      • T Max: 4 hours
      • Half Life: 20-60 hours
      • Metabolism and Elimination: Almost entirely hepatic
      • Reversal: Vitamin K
    • Dabigatran (Praxada)
      • Route: Oral
      • Frequency: Twice daily
      • T Max: 2 hours
      • Half Life: 12-17 hours
      • Metabolism and Elimination: Renal (80%) and Hepatic (20%)
      • Reversal: Idarucizumab
    • Rivaroxaban (Xarelto)
      • Route: Oral
      • Frequency: Once daily
      • T Max: 2.5-4 hours
      • Half Life: 5-9 hours (healthy) and 11-13 hours (elderly)
      • Metabolism and Elimination: Renal (35%) and Hepatic (65%)
      • Reversal: Andexanet alpha
    • Apixaban (Eliquis)
      • Route: Oral
      • Frequency: Twice daily
      • T Max: 1-3 hours
      • Half Life: 8-15 hours
      • Metabolism and Elimination: Renal (27%) and Hepatic (73%)
      • Reversal: Andexanet alpha

    Warfarin

    • Most widely used anticoagulant in the world
    • Synthesised in 1948
    • Used as a rodenticide in the USA in 1952
    • Human use began in 1954
    • Vitamin K Antagonist – Affects Factor II, VII, IX, and X

    NOAC (or DOAC) Therapy

    • AKA Non-Vitamin K antagonist Oral Anti-Coagulant Therapy
    • AKA Novel Oral Anti-Coagulant Therapy
    • AKA Direct Oral Anti-Coagulant
    • Selective in Coagulation Factor Inhibition (Eg. Dabigatran inhibits Factor IIa/Thrombin)
    • Higher compliance and lower side effect profile (?)
    • No blood test needed/possible

    Foods/Supplements with Blood Thinning Effects

    • Licorice
    • Nattokinase
    • Lumbrokinase
    • Niacin
    • Beer
    • Celery
    • Cranberries
    • Fish oil
    • Garlic
    • Ginger
    • Ginkgo
    • Ginseng
    • Green tea
    • Horse chestnut
    • Onion
    • Papaya
    • Red clover
    • Soybean
    • St.John’s Wort
    • Tumeric
    • Wheatgrass
    • Willow bark

    Foods and Supplements that Encourage Clotting

    • Avocado
    • Co-enzyme Q10
    • Dark leafy greens such as spinach
    • Grapefruit

    Documentation – Dental Point of View

    • Offending medication
    • Timing of onset
    • Reaction description and severity
    • Original indications
    • Cofactors – e.g. other medications involved, fever?

    Separate Adverse Drug Reaction to Allergy

    • Susceptibility/Risk Factors: Aronson, J.K., & Ferner, R.E.(2003).

    Medical History and Risk Assessment

    • Importance of medical history in dental treatment planning
    • Neurological disorders (e.g. dementia, acquired brain injury) may impact patient capacity to provide informed consent
    • Dentist must ensure patient understands treatment, examination, or procedure

    Risk Assessment Methods

    • Systemic Phase
    • Acute Phase
    • Disease control Phase
    • Definitive Phase
    • Maintenance Phase

    Antibiotic Prophylaxis

    • Prevention of MRONJ (Medication-Related Osteonecrosis of the Jaw)
    • Screening patients prior to anti-resorptive and anti-angiogenic medications
    • Understanding risk factors for IV vs. oral bisphosphonates and medical reasons for taking bisphosphonates
    • Up to 3-fold decrease in MRONJ incidence with preventive dentistry
    • Risks of MRONJ can be discussed prior to drug therapies, emphasizing good oral hygiene

    Medical Conditions

    • Multiple Myeloma (MM): history, medications, and impact on dentistry
    • Type 2 Diabetes: episodes of hypoglycaemia, medications, and impact on dentistry
    • Chronic Kidney Disease: stage IIIA, medications, and impact on dentistry
    • Hypertension: diagnosis, medications, and impact on dentistry
    • Osteoporosis: vitamin D deficiency, medications, and impact on dentistry
    • Gastric Oesophageal Reflux Disease (GORD): secondary effect to MM treatment
    • Prostamegaly: secondary effect to MM treatment

    Medications

    • Venlafaxine (Effexor): antidepressant, selective serotonin-norepinephrine reuptake inhibitor
    • Lithicarb (lithium carbonate): treatment and prophylaxis of mania, manic depressive illness, and recurrent endogenous depressive illness
    • Spironolactone (Aldactone): treatment of fluid build-up due to heart failure, liver scarring, or kidney disease
    • Atenolol (Tenormin): beta-blocker, treatment of angina and hypertension
    • Lipex (simvastatin): treatment of hypercholesterolemia and hyperlipidaemia, prevention of coronary heart disease
    • Alendronic acid (alendronate sodium, Fosamax): bisphosphonate, treatment of osteoporosis, osteogenesis imperfecta, and bone diseases

    Treatment Planning Phases

    • Systemic Phase
    • Acute Phase
    • Disease control Phase
    • Definitive Phase
    • Maintenance Phase

    Importance of Medical History

    • Understanding medical history helps tailor treatment towards the patient's needs and goals
    • More information leads to less unpredictability
    • Understanding medical history and performing risk assessments is crucial for a Dental Clinician

    Medical History

    • Multiple Myeloma (MM): diagnosed in 2017, currently in remission, previously treated with IV Zoledronic Acid, Prednisone, and Chemotherapy
    • Type 2 Diabetes Mellitus (NIDDM): diagnosed in 2019, with episodes of hypoglycaemia, treated with Insulin Aspart Protamine Suspension and Gliclazide
    • Chronic Kidney Disease: Stage IIIA, secondary to MM treatment, eGFR – 51 ml/min, treated with Dutasteride – Tamsulosin (Duodart) and Ceased oxybutynin
    • Hypertension: diagnosed prior to 2000, treated with Perindopril (Coversyl), Metoprolol (Minax), Lercanidipine (Lercadip), and Atorvastatin (Lipitor)
    • Osteoporosis: diagnosed with Vitamin D deficiency, treated with Vitamin D + Calcium (Ostevit-D)
    • Gastric Oesophageal Reflux Disease (GORD): secondary effect to MM treatment, previously treated with pantoprazole and sodium bicarbonate capsules
    • Prostamegaly: secondary effect to MM treatment, treated with Baclofen (Gablofen)
    • Hypothyroidism: with low energy, depression, and fatigue, treated with thyroid supplements

    Antibiotic Prophylaxis

    • National Institute for Health and Clinical Excellence (NICE) guidelines (2008): cessation of antibiotic prophylaxis for patients at risk of infective endocarditis (IE) for any invasive dental procedure
    • Risks of adverse events versus risk of IE

    Therapeutic Guidelines

    • 2008: Australian Therapeutic Guidelines
    • 2019: Therapeutic Guidelines – Dental Procedures Indicated

    Lifestyle Choices and Risk Factors

    • Cardiovascular Disease: antibiotic prophylaxis may be required in certain cases
    • Prevention: dental clinicians should screen patients prior to the use of anti-resorptive and anti-angiogenic medications
    • Risks of MRONJ can be discussed prior to drug therapies, ensuring patients understand the reason for good oral hygiene
    • Up to 3-fold decrease in incidence of MRONJ with patients undergoing preventive dentistry
    • Reduction in MRONJ incidence for cancer patients with IV bisphosphonates

    Oral Side Effects of Radiation Therapy (RT)

    • Short-term effects: mouth ulcers (mucositis), hyposalivation/xerostomia, loss of taste (dysgeusia)
    • Long-term effects: hyposalivation/xerostomia, radiation caries, osteoradionecrosis, periodontitis, trismus

    Dental Pre-Assessment Goals

    • Prepare patient for short-term and long-term side effects of cancer therapy
    • Minimise interruption of cancer treatment from acute dental concerns
    • Prevent future complications (e.g. osteoradionecrosis)
    • Develop an appropriate preventive regime to counter increased challenge to oral structures from oncology treatment

    Dental Treatment Plan

    • Minimise interruption of cancer treatment
    • Prevent future complications
    • Develop an appropriate preventive regime
    • Remove existing foci of infection
    • Stabilise periodontal disease
    • Develop a preventive regime (e.g. twice daily toothbrushing, high fluoride toothpaste, baking soda mouthrinse)

    Risk Factors for Oral Cancer

    • Lifestyle risk factors: smoking, alcohol
    • Immunosuppression: immunosuppressant use in autoimmune disease, HSCT/organ transplant

    The Dentist's Role

    • Early detection
    • Support through treatment
    • Post-treatment maintenance
    • Prevention and early detection
    • MDT diagnosis and treatment planning
    • Rehabilitation and restoration

    Support during Treatment

    • Oral mucositis pain management
    • Oral hygiene advice
    • Dry mouth advice
    • Assess for oral viral, bacterial, fungal infections
    • Communicate with medical team
    • Avoid elective dental treatment

    Regular Dental Reviews

    • Consider permanent aftermath of radiation therapy
    • Monitor for cancer recurrence
    • Continue management of caries and dry mouth
    • Preventive oral care regime
    • Dry mouth advice
    • Nip dental disease in the bud
    • Appropriate choice of restorative material in high caries risk patients

    Extractions Post-H&N RT

    • Assess risk of osteoradionecrosis (ORN)
    • Request radiation field map
    • Consider risk factors that impair healing
    • Refer to oral surgeon or specialist in SND if necessary

    Osteoradionecrosis (ORN) Management

    • Review extraction sockets
    • Refer if suspect ORN
    • Notani's classification of mandibular ORN: Grade I, II, III

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    Related Documents

    Dent4060 2024 Adverse Drug Reactions & Alternative Medicines PDF
    Dent4060 2024 Medical History & Risk Assessment PDF
    Head & Neck Oncology, May 2024 - DENT4060 PDF

    Description

    This quiz covers medication safety and adverse drug events in healthcare, including a literature review of medication safety in Australia and a study on adverse drug events in general practice patients.

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