DFT Lancaster - Drug Dilemma's (NW161111FLP)

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BPharm MRPharms - Lead pharmacist for the National Dental Medicines Information Service.

I work in Liverpool at the North West Medicines Information Centre (NWMIC), part of UKMi, the national medicines information pharmacists’ network. I lead the work of the National Dental Medicines Information Service provided by the NWMIC on behalf of UKMi. I have lectured to dentists from throughout the UK and have had papers published in Dental Update, Primary Dental Care and have contributed to the FGDP’s Antimicrobial Prescribing for General Dental Practitioners and the SDCEP’s Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs. I lead the work of Yellow Card Centre North West which acts locally on behalf of the Medicines and Healthcare Products Regulatory Agency (MHRA) to support and promote adverse drug reaction reporting through the Yellow Card Scheme. I graduated from The School of Pharmacy, University of London in 1987 and I have worked at the NWMIC since 1997.

The session will help new dentists by describing some of the idiosyncrasies of medicines law, common questions and current issues related to medicines and include when and where to find help.

Assessment: Pre course questions – review after session

Mandatory: Foundation Dentist

Focusing on issues relevant to the dental team, to raise awareness of:

• the laws that apply to medicines

• drug interactions

• oral adverse reactions to medicines and concerns around commonly taken and used medicines

• To manage and prescribe medicines within the current legal framework.

• Medicines and prescribing are highly regulated in the UK and knowing which aspects of the law are relevant to dental practice is essential. The session will cover:

• The legal framework for medicines

• Prescription and supply of medicines privately and on NHS prescription

• Patient Group Directions (PGDs)

• Controlled drugs in dental practice e.g. midazolam.

• To minimise risk to patients by raising awareness of drug interactions when prescribing and administering medicines.

• All medicines have the potential to cause or be affected by drug interactions. Some of the drug interactions that are clinically relevant and impact most in dental practice will be discussed.

• To identify some important oral adverse drug reactions and report them appropriately to the Yellow Card Scheme.

• All medicines cause adverse effects – not in all patients and not always severe. Adverse drug reactions (ADRs) that may be seen by the dental team are highlighted including osteonecrosis of the jaw associated with bisphosphonates. Reporting ADRs is an important professional responsibility for all members of the dental healthcare team and how this should be done via the MHRA’s Yellow Card Scheme will be described.

• To recognise areas of concern when treating patients on medicines or using medicines to treat patients.

• Patients taking medicines can provide challenges for the dental team but sometimes appropriate use of commonly used medicines is also unclear, the following will be covered:

• anticoagulants/antiplatelets including the new oral anticoagulants e.g. dabigatran

• lidocaine, maximum dose and contraindications

• Antifungal use

• Analgesics – choice, use and effectiveness for dental pain

• Appreciate the laws, guidance and legal constraints associated with assessing, prescribing and administering medicines.

• Recognise and assess risks to patients associated with drug interactions when prescribing and administering medicines.

• Identify oral adverse drug reactions, appreciate the value of the UK’s Yellow Card Scheme and to fulfil their professional responsibility to contribute appropriately to it.

• Recognise and manage common areas of concern when treating patients on medicines or using medicines to treat patients.