Navigation Workshop 1
1
NSAID
Non-steroidal
anti-inflammatory
drugs
eBNF: non-steroidal anti-inflammatory
drugs (NSAIDs)
2
Flagyl S
Suspension
Orange and lemon
flavouring
eMC (PIL): Flagyl S is a white to cream
suspension with a slight yellow tinge. It
has an odour of oranges and lemons.
3
POM
Prescription Only
Medicine
eBNF: The symbol POM has been placed
against those preparations that are
available only on a prescription issued by
an appropriate practitioner.
4
Aspirin &
Clopidogrel
Increased risk of
bleeding
eMC: A pharmacodynamic interaction
between clopidogrel and acetylsalicylic
acid is possible, leading to increased risk
of bleeding.
eBNF: increased risk of bleeding when
clopidogrel given with aspirin.
5
DPF
Dental
Practitioner’s
Formulary
eBNF: DPF - Dental Practitioners'
Formulary - list approved by the
Secretaries of State, and the
preparations therein may be prescribed by
dental practitioners on form FP10D
6
Safe analgesic
in pregnancy
Paracetamol
eBNF: Not known to be harmful
eMC: There is clinical and epidemiological
evidence of safety of paracetamol in
pregnancy.
Netdoctor: There are no known harmful
effects when this medicine is used during
pregnancy.
7
ACBS
Advisory
Committee on
Borderline
Substances
Role Preparation for Dental Nurse Advisors
eBNF: ACBS Advisory Committee on
Borderline Substances, In certain
conditions some foods (and toilet
preparations) have characteristics of
drugs and the Advisory Committee on
Borderline Substances advises as to the
circumstances in which such substances
may be regarded as drugs.
May 2006
8
Ibuprofen
Maximum 1200mg
daily (OTC)
Medicines Chest: Ibuprofen 200 mg
Dosage: Adults, elderly and young persons
over 12 years: 1 or 2 tablets to be taken 2
or 3 times a day, with or after food.
Maximum 6 tablets in 24 hours.
eMC: Adults and children over 12 years:
Initial dose two tablets taken with water,
then if necessary, one or two tablets
every four hours. Do not exceed six
tablets in any 24 hours.
9
Duraphat
Sodium, Fluoride
Toothpaste
0.619%
eBNF: Sodium Fluoride Toothpaste 0.619%
-Duraphat Toothpaste
10 Artificial Saliva
eBNF: Artificial Saliva, DPF - Supplies may
Supplies may be
difficult to obtain be difficult to obtain
11
Take with or
after food
Aspirin &
Ibuprofen
12
FP10D
NHS Dental
prescription
13
GSL
Can be sold from
any locked
premises
14
Erythroped PI
SF Suspension
15
Medinol over 6
suspension
Once
reconstituted
should be used
within 7 days
Paracetamol
250mg per 5ml
Role Preparation for Dental Nurse Advisors
Netdoctor: Aspirin: Take this medication
with or after food. Ibuprofen: Take this
medication with or after food.
eMC: Tablets to be taken preferably after
food.
eBNF: DPF preparations prescribed by
dental practitioners on form FP10D
eMC: Regulatory affairs: General sales list
– may only be sold from a registered
premises, which is able to close to exclude
the public.
eMC: Once reconstituted Erythroped PI
SF should be used within 7 days.
eMC: Paracetamol BP 250mg/5ml.
eBNF: paracetamol 250 mg/5 ml. Medinol® Over 6
Medicines Chest: Strawberry flavour oral
suspension sugar-free colour-free and
contains no alcohol or animal fats
containing in 5ml:Paracetamol 250 mg
May 2006
16
Contraindicated
in patients with
previous or
active peptic
ulceration
NSAIDs
17
P
Sold under the
supervision of a
pharmacist
18
Corsodyl
Dental Gel
Chlorhexidine
Gluconate Gel 1%
19
Co-codamol
Combination of
codeine and
paracetamol
20
Tetracycline
Tablets
Tablets should be
swallowed with
plenty of fluid
whilst sitting or
standing
21
Paracetamol
Maximum of 2
tablets four times
Medicines Chest: Dosage - Adults: 2
a day
eBNF: The CSM has advised that nonselective NSAIDs are contra-indicated in
patients with previous or active peptic
ulceration
Medicines Chest: pharmacy status (P)
eBNF: Corsodyl®(GSK Consumer
Healthcare) Dental gel, chlorhexidine
gluconate 1%.
eMC:Corsodyl Dental Gel
Chlorhexidine Digluconate 1.0% w/w
(equivalent to Chlorhexidine Digluconate
Solution Ph Eur 5.325 % w/w)
Netdoctor: This medicine contains two
active ingredients, paracetamol and
codeine phosphate.
eBNF: Tablets should be swallowed whole
with plenty of fluid while sitting or
standing
Netdoctor: This medicine should be
swallowed whole with plenty of water while
you are sitting or standing. This is to
prevent the medicine irritating the throat.
Avoid
a dose
justg before
going
to
eBNF:taking
By mouth,
0.5–1
every 4–6
hours
bed.
to a max. of 4 g daily
tablets every 4 hours. Maximum 8 tablets
in 24 hours.
22
Solpadeine
Soluble Tablets
Combination of
codeine,
paracetamol and
caffeine
23
Avoid in under
16’s except in
specific
circumstances
Aspirin
Role Preparation for Dental Nurse Advisors
Medicines Chest: Effervescent white
tablet containing:
Codeine phosphate 8mg
Paracetamol 500mg
Caffeine 30mg
cBNF: Due to association with Reye’s
syndrome aspirin should be avoided in
children under 16 years of age except in
Kawasaki syndrome or for its antiplatelet
action
May 2006
24
Over the
counter
preparation
containing
dihydrocodeine
Paramol Tablets
Medicines Chest: Round beveled edge
tablet marked ‘Paramol’ containing:
Paracetamol 500mg and dihydrocodeine
tartrate 7.46mg
25
Milligrams of
Calprofen that
can be given to a
child of 8 months
(per dose)
50mg of
Ibuprofen
eMC: Calprofen contains 100mg of
ibuprofen per 5ml spoon. Dose for 6-12
months: 2.5ml three times daily
26
Dentinox
Teething Gel
Suitable from
Birth
27
Bonjela
Teething Gel
Suitable for
infants 2 months
and over
28
Clove Oil
Therefore 50mg three times daily
Medicines Chest: Infants from birth
onwards
Medicines Chest: Infants under 2 months:
not recommended
Not recommended Herbal Medicines (via Medicines
Complete): Repeated application of clove
for repeated
oil as a toothache remedy may result in
application
damage to the gingival tissue
29
Maximum
quantity of
paracetamol
(mg) for non
severe pain per
24 hours for a
child aged 4
months
480mg
cBNF: Child 3-12 months 60-120mg every
4-6hours (max 4 doses in 24 hours)
30
Benzydamine
Oromucosal
Spray 0.15%
Difflam Spray
eBNF: Difflam (3M)
Spray, benzydamine hydrochloride 0.15%
Dental prescribing on NHS may be
prescribed as Benzydamine Oromucosal
Spray 0.15%
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 2: Handling Medicines Calls
Case Scenario 1
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
A lady explains that she has broken her tooth. Her friend has told her
Nurofen will help with the pain. Is this ok as she is pregnant?
PERSON
MEDICINES
Who is asking?
27 year old pregnant female
Exact type of Nurofen:
Nurofen 200mg caplets
Any allergies/ medical
conditions?
Paracetamol makes her feel sick
Medicines (name, dose, freq?):
None
Pregnancy (stage, going well)?
33 weeks. First pregnancy, all well.
Why asking about Medicines?
Unable to get an appointment at the
dentist till mid-week and needs
something to help with the pain.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
Medicines chest:
Nurofen caplet contains Ibuprofen 200mg
eBNF:
Most manufacturers advise avoid (or avoid unless potential benefit outweighs risk);
Third trimester: With regular use closure of fetal ductus arteriosus in utero and
possibly persistent pulmonary hypertension of the newborn. Delayed onset and
increased duration of labour
eMC:
Whilst no teratogenic effects have been demonstrated in animal experiments, the
use of Nurofen during pregnancy should be avoided. The onset of labour may be
delayed and duration of labour increased.
Netdoctor:
This medicine is not recommended for use in pregnancy unless considered
essential by your doctor. If taken in the third trimester it may delay labour, increase
the length of labour and cause complications in the newborn baby.
FAQ: Can Ibuprofen be taken during pregnancy?
Use of ibuprofen during the third trimester is not recommended, unless treatment is
under medical supervision.
What advice
would you give?
Or would you
refer?
Ibuprofen is best avoided during the last weeks of pregnancy as it has been
associated with delayed labour, increased length of labour and also complications in
the newborn.
If paracetamol cannot be tolerated it would be best to discuss needing an earlier
appointment with your dentist.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 2: Handling Medicines Calls
Case Scenario 2
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
A lady asks if it safe for her to take Metronidazole whilst breastfeeding?
PERSON
MEDICINES
Who is asking?
32 year old lady
Medicines (name, dose, freq?):
Metronidazole 200mg three times a
day for 7 days prescribed for dental
abscess.
Any allergies/ medical
conditions?
Penicillin allergy
Baby?
12 weeks. Born at term. Healthy.
Feeding about every 2-3 hours
Has medicine been taken?
Yes, one this morning
Why asking about medicines?
Forgot to mention to dentist. Tried to
speak to dentist / health visitor but
dentist only available half day and
the health visit does not work today.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
Significant amount in milk; manufacturer advises avoid large single doses
eMC:
Flagyl should not be given during pregnancy or during lactation unless the
physician considers it essential; in these circumstances the short, highdosage regimens are not recommended.
Netdoctor:
This medicine passes into breast milk. It should be used with caution in
breastfeeding mothers and only if the expected benefit to the mother is
greater than any possible risk to the nursing infant. High dosage regimens
should be avoided unless the mother stops breastfeeding during the course.
Seek medical advice from your doctor.
UKMI Central:
Metronidazole
 (high dose)(eg IV or rectal) -Insufficient information relating to breastfeeding available to allow classification as a safe drug.
 (low dose)(eg oral 200-400mg tds) single course only - They either: Are
not excreted in breast milk. Are not absorbed by the infant. Give very low
levels in infant with no apparent effects.
 May change taste of breast milk
Role Preparation for Dental Nurse Advisors
May 2006
What advice
would you give?
Or would you
refer?
The information is conflicting – refer to MI
MI Service answer:
Breastfeeding mothers can be treated with low dose metronidazole courses
(200-400mg three times daily) without concern of untoward effects on the
nursing infant. Metronidazole may change the taste of the breast milk;
therefore the infant should be monitored for signs of poor feeding.
In general, medicines should be avoided by mothers’ breastfeeding
premature or low birth weight infants, or in infants who have any underlying
medical conditions. The decision to treat should always be based on a risk
versus benefit evaluation in each individual case.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 3: Adverse Drug Reactions
Case Scenario 1
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
Can you take Cuprofen if you have asthma?
PERSON
MEDICINES
Who is asking?
18 year old male
Medicines (name, dose, freq?):
Cuprofen Tablets Maximum
Strength
Why asking about Medicines?
Wisdom tooth coming through and Ventolin inhaler 2 puffs when
mum recommended Cuprofen but required (not used for over 6 months)
leaflet says not to be taken if
asthmatic
Any allergies/ medical conditions?
Asthmatic
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
Medicines Chest:
Tablets contain Ibuprofen 400mg
eBNF:
CSM warning (asthma)
Any degree of worsening of asthma may be related to the ingestion of
NSAIDs, either prescribed or (in the case of ibuprofen and others)
purchased over the counter.
eMC:
Caution should be exercised in administering ibuprofen to patients with
asthma and especially patients who have developed bronchospasm with
other non-steroidal agents.
Nedoctor:
Not to be used in people in whom aspirin or other NSAIDs, eg ibuprofen,
cause allergic reactions such as asthma attacks, itchy rash (urticaria), nasal
inflammation (rhinitis) or swelling of the lips, tongue and throat
(angioedema)
What advice
would you give?
Ibuprofen and other drugs like aspirin can cause allergic reactions such as
asthma in some individuals.
Or would you
refer?
If you haven’t taken ibuprofen or aspirin before then it may be best to
consider an alternative pain killer like paracetamol as this is safe in
asthmatics.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 3: Adverse Drug Reactions
Case Scenario 2
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
I’ve been prescribed a course of cephalexin capsules by my dentist is this
ok as I have a penicillin allergy?
PERSON
MEDICINES
Who is asking?
55 year old female about herself
Medicines (name, dose, freq?):
Cephalexin 500mg capsules three
times a day for 5 days
Why asking about Medicines?
Any allergies/ medical conditions?
Normal dentist on holiday and forgot Penicillin allergy – breathing
to mention about penicillin allergy
difficulties
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
The principal side-effect of the cephalosporins is hypersensitivity and about
10% of penicillin-sensitive patients will also be allergic to the
cephalosporins.
eMC:
Before instituting therapy with cefalexin, every effort should be made to
determine whether the patient has had previous hypersensitivity reactions to
the cephalosporins, penicillins, or other drugs. Cefalexin should be given
cautiously to penicillin-sensitive patients. There is some clinical and
laboratory evidence of partial cross-allergenicity of the penicillins and
cephalosporins. Patients have had severe reactions (including anaphylaxis)
to both drugs.
Netdoctor:
Use with caution in allergy to penicillin-type antibiotics
What advice
would you give?
Or would you
refer?
10% of patients who have an allergic reaction to penicillin antibiotics may
also have a reaction to a group of antibiotics called cephalosporins.
Cefalexin is a cephalosporin antibiotic.
Recommend that patient contacts dentist who may suggest a more suitable
antibiotic.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 3: Adverse Drug Reactions
Case Scenario 3
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
Previously I’ve been recommended to gargle aspirin when I have a sore
throat but my pharmacist won’t sell dispersible aspirin to me – why is this?
PERSON
MEDICINES
Who is asking?
64 year old male
Medicines (name, dose, freq?):
Omeprazole 20mg capsules once
daily
Why asking about Medicines?
Any allergies/ medical conditions?
When I last visited my dentist (at Peptic ulcer last year
least 2 years ago) he recommended
gargling with aspirin when I get a
sore throat. When I went to buy
some from the pharmacy the
pharmacist asked if I had any
stomach problems and when I said
I’d had an ulcer about a year ago
they said they couldn’t sell them to
me.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
All NSAIDs are associated with serious gastro-intestinal toxicity; All NSAIDs
(including selective inhibitors of cyclo-oxygenase-2) are contra-indicated in
patients with active peptic ulceration. The CSM also contra-indicates nonselective NSAIDs in patients with a history of peptic ulceration.
eMC:
4.3 Contraindications
A history of, or active peptic ulceration,
Netdoctor:
Not to be used in:
Peptic ulcer or a history of this
What advice
would you give?
Or would you
refer?
Aspirin and other drugs within the aspirin family have been associated with
serious gastrointestinal adverse effects. The manufacturer’s licence
prohibits aspirin being used by people who have previously had a peptic
ulcer. It may be better to either try a paracetamol based painkiller or a
mouthwash, which you could gargle with. Your dentist will be able to advise
on the most suitable product for your symptoms.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 4: Drug Interactions
Case Scenario 1
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
Can paracetamol and ibuprofen be taken together?
PERSON
MEDICINES
Who is asking?
Mom regarding 13 year old daughter
Medicines (name, dose, freq?):
Paracetamol 500mg – two tablets
every 6 hours
New or worsening symptoms?
Severe toothache
Allergies / Medical conditions?
None
Why asking about Medicines?
Daughter has severe toothache
which is not controlled with
paracetamol alone. The dentist is
not open until after the weekend and
she wondered whether she could
give ibuprofen as well as the
paracetamol.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
No interaction listed
cBNF:
Child 12-18years: 200-400mg 3-4 times daily preferably after food;
increased if necessary to max 2.4g daily
eMC:
No interaction listed
NHS Direct Common Health Questions:
There is no known harmful interaction between paracetamol and ibuprofen.
Paracetamol should always be the first choice as it has fewer side effects
than ibuprofen, so it is better to take paracetamol first and only to use
ibuprofen 1-2 hours later if the paracetamol has not worked in controlling
symptoms. Further doses can be taken at the same time if necessary (avoid
overdosing on either medicine).
What advice
would you give?
Or would you
refer?
There is no known harmful interaction between paracetamol and ibuprofen.
Paracetamol should always be the first choice as it has fewer side effects
than ibuprofen, so it is better to take paracetamol first and only to use
ibuprofen 1-2 hours later if the paracetamol has not worked in controlling
symptoms. Further doses can be taken at the same time if necessary (avoid
overdosing on either medicine).
The dose is that is acceptable for a child of 13 years according to the
children’s BNF is 200-400mg three – four times daily
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 4: Drug Interactions
Case Scenario 2
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
Is it okay to take amoxicillin whilst taking the pill?
PERSON
MEDICINES
Who is asking?
28 year old female - about herself
Medicines (name,dose,freq)?
Amoxil 500mg three times daily for 7
days
Cilest.
How many pills left? 12
Have you taken the antibiotic? No
New or worsening symptoms?
Dentist diagnosed a tooth infection
Any allergies/medical conditions?
No allergies. Asthma.
Why asking about medicines?
Forgot to check that doctor aware I
was taking the pill.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
Some broad-spectrum antibiotics (e.g.ampicillin, doxycycline) may reduce
the efficacy of combined oral contraceptives by impairing the bacterial flora
responsible for recycling of ethinylestradiol from the large bowel. FPA
advice is that additional contraceptive precautions should be taken whilst
taking a short course of a broad-spectrum antibiotic and for 7 days after
stopping. If these 7 days run beyond the end of a packet the next packet
should be started immediately without a break (in the case of ED tablets the
inactive ones should be omitted).
eMC / Cilest:
Irregular cycles and reduced reliability of oral contraceptives may occur
when used concomitantly with drugs such as antibiotics.
Netdoctor / Cilest:
The contraceptive effect of this medicine may be reduced when taken with:
 Antibiotic medicines such as penicillins
Tell your doctor if you are taking any of these medicines before starting the
pill. Barrier contraceptives such as condoms should be used whilst taking a
short course of antibiotics or and for 7 days after the course has finished.
Stockley 7th edition:
The oral contraceptive / penicillin interaction is controversial. The total
number of failures is extremely small. However, the personal and ethical
consequences of an unwanted pregnancy can be very serious. For this
reason the general advice is that a second (barrier) method of contraception
be used whilst taking the penicillin and for 7 days after finishing the course.
The FPA recommend that if the 7 days run beyond the end of the packet
then the new packet should be started without a pill-free break.
Role Preparation for Dental Nurse Advisors
May 2006
What advice
would you give?
Or would you
refer?
There is a risk that amoxicillin may stop the pill from working properly.
Advise to use a barrier method during the time that she is on the antibiotic
and for 7 days following the end of the course (i.e. 14 days).
As there are only 12 tablets left in the pack, start the next pack of pills
straight away without the 7-day pill free period. Explain that this is safe and
that she will not get the usual withdrawal bleed.
Further learning points
For questions about the contraceptive pill
 Ask how many pills are left in the pack
 Ask if the second medicine has already been taken. May need to assess the risk of
contraceptive failure.
Role Preparation for Dental Nurse Advisors
May 2006
Workshop 4: Drug Interactions
Case Scenario 3
Question
What further
background
information do
you need to
clarify the
question and
minimise the risks
when advising the
caller?
Can I take paracetamol with the tablets the doctor prescribed for my bad
back?
PERSON
MEDICINES
Who is asking?
76yr old male
Medicines (name, dose, freq?):
Solpadol caplets 1-2 tablets every 68 hours when required (actually only
taking 2 tablets at bed time as back
only aches at night)
Any allergies/ medical
conditions?
Allergy to aspirin
Paracetamol 500mg tablets
Why asking about Medicines?
Dentures have mad the inside of
mouth sore. Due to see the dentist
next week. Have tried Anbesol gel
and Bonjela but not working.
Gather the further background information BEFORE searching for information.
What information
sources would
you use?
eBNF:
Solpadol® Caplets, co-codamol 30/500 (codeine phosphate 30 mg,
paracetamol 500 mg).
Dose of paracetamol:
By mouth, 0.5–1 g every 4–6 hours to a max. of 4 g daily;
eMC:
Paracetamol:
Adults, the elderly and young persons over 12 years:
2 tablets every 4 hours to a maximum of 8 tablets in 24 hours.
Solpadol:
Patients should be advised not to exceed the recommended dose and not
take other paracetamol containing products concurrently.
What advice
would you give?
Or would you
refer?
Solpadol caplets contain paracetamol 500mg and codeine phosphate 30mg
per tablet. If you take another product containing paracetamol then you
should take no more than 1 gram of paracetamol (2 tablets of either
Solpadol or paracetamol) every 6 hours up to a maximum of 8 tablets of
paracetamol OR Solpadol NOT BOTH.
It may be better to visit your normal community pharmacist who may be able
to recommend something specific for denture pain.
Role Preparation for Dental Nurse Advisors
May 2006