3 - Steroids Flashcards Preview

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Flashcards in 3 - Steroids Deck (27):
1

What are the functions of natural cortisol?

  • Regulation of carbohydrate, fat and protein metabolism
  • Maintenance of vascular reactivity
  • Anti-inflammatory
  • Homeostasis during stress

2

What is the most potent activator of stress?

Surgery

& pain cause an increased level of endogenous cortisol

3

What are the diseases of excess and insufficient cortisol production?

  • Excess
    • Cushing's disease (primary)
  • Insufficient 
    • Addison's disease (primary)
    • Secondary = HPA axis suppressed from taking glucocorticoids

4

What causes a secondary disorder of adrenal insufficiency?

Secondary = HPA axis suppressed from taking glucocorticoids

5

What are the common signs of adrenal crisis?

  • Profuse sweating
  • Hypotension
  • Weak pulse
  • Dyspnea
  • Cyanosis

6

What are synthetic glucocorticoid medications indicated for?

  • Autoimmune diseases
  • Immunosuppressive therapy - organ transplant
  • Respiratory disease management

7

What's the mechanism of action of steroids?

  • Anti-inflammatory effects
    • Peripheral leukocytes decrease
  • Inhibits phospholipase A
    • Lowers prostaglandins and leukotrines

8

How are steroids rated?

As to potency compared to hyrdocortisone equivalent dose

9

The more potent the steroid - The...?

  • lower the dose
  • higher the risk for adrenal suppression

10

How are equivalent doses based?

On 20mg hydrocortisone = amount normally secreted daily by an adult without stress

11

What are the short acting corticosteroids?

  • hydrocortisone 
  • prednisone
  • methylprednisolone

12

What are the intermediate acting corticosteroids?

  • triamcinolone
  • prednisolone

13

What are the long acting corticosteroids?

  • dexamethasone
  • betamethosone

14

What is alternate day therapy used with steroids used for?

Patients who must take steroids for longer than 1 month

15

Any medication that exceeds the normal adrenal output amount of cortisol may cause suppression, what is that dosage?

20-30 mg

16

What are the contraindications with steroids?

  • Systemic fungal infections
  • Viral infections - oral herpes lesions
  • Latent or active TB
  • Allergy 

17

How are steroids used in dentistry?

  • Reduction of pain and swelling
  • Treatment of inflammatory pathologies of oral mucosa

18

What is the most common route of delivery of steroids in dentistry?

Topical

19

How long can you use high potency topicals?

Only for 2 weeks

20

What are some steroids ointments/topicals used?

  • traimcinolone (Kenalog in Orabase)
  • fluocinonide (lidex) - lichen planus
  • clobetasol proprionate (Temovate) - oral inflammation
  • betamethasone 

21

What are the preps of topical rinses of steroids?

  • dexamethasone (Decadron) elixer
  • prednisolone syrup

22

What are some special considerations of oral steroids?

  • Avoid in pregnant/lactating women - Category C
  • Extreme caution with pediatric patients
  • Geriatric patients more susceptible to hypertension and osteoporosis side effects

23

What are the common oral side effects of steroids?

  • Candidiasis - most common
  • Poor wound healing
  • Masking of oral infections
  • Xerostomia

24

What are the 4 important factors that increase risk for adrenal crisis perioperatively?

  1. Severity of surgery
  2. Drugs administered
  3. Overall health
  4. Extent of pain control

25

Why do you wait 2 weeks after steroids are discontinued prior to intiating any invasive procedure?

To ensure HPA axis is functioning normally

Persists up to 2 years, following as little as 2 weeks of steroid therapy - stress response returns after 2 weeks

26

How do you treat a patient that is currently taking steroids?

  • Patient takes usual dose
  • Schedule first thing in morning
  • Stress reduction protocol
  • Monitor blood pressure

27