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Pharm II > Exam 3 Steroids > Flashcards

Exam 3 Steroids Flashcards

1
Q

2 uses in dentistry for steroids

A
  1. reduction of pain and swelling

2. tx of inflammatory pathologies of oral mucosa

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2
Q

8 uses in medicine for steroids

A
  1. autoimmune diseases
  2. immunosuppressive therapy in organ transplant patients
  3. respiratory disease management
  4. replacement therapy (adrenal insufficiency)
  5. arthritis
  6. rheumatic carditis
  7. allergic diseases (for anti-inflam. effect)
  8. collagen diseases (lupus erythematosus)
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3
Q

In dentistry, when steroids are used for the treatment of inflammatory pathologies of oral mucosa, specificially, what are 2 effects of this?

A
  1. suppress migration of PMNs

2. decreased capillary permeability

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4
Q

9 side effects of corticosteroids (non oral)

A
  1. insomnia
  2. peptic ulceration
  3. osteoporosis
  4. hyperglycemia
  5. cataract formation
  6. glaucoma
  7. redistribution of fat pads (moon face)
  8. growth suppression
  9. delayed wound healing
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5
Q

4 oral side effects of corticosteroids

A
  1. candidiasis (most common)
  2. poor wound healing (long term)
  3. masking of oral infections (bc its anti-inflam)
  4. xerostomia
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6
Q

9 populations most at risk for adverse effects of steroids

A
  1. CV disease/hypertension
  2. peptic ulcer/gastritis/esophagitis
  3. osteoporosis
  4. diabetes mellitus
  5. TB/infections
  6. psychological difficulties
  7. glaucoma
  8. pregnancy (category C)
  9. young/elderly
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7
Q

biggest complication associated with long term use of corticosteroids

A

poor wound healing

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8
Q

____ patients more susceptible to hypertension and ____ side effects, check to ensure adequate ___ function, and lower dose to limit ___ and ___ damage

A 
Geriatric
osteoporosis
liver
liver
kidney
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9
Q

Use with extreme caution in ___ patients, more susceptible to suppression with _____. __ mg can limit growth

A

pediatric
topicals
5mg

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10
Q

What are the 2 etiologies of adrenal insufficiency?

A
  1. excessive production of cortisol

2. Insufficient production of cortisol

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11
Q

What is the primary disorder that causing excessive production of cortisol?

A

cushing’s disease

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12
Q

What is the primary disorder that causing insufficient production of cortisol?

A

Addison’s disease - glands do not function

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13
Q

What is the secondary disorder that causes insufficient production of cortisol?

A

HPA (hypothalamic-pituitary adrenal) axis is suppressed due to taking glucocorticoid medications

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14
Q

Taking glucocorticoid medications (exogenous steroids) suppresses the body’s own production of ____ ____. More common than ____ disease. Associated with ____ steroid use. 60 cases per 1 million adults per year. Avg dental practice with 2000 patients will have at least __ patients who are chronic steroid users who have the potential for ____ ____. Condition usually does not produce symptoms unless the pt is significantly ____.

A 
exogenous steroids
Addison's
chronic
50
adrenal insufficiency
stressed
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15
Q

13 signs/symptoms of adrenal crisis

A
  1. sunken eyes
  2. profuse sweating
  3. hypotension
  4. weak pulse
  5. dyspnea
  6. cyanosis
  7. headache
  8. dehydration
  9. fever
  10. myalgias
  11. arthralgias
  12. hyponatremia
  13. eosinophilia
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16
Q

Without treatment, adrenal crisis will continue to decline and lead to what 5 things?

A
  1. hypothermia
  2. severe hypotension
  3. hypoglycemia
  4. circulatory collapse (SHOCK)
  5. death
17
Q

Treatment for adrenal crisis, name 5 things

A
  1. elevate patients feet above head
  2. IV glucocorticoids
  3. Fluid and electrolyte replacement therapy
  4. Administration of vasopressors (epi)
  5. Monitor BP carefully
18
Q

4 important factors in risk for adrenal crisis when trying to manage treatment in a dental office

A
  1. severity of surgery
  2. drugs administered during procedure
  3. overall health of the patient
  4. extent of pain control
    (additional factors
  5. amount of blood loss - hypotention
  6. fasting state - hypoglycemia)
19
Q

3 clinical considerations when planning a dental surgery on a pt with adrenal insufficency

A
  1. surgeries that last longer than 1 hour
    2, blood and fluid loss exaverbate hypotension
  2. Monitor BP (
20
Q

5 routes of delivery for steroids

A
  1. topical
  2. ointments/gels
  3. rinses
  4. injected
  5. systemic oral
21
Q

____ - most common delivery route in dentistry, when used for

A 
Topical
adverse effects
 2 weeks
adrenal suppression
least
22
Q

Ointments/gels - applied _____ with a cotton tip to reduce cross contamination. Apply after brushing, ____/____ and at bedtime. Do not take anything by mouth for at least ___ minutes following application. Can also be placed in ____ to prolong contact with lesion. ___ adheres best. Lesions usually respond in_____ days Ointments are usually mixed with _____ adhesive to prolong contact.

A 
intraorally
eating/drinking
30
mouthguards
gel
7-14 
tissue
23
Q

Name the 4 intraoral steroid gels/ointments discussed in class

A
  1. triamcinolone (Kenalong in Orabase)
  2. flucinonide (Lidex)
  3. clobetasol proprionate (Temovate)
  4. betamethasone valerate (Valisone)
24
Q

Which steroid gel treats mild lichen planus and recurrent aphthous stomatitis?

A

fluocinonide (Lidex)

25
Q

What topical rinses is used 2-4x per day and rinsed for 30 seconds at a time?

A

dexamethasone (Decadron) elixir or prednisolone syrup

26
Q

2 types of injected steroids

A
  1. intralesional - used intermittently with no systemic complications
  2. Intra-articular - used at 3 week intervals to treat bone pathologies
27
Q

____ - most likely to cause adrenal suppression. Used before during and after oral surgery to ___ ___.

A

Systemic

reduce swelling

28
Q

Name 2 oral steroids used in dentistry

A
  1. methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)

2. prednisone (Prednisone Intensol, Sterapred)

29
Q

Cortisol increases are not typically seen ___ or ___ the procedure. Increase in postoperative period __ to __ hours after procedure has begun, most likely a response to ___, correlates with loss of local ____, improves with use of _____ and anti-anxiety meds.

A 
before or during
1 to 5
pain
anesthesia
analgesics
30
Q

If patient has a history of steroid use and a large surgery is planned, what 2 things should be done?

A

Physician consult

Lab testing

31
Q

what 3 tests are looked for when testing for adrenal sufficiency before an invasive surgery?

A
  1. basal plasma ACTH & cortisol levels
  2. urine tests
  3. stimulation tests
    If adrenal insufficient, implement steroid supplementation
32
Q

If a patient is currently taking a steroid and minimally invasive procedure is planned, what 4 things should be done?

A
  1. pt takes usual daily dose
  2. schedule pt first thing in morning
  3. stress reduction protocol
  4. monitor BP
33
Q

2 things that can be done to help reduce stress in a patient taking steroids?

A
  1. nitrous oxide
  2. benzodiazepines (valium)
    (these drugs have no effect on cortisol levels)
34
Q

What is the target dose of hydrocortisone per day for minor oral surgeries and major surgeries involving general anesthesia?

A

Minor - 25 mg

Major 50-100 mg

Pharm II (18 decks)

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