E3: I'M NOT ON STEROIDS! Flashcards Preview

Pharm Part II > E3: I'M NOT ON STEROIDS! > Flashcards

Flashcards in E3: I'M NOT ON STEROIDS! Deck (63):
1

Which hormone and class is for the maintenance of homeostasis during periods of STRESS...Maintains stability during Emotional stress and/or Physical stress

Cortisol (a glucocorticoid)

2

What are the 4 main effects of Natural Cortisol?

1.Metabolism 2.Vascular Reactivity 3.Anti-Inflammatory 4.Homeostasis in stress

3

WHAT IS THE MOST POTENT ACTIVATOR of endogenous cortisol? What is the secondary activator?

SURGERY...pain

4

What is the name of EXCESSIVE cortisol disease? also it is a disorder of what body organ?

Excessive: CUSHING's disease...disorder of the Adrenal Gland

5

What is the disease of INSUFFICIENT production of cortisol in the adrenal glands?

Addison's Disease

6

What is SECONDARY adrenal gland disorder caused by?

secondary disorder = HPA axis is suppressed due to taking glucocorticoid medications

7

What is more common? Addison's disease or Secondary Adrenal Insufficiency?

2ndary

8

Secondary Adrenal Insufficiency is associated with:

Chronic STEROID use

9

What is the most dangerous aspect about secondary adrenal insufficiency in the dental practice? But thank God it is relatively ______ to have a medical emergency!

It does not usually produce symptoms unless the Pt is highly stressed!..>RARE

10

What is the main sign of an acute secondary adrenal insufficiency in the dental operatory?

Hypotension

11

What are the three things that a patient could die from in an acute adrenal insufficiency?

1.Hypotension 2.Hypoglycemia 3.Hypothermia

12

What are the three things you would administer to a patient in a emergency adrenal insufficiency situation?

1.Glucocorticoids 2.Glucose 3.Epinephrine

13

What are the 3 main indications for Synthetic Glucocorticoids in medicine?

1.Autoimmune diseases 2. Organ Transplants (immunosuppresive) 3.Respirtatory disease

14

Besides the more obvious uses for steroid use in systemic disease (like ARTHRITIS) what are the five other indications?

1.Replacement therapy (adrenal insufficiency) 2.Rheumatic CARDITIS 3.Renal Diseases 4.Collagen Diseases 5.Allergic diseases

15

I freaking love MECH of ACTION's...Steroids-Steroid-receptor complex TRANSLOCATES into the ______ and alters _________

nucleus....gene expression

16

??I freaking love MECH of ACTION's...Steroids-Other effects of glucocorticoids are mediated by __________...producing vasodilation or bronchodilation

catecholamines

17

What is the main mechanism of action for steroids? What are the 3 ways it takes care of this action?

ANTI-Inflammatory--1.Effecting Peripheral Leukocytes (increase neutrophils, decrease everything else) 2.Inhibit phospholipase A 3.inhibit IL's n stuff

18

Adverse reactions of Steroid use are proportional to ____, frequency, time of administration and ______ of treatment

dose...duration

19

Steroid treatment is _______ rather than curative

palliative

20

Potency: Each steroid is rated as to potency as compared to a ________ equivalent dose

hydrocortisone

21

WHICH type of steroid administration/application is least likely to cause ADRENAL SUPPRESSION? Therefore, _______ steroids are more likely to cause adrenal suppression.

Topical Application...systemic steroids more likely

22

How are coritcoSteroid Products CHARACTERIZED?

Duration of Action

23

Relative anti-inflammatory activity and equivalent oral dose, with _________ arbitrarily assigned the value of 1

HYDRO-CORTISONE (cortisol)

24

What are the 3 types of SHORT acting corticosteroids?

1.HydroCortisone 2.Prednisone 3.MethylPrednisone

25

Prednisone = anti-inflammatory activity of __...Prednisone has ___ times the anti-inflammatory action of __________

4...4....hydrocortisone(cortisol)

26

Equivalent doses are based on _____ mg hydrocortisone = amount normally secreted daily by an adult WITHOUT STRESS

20 mg

27

What are the two examples of INTERMEDIATE acting corticosteroids?

1.TRI-AM-CIN-OLONE 2.Prednis-OLONE

28

What are two examples of LONG acting corticosteroids?

1.DEXA-meth-a-sone 2.BETA-meth-a-sone

29

Dosing corticosteroids: drugs are taken in what part of the day? With what type of daily pattern? (used for pts on these drugs for more than ____ in time)

MORNING....alternate day pattern...(longer than 1 month)

30

What does the "alternate day therapy" do for the adrenal gland function?

Allows adrenal gland to function normally on the off day of the drug.

31

VERY INTERESTING: during stress adrenals may secrete up to ____ mg of hydrocortisone equivalent!

300 mg

32

Any medication that EXCEEDS the amount of ___-___ mg hydrocortisone equivalent may cause adrenal gland suppression.

20-30 mg hydrocortisone equivalent

33

When on coritosteroids, AVOID aspirin and NSAIDS for consequence of ________

peptic ulcerations

34

What are 3 (of 10) common side effects of chronic steroid use?

1.MOON FACE 2.CATARACTS 3.OSETEOPEROSIS(*leading risk factor)

35

What are the 4 ORAL side effects of steroids?? whats MOST common?

1.Candidiasis(MOST COMMON) 2.Poor wound healing 3.masking of oral infections 4.Xerostomia

36

What are the 4 contraindications to steroids? (haha besides peptic ulcers/other side effects)

1.Systemic Fungal Infections 2.Viral INfections 3.Latent/active TB 4.Allergy to meds

37

BIG FlashCard!!!! WHAT ARE THE 2 MAIN INDICATIONS for Steroid use in Dentistry? What are the 2 mechanisms by which it does this?

1.Reduce pain and swelling 2.tx inflammatory path of oral mucosa....1.suppress migration of PMNs 2.Reverse capillary permeability

38

So, one of the indications for steroid use in dentistry is tx of oral inflammatory conditions, what are 3 (of the 6) examples?

1.Lichen Planus 2.Apthous Ulcers 3.TMJ disorders

39

What is the most common route of delivery for corticosteroids in dentistry? What is the max duration of use?

Topical...for 2 weeks.

40

When teaching Pts about topical steroid use: use a _____ tip, put on after _____, and don't do anything oral for ___ minutes

cotton tip.....brushing/eating/drinking/bedtime...30 minutes

41

*Everyone should know* What is the corticosteroid that Crest added adhesive for prolonged oral contact?

TRI-AM-CIN-OLONE (KEN-A-LOG in ORA-BASE)

42

An inflammatory lesion being treated with a topical corticosteroid should respond in ___ to ___ days.

7-14 days

43

"Other Topical Ointments": For Mild lichen planus, recurrent aphthous stomatitis- use:

FLU-O-CIN-O-NIDE

44

"Other Topical Ointments": Fororal inflammation; apply with Q-tip- use: (its tot's popular)

CLO-BETA-SOL PRO-PRI-ON-ATE

45

"Other Topical Ointments": Apply with Q-tip- use:

BETA-METHA-SONE

46

Topical Rinses: elixer-

DEXA-METHA-SONE

47

Topical Rinses: syrup-

PRED-NIS-OLONE

48

Ranking Steroid Potency: What are the 2 low potency preparations?

hydrocortisone cream 1% (OTC) and 2.5% (Rx)

49

Ranking Steroid Potency: What is the 1 moderate prep?

1.TRI-AM-CIN-OLONE acetonide (0.025% and 0.1%)

50

Ranking Steroid Potency: What are the 3 HIGH preps?

1.TRI-AM-CIN-OLONE acetonide (0.5%) 2.FLU-O-CIN-O-NIDE (0.05%) 3.CLO-BETA-SOL (0.05%)

51

What are the two methods of INJECTED steroids?

1.IntraLesional (no systemic effects) 2.Intra-articular (bone path)

52

What are the two examples of orally taken steroids used before, during and after oral surgery?

1. Methyl-Pred-Nis-O-Lone 2.Pred-nis-one

53

CORTICOSTEROIDS ARE A PREGNANCY CATEGORY ___ DRUG. AVOID.

C

54

USE CORTICOSTEROIDS WITH EXTREME CAUTION IN _______ PATIENTS. They are more susceptible to suppression with Topicals and 5 mg can limit ______

PEDIATRIC...growth

55

Corticosteriods: Geriatric patients are more susceptible to _______ and _______ side effects.

hypertension and osteoperosis

56

Other than _____________, few DENTAL procedures warrant use of supplemental steroids before, during, or after the operative period

major surgical procedures (Routine dental procedures do not stimulate cortisol production at levels comparable to those produced at time of surgery)

57

Cortisol increases are not typically seen BEFORE or DURING the procedure: increase in postoperative period __ to _______ after procedure has begun...Correlates with loss of _________....Improves with use of analgesics and anti-anxiety meds


1 to 5 hours...local anesthesia

58

4 Factors that increase risk for POST OP Adrenal Crisis: Wait. 2 additional factors :)

1.Severity of surgery 2.Drugs administered 3.overall health of Pt. 4.extent of pain control....5. blood loss 6.fasting

59

WHAT ARE THE NUMBERS THAT REPRESENT HYPOTENSION????

Systolic less than 100mmHg, Diastolic less than 60mmHg

60

What are three types of tests we can use for Pts with a Hx of steroid use?

1.Plasma ACTH & Cortisol Levels 2.urine 3.Stimulation

61

For a Pt currently on steroids: Patient takes usual daily ____....Schedule patient _________....______ reduction protocol (Pain control, Anxiety control)....Monitor blood pressure

dose...first thing in morning...Stress

62

Do I SUPPLEMENT Steroids? Routine dental procedures (excluding extractions)---Patients currently taking steroids: _____,Use good pain and anxiety control......Patients with history of regular steroid use: _____........Patients currently using topical or inhaled steroids: _____

None, None, and None :)

63

Target dose of ____ mg hydrocortisone per day for minor oral and PERIODONTAL surgery

25 mg