Flashcards in E3: I'M NOT ON STEROIDS! Deck (63):
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)
What are the 4 main effects of Natural Cortisol?
1.Metabolism 2.Vascular Reactivity 3.Anti-Inflammatory 4.Homeostasis in stress
WHAT IS THE MOST POTENT ACTIVATOR of endogenous cortisol? What is the secondary activator?
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
What is the disease of INSUFFICIENT production of cortisol in the adrenal glands?
What is SECONDARY adrenal gland disorder caused by?
secondary disorder = HPA axis is suppressed due to taking glucocorticoid medications
What is more common? Addison's disease or Secondary Adrenal Insufficiency?
Secondary Adrenal Insufficiency is associated with:
Chronic STEROID use
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
What is the main sign of an acute secondary adrenal insufficiency in the dental operatory?
What are the three things that a patient could die from in an acute adrenal insufficiency?
1.Hypotension 2.Hypoglycemia 3.Hypothermia
What are the three things you would administer to a patient in a emergency adrenal insufficiency situation?
1.Glucocorticoids 2.Glucose 3.Epinephrine
What are the 3 main indications for Synthetic Glucocorticoids in medicine?
1.Autoimmune diseases 2. Organ Transplants (immunosuppresive) 3.Respirtatory disease
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
I freaking love MECH of ACTION's...Steroids-Steroid-receptor complex TRANSLOCATES into the ______ and alters _________
??I freaking love MECH of ACTION's...Steroids-Other effects of glucocorticoids are mediated by __________...producing vasodilation or bronchodilation
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
Adverse reactions of Steroid use are proportional to ____, frequency, time of administration and ______ of treatment
Steroid treatment is _______ rather than curative
Potency: Each steroid is rated as to potency as compared to a ________ equivalent dose
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
How are coritcoSteroid Products CHARACTERIZED?
Duration of Action
Relative anti-inflammatory activity and equivalent oral dose, with _________ arbitrarily assigned the value of 1
What are the 3 types of SHORT acting corticosteroids?
1.HydroCortisone 2.Prednisone 3.MethylPrednisone
Prednisone = anti-inflammatory activity of __...Prednisone has ___ times the anti-inflammatory action of __________
Equivalent doses are based on _____ mg hydrocortisone = amount normally secreted daily by an adult WITHOUT STRESS
What are the two examples of INTERMEDIATE acting corticosteroids?
What are two examples of LONG acting corticosteroids?
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)
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.
VERY INTERESTING: during stress adrenals may secrete up to ____ mg of hydrocortisone equivalent!
Any medication that EXCEEDS the amount of ___-___ mg hydrocortisone equivalent may cause adrenal gland suppression.
20-30 mg hydrocortisone equivalent
When on coritosteroids, AVOID aspirin and NSAIDS for consequence of ________
What are 3 (of 10) common side effects of chronic steroid use?
1.MOON FACE 2.CATARACTS 3.OSETEOPEROSIS(*leading risk factor)
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
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
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
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
What is the most common route of delivery for corticosteroids in dentistry? What is the max duration of use?
Topical...for 2 weeks.
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
*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)
An inflammatory lesion being treated with a topical corticosteroid should respond in ___ to ___ days.
"Other Topical Ointments": For Mild lichen planus, recurrent aphthous stomatitis- use:
"Other Topical Ointments": Fororal inflammation; apply with Q-tip- use: (its tot's popular)
"Other Topical Ointments": Apply with Q-tip- use:
Topical Rinses: elixer-
Topical Rinses: syrup-
Ranking Steroid Potency: What are the 2 low potency preparations?
hydrocortisone cream 1% (OTC) and 2.5% (Rx)
Ranking Steroid Potency: What is the 1 moderate prep?
1.TRI-AM-CIN-OLONE acetonide (0.025% and 0.1%)
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%)
What are the two methods of INJECTED steroids?
1.IntraLesional (no systemic effects) 2.Intra-articular (bone path)
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
CORTICOSTEROIDS ARE A PREGNANCY CATEGORY ___ DRUG. AVOID.
USE CORTICOSTEROIDS WITH EXTREME CAUTION IN _______ PATIENTS. They are more susceptible to suppression with Topicals and 5 mg can limit ______
Corticosteriods: Geriatric patients are more susceptible to _______ and _______ side effects.
hypertension and osteoperosis
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)
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
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
WHAT ARE THE NUMBERS THAT REPRESENT HYPOTENSION????
Systolic less than 100mmHg, Diastolic less than 60mmHg
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
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
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 :)