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Flashcards in Exam 3 Steroids Deck (34):
1

2 uses in dentistry for steroids

1. reduction of pain and swelling
2. tx of inflammatory pathologies of oral mucosa

2

8 uses in medicine for steroids

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)

3

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

1. suppress migration of PMNs
2. decreased capillary permeability

4

9 side effects of corticosteroids (non oral)

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

5

4 oral side effects of corticosteroids

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

6

9 populations most at risk for adverse effects of steroids

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

7

biggest complication associated with long term use of corticosteroids

poor wound healing

8

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

Geriatric
osteoporosis
liver
liver
kidney

9

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

pediatric
topicals
5mg

10

What are the 2 etiologies of adrenal insufficiency?

1. excessive production of cortisol
2. Insufficient production of cortisol

11

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

cushing's disease

12

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

Addison's disease - glands do not function

13

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

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

14

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 ____.

exogenous steroids
Addison's
chronic
50
adrenal insufficiency
stressed

15

13 signs/symptoms of adrenal crisis

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

16

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

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

17

Treatment for adrenal crisis, name 5 things

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

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

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

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

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

20

5 routes of delivery for steroids

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

21

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

Topical
adverse effects
2 weeks
adrenal suppression
least

22

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.

intraorally
eating/drinking
30
mouthguards
gel
7-14
tissue

23

Name the 4 intraoral steroid gels/ointments discussed in class

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

24

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

fluocinonide (Lidex)

25

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

dexamethasone (Decadron) elixir or prednisolone syrup

26

2 types of injected steroids

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

27

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

Systemic
reduce swelling

28

Name 2 oral steroids used in dentistry

1. methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol)
2. prednisone (Prednisone Intensol, Sterapred)

29

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.

before or during
1 to 5
pain
anesthesia
analgesics

30

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

Physician consult
Lab testing

31

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

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

32

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

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

33

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

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

34

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

Minor - 25 mg
Major 50-100 mg