Lecture 1- Exam 2

Question 1

Regulate water and electrolyte balance:

Answer 1

Mineralocorticoids

Question 2

What is produced in the zona glomerulosa?

Answer 2

Mineralocorticoids

Question 3

Main hormone produced by adrenal glands?

Answer 3

Aldosterone

Question 4

Essential hormone for blood pressure regulation and electrolyte and fluid homeostasis:

Answer 4

Aldosterone

Question 5

Increases Na+ reabsorption by distal tubules in kidney with concomitant increased excretion of K+ and H+:

Answer 5

Aldosterone

Question 6

Hormone that increases BP and blood volume- balance/control the amount of sodium and fluids in the body:

Answer 6

Aldosterone

Question 7

Aldosterone works on specific receptors in the:

Answer 7

Kidney

Question 8

Main drug used when adrenals of the kidneys don’t produce enough aldosterone:

Answer 8

Fludrocortisone (Florinef)

Question 9

Fludrocortisone (Floridnef) is a:

Answer 9

Mineralocorticoid drug

Question 10

Fludrocorticone (Florinef) is functionally similar to:

Answer 10

Aldosterone

Question 11

Most mineralocorticoid effect of available steroids:

Answer 11

Fludrocortisone (Florinef)

Question 12

Replacement therapy for Addison’s disease/adrenal insufficiency:

Answer 12

Fludrocortisone (Florinef)

Question 13

Imbalances in aldosterone and OVERactivity of the mineralocorticoid receptor contribute:

(too much aldosterone)

Answer 13

1. HTN
2. Kidney insufficiency
3. heart failure
4. other cardiovascular diseases

Question 14

Our two steroidal drugs that function as competitive aldosterone antagonist:

(Used when too much aldosterone production)

Answer 14

1. Spironolactone (Aldactone)
2. Eplerenone (Inspire)

Question 15

These drugs are also known as potassium sparing diuretics:

Answer 15

1. Spironolactone (Aldactone)
2. Eplerenone (Inspire)

Question 16

Common indications for the drugs:
1. Spironolactone (Aldactone)
2. Eplerenone (Inspire)

Answer 16

1. Hyperaldosteronism (secondary cause of HTN & causes low potassium)
2. Heart failure
3. HTN

Question 17

Drug that inhibits aldosterone (nonsteroidal):

(used w too much aldosterone)

Answer 17

Finerenone (kerendia)

Question 18

Nonsteroidal drug that inhibits aldosterone (Finerenone/Kerendia) is only indicated in:

Answer 18

Type II diabetics with CKD

Question 19

Endogenously produced in the zona fasiculata:

Answer 19

Glucocorticoids

Question 20

Glucocorticoids work in both ____ and ___ functions

Answer 20

-metabolic
-immune function

Question 21

Glucocorticoids=

Answer 21

Corticosteroids

Question 22

Main endogenous hormone in humans:

Answer 22

Hydrocortisone (cortisol)

Question 23

The highest concentration of cortisol occurs:

Answer 23

In the morning

Question 24

Why are corticosteroids GOOD/why would we use them in treatment?

Answer 24

Most are used for anti-inflammatory and immunosuppressive properties

Question 25

Use of steroids in dentistry/facial indications:

Answer 25

Used for anti-inflammatory, pain management and auto-immune properties

Question 26

What is Kenalog?

Answer 26

-Dental topical corticosteroid

Question 27

What are two important factors when using dental topical corticosteroids like Kenalog?

Answer 27

1. contact time with lesion 2. patient education

Question 28

The efficacy of a topical steroid is based on:

Answer 28

Contact time with lesion

Question 29

The main steroid dosing consideration:

Answer 29

If patient on systemic therapy longer than 14 days taper dose off. DO NOT STOP ABRUPTLY-- use taper

Question 30

What is the time frame of steroid usage that requires taper dose?

Answer 30

Longer than 14 days

Question 31

Relative potencies and equivalent doses of common corticosteroids key points:

Answer 31

1. take in morning if taking orally once a day 2. take with food if taking orally 3. if given for chronic adrenal insufficiency, may need to give 2/3 dose in AM and 1/3 dose in PM

Question 32

Why do we tend to reccomend taking oral steroids in the morning if taken once a day?

Answer 32

To mimic circadian rhythm

Question 33

Less than 10mg of prednisone/day:

Answer 33

Low dose

Question 34

10-20mg of prednisone/day:

Answer 34

Moderate dose

Question 35

Greater than 20mg of prednisone/day:

Answer 35

High dose

Question 36

If patient on prednisone has to split dose, we recommend they take second dose mid day because:

Answer 36

minimize insomnia and mimic endogenous steroid production (higher in morning)

Question 37

Give an example of a dental scenario in which we might use IV steroids:

Answer 37

Intraoperative procedures (such as 3rd molars)

Question 38

When providing supraphysiologic doses of corticosteroids (greater than 25-35mg of hydrocortisone/cortisol equivalents) X 14 days or more=

Answer 38

HPA axis suppression

Question 39

T/F: Current evidence shows that routine dental care and minor oral surgical procedures under local anesthesia, including uncomplicated dental extractions, DO NOT increase stress levels enough to precipitate an adrenal crisis:

Answer 39

True

Question 40

Give an example of how you might dose steroids in a patient at highest risk (addisons disease) undergoing major dental surgery with general anesthesia (considered steroid cover):

Answer 40

10-25 mg hydrocortisone equivalents PO

Question 41

Acute adverse effects to long-term effects of corticosteroids:

Answer 41

-CV (Tachy, HTN) -DERM: (acne, delayed wound healing, facial flushing) -ENDO: (hyperglycemia) -GI: (abdominal distention, diarrhea, constipation, heartburn, increased appetite, peptic ulcers, and GI bleeds) -INFECTION: (suppression of response to infection, opportunistic effects) -NEURO: (anxiety, insomnia, mood swings, euphoria, hallucinations, depression) -BONE: (osteoporosis) -Muscle: (muscle wasting and weakness) GROWTH: (inhibition in children) -EYES: (glaucoma in genetically predisposed, increased cataracts) -ADDRENAL SUPPRESION: (Sudden withdrawal, acute adrenal insufficiency) -CUSHING SYNDROME (abnormally high levels of cortisol)

Question 42

Corticosteroid drug interactions:

Answer 42

1. Increased prothrombin time/INR with warfarin 2. Risk of hypokalemia with potassium-depleting diuretics, hydrochlorothiazide, others 3. Increased risk of cardiac toxicity and arrhythmias with cardiac glycosides (digoxin) 4. Interferes with calcium absorption in food 5. Absorption of glucocorticoids is decreased in presence in presence of St. Johns wort

Question 43

Corticosteroid contraindications:

Answer 43

1. severe infections 2. severe HTN 3. severe heart failure 4. severe renal impairment

Question 44

What are the oral drug therapies used for HYPERthyroidism:

Answer 44

1. Propylthiouracil (PTU) 2. Methimazole (MMI)

Question 45

Inhibits biosynthesis of thyroid hormones by blocking oxidation of iodine in the thyroid gland; blocks synthesis of thyroxine (T4) and tri-iodothyronine (T3); does NOT inactivate circulating form of T4 and T3 :

Answer 45

1. Propylthiouracil (PTU) 2. Methimazole (MMI) (oral hyperthyroidism drugs)

Question 46

Term used for severe HYPOthyroidism:

Answer 46

Myxedema

Question 47

Most common therapy for HYPOthyroidism:

Answer 47

Levothyroxine/synthroid (synthetic T4)

Question 48

Lower doses of levothyroxine/synthroid should be given in patients with:

Answer 48

Coronary artery disease

Question 49

In patients with hypothyroidism, the most common drug prescribed is levothyroxine/synthroid which is:

Answer 49

synthetic T4

Question 50

What directions are given to a patient taking levothyroxine/synthroid?

Answer 50

Take on an empty stomach 30-60min before meals in morning and before other medications!

Question 51

Dental implications of hyperthyroidism:

Answer 51

1. increased sensitivity to sympathomimetic drugsvasopressors such as epinephrine 2. decreased effectiveness of/increased tolerance to sedatives/CNS depressants

Question 52

Dental implications of hypothyroidism:

Answer 52

increased respiratory and cardiac depression with sedatives/CNS depressants wuch as benzodiazepine, barbituates and opioid analgesics