Lecture 1- Exam 2 Flashcards by Abagayle Moody

Regulate water and electrolyte balance

mineralocorticoids

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What is produced in the zona glomerulosa?

mineralocorticoids

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What is the main hormone produced by the adrenal glands?

aldosterone

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

aldosterone

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

aldosterone

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

aldosterone

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Aldosterone works on specific receptors in the:

kidney

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

Fludrocortisone (Florinef)

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Fludrocortisone (Florinef) is a:

mineralocorticoid (drug)

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Fludrocortisone (Fluorinef) is functionally similar to:

aldosterone

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Most mineralocorticoid effect of available steroid:

Fludrocortisone (Florinef)

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Replacement therapy: Addison’s diseases/adrenal insufficiency

Fludrocortisone (Florinef)

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Inbalances in aldosterone and overactivity of the mineralocorticoid receptor contribute to:

(too much aldosterone)

HTN
Kidney insufficieny
Heart failure
Other cardiovascular diseases

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Our two steroidal drugs that function as competitive aldosterone antagonists (used when we have too much aldosterone)

Spironolactone (Aldactone)
Eplerenone (Inspra)

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These drugs are also known as potassium sparing diuretics:

Spironolactone (Aldactone)
Eplerenone (Inspra)

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

hyperaldosteronism (secondary cause of hypertension and causes low potassium)
heart failure
hypertension

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Drug that inhibits aldosterone (non-steroidal)

(when we have too much aldosterone)

Finerenone (Kerendia)

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Non-steroidal drug that inhibits aldosterone (Finerenone/ Kerendia) is only indicated in:

Type 2 diabetics with CKD

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Endogenously produced in the Zona Fasiculada:

Glucocorticoids

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Glucocorticoids work in both ____ & ____ function

metabolic
immune

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Glucocorticoids =

corticosteroids

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Main endogenous hormone produced in Humes:

hydrocortisone (cortisol)

The highest concentration of cortisol occurs:

in the mornings

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

most are used for anti-inflammatory and immunosuppressive properties

Use of steroids in dentistry/facial indications:

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

What is Kenalog

dental topical corticosteroid

What are two important factors when using dental topical corticosteroid (Kenalog)?

1. Contact time with lesion 2. Patient education

The efficacy of a dental topical steroid is based on:

contact time with lesion

The main steroid dosing consideration =

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

What is the timeframe of steroid usage that requires taper dose?

longer than 14 days

Relative potencies and equivalent doses of common corticoid steroids key points:

1. Take in the 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

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

to mimic circadian rhythm

Less than 10mg per day of prednisone:

Low dose

10-20mg per day of prednisone:

Moderate dose

Greater than 20mg per day of prednisone:

High dose

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

Minimize insomnia and mimic endogenous steroid production (higher in the morning)

Give an example of dental scenario when we might use IV steroids?

Intra-operative procedures (such as 3rd molars)

When providing supra physiologic doses of corticosteroids (greater than 25-30mg of hydrocortisone/cortisol equivalents) X 14 days or more =

HPA Axis Suppression

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:

True

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

20-25mg hydrocortisone equivalents (po)

Acute adverse affects to long-term effects of corticosteroids:

1. CV (tachy, HTN) 2. DERM (acne, delayed wound healing, facial flushing) 3. Endo (hyperglycemia) 4. GI (abdominal distention, diarrhea, constipation, heartburn, increased appetite, peptic ulcers, and GI bleeds) 5. Infection (suppression of response to infection & opportunistic effects) 6. Neuro (anxiety, insomnia, mood swings, euphoria, hallucinations, depression) 7. Bone (osteoporosis) 7. Muscle (muscle wasting & weakness) 9. Growth (inhibition in children) 10. Eyes (glaucoma & genetically disposed increased cataracts) 11. Adrenal Suppression (sudden withdrawal- acute adrenal insufficiency) 12. Cushing Syndrome (abnormally high levels of cortisol)

Corticosteroid drug interactions:

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 cardiac absorption in food 5. absorption of glucocorticoids is decreased in presence of St. John's wort.

Corticosteroid Contraindications:

1. severe infections 2. severe hypertension 3. severe heart failure 4. sebere renal impairment

What are the oral drug therapies used for HYPERthyroidism?

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

Inhibits biosynthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland; blocks synthesis of thyroxine (T4) and triiodothyronine (T3); does NOT inactive circulating form of T4 and T3

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

Term used for severe HYPOthyroidism:

Myxedema

Most common therapy for HYPOthyroidism:

Levothyroxine/Synthroid (synthetic T4)

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

coronary artery disease

In patients with HYPOthyroidism, the most common drug prescribed is Levothyroxine/Synthroid which is:

synthetic T4

What directions are given to a patient taking Levothyroxine/Synthroid?

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

Dental implications of HYPERthyroidism:

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

Dental implications of HYPOthyroidism:

increased respiratory and cardiac depression with sedatives/CNS depressants such as benzodiazepines, barbiturates and opiod analgesics