Lecture 4- Endocrine & Metabolic disease Flashcards
(153 cards)
1
Q
The hormones of the adrenal cortex are to maintain:
A
BP
2
Q
Related to lack of beta cell pancreatic production of insulin:
A
DM
3
Q
Up to 90% of DM cases are:
A
Type II
4
Q
For those that are pregnant, there is a 2-10% risk of getting:
A
Gestational diabtetes
5
Q
For a pregnant patient who gets diabetes, they are at an increased risk of _____ in the future
A
Type II DM
6
Q
Insulin is needed for _____ into cells
A
sugar absorption
7
Q
A lack of insulin leads to increased _____ aka ____
A
serum glucose; hyperglycemia
8
Q
What does hyperglycemia result in? (think tissues)
A
Results in undernourished tissues
9
Q
What is responsible for producing insulin?
A
Beta cells of pancreas
10
Q
T/F: You can get Type 1 DN at the age of 64
A
True
11
Q
How many people are type 1 diabetics?
A
10-20% of diabetics are Type 1
12
Q
Insulin dependent-
A
Type 1
13
Q
Type 1 diabetes is considered a ___ disease
A
autoimmune
14
Q
In Type 1 diabetes what leads to the insulin deficiency?
A
Destruction of pancreatic beta cells (insulin producing cells)
15
Q
Type 1 diabetes onset is broken down into 3 stages. Which stages are symptomatic and which are symptomatic?
A
Stage 1&2: asymptomatic
Stage 3: symptomatic
16
Q
Describe how diabetes presents at the MICROVASCULAR level:
A
- neuropathy
- retinopathy
- nephropathy
(microvascular = opathy(s))
17
Q
Where are some areas that diabetics can experience neuropathy:
A
- extremeties
- bladder
- gastroparesis
- impotence
18
Q
Describe the effects of retinopathy:
A
- cataracts
- blindndess
19
Q
Describe how diabetes presents at the MACROVASCULAR level:
A
- peripheral vascular disease
- CHF
- HTN
- MI
- Stroke
20
Q
Why might see a diabetic patient having an increased risk for MI?
A
Diabetes accelerates atherosclerosis
21
Q
Describe diabetes affects on the bodies ability to heal itself:
A
DM causes impaired wound healing & susceptibility to infection
22
Q
Diabetic patients release ____ which breaks down soft tissue and contribute to the impaired wound healing ability seen in these patients
A
collagenase
23
Q
Reasons why diabetics struggle with wound healing:
A
- release of collagenase
- neutrophil dysfunction
- increased pro-inflammatory cytokines
- increase MMPs (metal metalloproteinase)
- impaired angiogenesis
- endothelial dysfunction
24
Q
Type 2 diabetes may also be referred to as:
A
- adult onset
- non-insulin dependent
25
In this disease the pancreas produces insulin but it is low in titers or it does not work properly:
Type 2 DM
26
What percentage of diabetics are type 2?
80-90%
27
Fasting plasma glucose level:
normal:
pre-DM
Type 2 DM:
normal: <100 mg/dl
pre-DM: 100-125 mg/dl
Type 2 DM: 126+
28
For oral glucose tolerance test (2hr plasma glucose):
normal:
pre-DM:
Type 2 DM:
normal: <140 mg/dl
pre-DM: 140-199 mg/dl
Type 2 DM: 200+ mg/dl
29
HgA1C:
normal:
pre-DM:
Type 2 DM:
normal: <5.7%
pre-DM: 5.7-6.4%
Type 2 DM: 6.5%+
30
Random glucose in patients with Type 2 DM:
>200 mg/dl in patients with symptoms
31
Measures the glycosylaton of HbA (the protein than connects hemoglobin A where the glucose is attaching to):
A1C
32
If there is too much glucose in the blood stream, it attaches itself to ___ on the ____
hemaglobin; RBCs
33
A stable measure not affected by QD glucose fluctuation:
A1C
34
An HBA1c measures the amount of:
gylcosylation
35
Higher prevalences of ______ in poorly controlled diabetics
severe periodontal disease
36
T/F: According to a study, short-term reduction in HbA1C levels at 3-4 months after periodontal intervention occurred, but there was not long term studies
True
37
T/F: There is a correlation between the severity of periodontitis and the severity of retinopathy
True
38
If someone has periodontitis + diabetes, this puts then at risk for more ____ & _____ complications
renal & cardiovascular
39
All of the diabetic drugs work to:
lower sugar in the blood stream one way or another
40
List the mechanism of the following diabetic drugs:
-Biguanide (metformine)
-insulin (rapid, short, LL)
Decrease in gluconeogenesis
41
List the mechanism of the following diabetic drugs:
-Sulfonylureas (Glipizode, Chlorpropamide, Tolbutamide)
-Glucagon-like peptide 1 (GLP1) receptor agonist (Exenatide, Liraglutide)
Increase insulin secretion
42
List the mechanism of the following diabetic drugs:
-Thiazolidinediones (pioglitazone)
Sensitization to insulin
43
List the mechanism of the following diabetic drugs:
-Dipeptidyl peptidase 4 (DPP4) (sitagliptin)
-GLP1 receptor agonist (Exenatide, Liraglutide)
Decrease in glucagon secretion
44
List the mechanism of the following diabetic drugs:
-Sodium-glucose co-transporter-2-inhibitors (Canagliflozin)
-Alpha-glucoside inhibitor (Acarbose)
Intestinal & renal absorption of glucose
45
If the body is not getting enough sugar, then it goes to the bodies reserves to get sugar, and it breaks down cholesterol & fats into glucose to provide glucose to the bloodstream, but there already is glucose in the bloodstream its just not being taken up properly.
A medication that slows down the biofeedback mechanism that the body is telling itself if needs more sugar from the stores even though there is sugar in the bloodstream. What medication is this?
Metformin
46
What are some of the oral manifestation of diabetes:
1. xerostomia
2. oral burning (not burning mouth syndrome, secondary)
3. infections (bacterial, FUNGAL, viral)
4. poor wound healing
5. increased caries
6. increased severity of periodontal risk
47
One way to tell if a diabetic patient has control or not is by:
Fungal infection in the oral cavity
(everyone has Candida albicans in their oral cavity but this becomes opportunistic in diabetic patients often causing infection)
48
Fasting glucose (or 2hrs post meal) = less than 70 or greater than 200
HbA1C= >8.0%
As a dentist you should:
1. DEFER elective treatment
2. If emergency, consider referral to hospital/specialized setting
3. send medical consult
49
Fasting glucose (or 2hrs post meal) = less than 70 or greater than 200
HbA1C= >8.0%
Discuss prophylactic antibiotics for this patient:
Context-dependent
50
With diabetes, control of comorbities & drug interactions includes:
1. HTN
2. HLP
3. Other CVD (angina, MI, CHF)
4. Renal impairment
51
What antibiotics/drugs should be AVOIDED in patients with diabetes?
1. Tetracyclines (including Doxycycline)- hypoglycemia
2. Fluoroquinolones (Cipro, Levo, Leva) - hypoglycemia
3. Aspirin with sulfonylureas - hypoglycemia
52
Many antibiotics should be avoided with diabetics patients that are specifically on ____ because this may cause _____
insulin; hypoglycemia
-tetracycline
-doxycycline
-ciprofloxacin
-levofloxacin
-levaquin
-(fluoroquinolone)
53
For a diabetic patient, aspirin with ____ should be avoided if they are taking insulin due to risk of _____
sulfonylureas; hypoglycemia
54
In patients with diabetes, be aware that sulfonylureas may cause:
thrombocytopenia
55
What medication may be responsible for thrombocytopenia in diabetic patients?
Sulfonylureas
56
What timing of appointments is best suited for diabetic patients?
Early morning
57
Describe how diabetic patients should prepare for a morning appointment:
Eat normal meal and take medications prior to appointment
58
As a dental provider, when treating a diabetic patient you should be away of and have your patient communicate _______.
In addition, have _____ readily available
Symptoms of hypoglycemia; high-concentration sugar products (orange juice, cake icing, soft drinks)
59
____ is not recommended for diabetics as fasting is necessary
oral sedation
60
In what term does gestational diabetes typically present in a pregnant patient?
Presents at mid term - 24-28 weeks
between second & third trimester
61
The ovaries are responsible for releasing:
estrogens & progesterone
62
Pregnancy can be a stressor to:
oral health
63
Pregnancy duration = ______ form the 1st day of the last menstrual cycle
40 weeks
64
First trimester:
Second trimester:
Third trimester:
First trimester: 0-12 weeks (12 weeks)
Second trimester: 13-28 weeks (16 weeks)
Third trimester: 29-40 weeks (12 weeks)
65
Dental procedures could harm the developing fetus through effects of: (3)
1. ionizing radiation
2. drugs
3. stress
66
Drugs can harm the developing fetus and continues postpartum from transmission of drugs via:
breast milk
67
Common pregnancy discomforts include:
1. nausea & vomiting
2. indigestion
3. headaches
4. polyuria
5. lumbar pain
6. perspiration
7. breast tenderness
68
What is responsible for the nausea & vomiting discomforts of pregnancy?
-hormonal imbalances
-stress (physical & emotional)
-hyperacidity
69
Pregnant women have indigestion, especially with:
digesting foods rich in fats. sugars, and acids
70
What is important to do regarding a pregnant womans oral health?
Maintain optimal oral health
71
T/F: It is okay to perform elective dental care during the first trimester of pregnancy
False- avoid elective dental care during the first trimester
72
T/F: Second trimmest is the best tine to perform dental treatment on a pregnant lady
True
73
T/F: After the middle of the third trimester, elective dental care is best postponed
True
74
T/F: Dental treatment can be safely performed in all trimesters
True
75
Lack of proper oral health care during pregnancy could:
1. harm the developing fetus
2. affect the time of delivery
76
When taking radiographs of a woman of childbearing age, you should inquire:
If the patient could possibly be pregnant
77
The gonadal/fetal dose incurred with 2 periapical images when a lead apron is used is _____ than that for 1 day of exposure to natural background radiations in the US/
700 times less
78
Describe when a radiograph is acceptable during pregnancy:
Radiographs are contraindicated in ALL but EMERGENCY situations. When taken, lead shielding is mandatory
79
List the guidelines for radiographing "NEW AND RECALL PREGNANT DENTAL PATIENTS" at UMKC SOD:
Radiographs should be postponed until post-partum
80
T/F: Long term benefit to the health of the mother form new patient or recall exam radiographs. Also benefit to the health of a developing child.
First statement true
Second statement false- NO benefit to health of developing child
81
When radiographing a pregnant person,
The ____ faces greater risks from the radiation exposure than the ___, without any benefit to their health
unborn child, mother
82
The _____ recommends different radiation exposure thresholds for pregnant radiation workers than non-pregnant radiation workers
National council on radiation & protection measurements (NCRP)
83
Radiation exposure thresholds for pregnant radiation workers is lowered to the same threshold as the:
general population
84
What guidelines does the UMKC SoD follow in regards to pregnant persons?
NCRP recommendations
85
For emergency pregnant dental patients:
1. necessary radiographs are part of the standard of care to treat & diagnose a condition that threatens health of the mother & unborn child
2. lack of radiographs compromises the emergency care diagnosis & treatment (and this will directly impact the health of the unborn child)
3. primary beam is not directed toward the child-bearing area
86
When is it okay to perform EMERGENCY dental treatment during pregnancy?
May be provided as needed any time during pregnancy
87
What procedures should be performed on a pregnant patient to avoid stress of the mother and endangerment of the fetus?
pain control & elimination of infections
88
When performing emergency treatment on a pregnant patient, this may require a consult with the OB, if:
There is a concern about medications or the effect of treatment on the fetus
89
T/F: Untreated dental infections may pose a risk to the developing fetus
True
90
____ & ____ may precipitate a spontaneous abortion
Fever & sepsis
(this is why we say its better to go ahead and provide emergency care to pregnant patients in regard to pain & infection)
91
In advanced stages of pregnancy (late third trimester), avoid ____ position for long periods
supine position
92
Why should the supine position be avoided in advanced stages of pregancy?
Supine hypotension syndrome
93
What is supine hypotension syndrome?
Occurs late in third trimester, due to compression of the inferior vena cava that results in impaired venous return to the heart
94
Supine hypotension syndrome manifests as:
1. fall in BP
2. bradycardia
3. sweating
4. nausea
95
Supine hypotension syndrome is due to compression of the:
Inferior vena cava
96
What happens if your patient is experiencing supine hypotension syndrome?
Patient can rotate to their side to allow venous return to recover (studies have indicated that the LEFT side is best)
97
Discuss taking drugs during pregnancy in a general sense:
All drugs should be avoided during pregnancy if possible (benefit should outweigh potential risks)
98
T/F: Most common dental drugs can be safely used in pregnant patients
True
99
Discuss use of local anesthetics in pregnant individuals:
Do not exceed maximum doses of LA- lido with or without epi is safe
100
Avoid ____ & ____ due to:
1. closure of the ductus arteriosus
2. risk of postpartum hemorrhage and delayed labor
Aspirin & other NSAIDS
101
Aspirin and NSAIDs should be avoided during pregnancy due to: (2)
1. closure of the ductus arteriosus
2. risk postpartum hemorrhage and delayed labor
102
What is the analgesic of choice in a pregnant patient?
Acetaminophen
103
When are opioids acceptable during pregnancy?
Opioids should be avoided & only use when absolutely necessary and in consolation with the physician
104
what is typically preferred for the effects of opioids in a pregnant patients while avoiding opioids?
Codeine with aetaminophien (APAP) is usually the preferred agent
105
What antibiotics are ACCEPTABLE during pregnancy? (5)
1. Amoxicillin
2. Azithromycin
3. Clindamycin
4. Erythromycin
5. Metronidazole
106
What antibiotics are CONTRAINDICATED during pregnancy? (2)
Why?
1. Tetracycline
2. Doxycycline
These antibiotics are teratogenic
107
Discuss sedation during pregnancy: (2)
1. no pharmacologic sedation is preferred
2. if absolutely necessary, NO may be used for less than 30 min with at least 50% O2
108
T/F: Pregnant patients should not have multiple appointments or extended appointments with NO sedation as cumulative effects are a point for concern
True
109
You should avoid NO during _____ trimester. As always appropriate oxygenation after nitrous is necessary to avoid diffusion hypoxia
first trimestser
110
T/F: Benzodiazepines are okay to take during pregnancy
False
111
If you plan on using any type of sedation (including NO), during pregnancy, you must:
consult physician
112
Women of child-bearing age should not be chronically exposed to nitrous in an occupation capacity for more than _____ hours per week without scavenging equipment
3
113
Women of child-bearing age should not be chronically exposed to nitrous in an occupation capacity for more than 3 hours per week without scavenging equipment due to the risk for:
1. decreased fertility
2. greater rates of spontaneous abortion
114
Pregnant radiation workers should we dosimeter monitoring devices to monitor occupational dose limits and assure the annual effective dose:
Less than or equal to 1mS/yr
115
What is the occupation limits of ionizing radiation?
1 mSv/yr (same as pregnant radiation workers)
116
Average dental occupational exposure is _____ although 68% of dental workers have readings BELOW the threshold
0.2 mSv/yr
117
T/F: Most drugs are of little pharacologic significant to lactation. Medications should be taken just before breast feeding.
First statement true, second statement false
118
Also known as "pregnancy tumor":
Pyogenic granuloma epulis gravidarum
119
In pregnancy, this is an exacerbated response to plaque & bacteria precipitated by the changes in progesterone and estrogen hormone levels; not an actual granuloma as there is proliferation of vascular & fibrous tissues:
Pyogenic granuloma
120
Gestational diabetes risks to fetus:
1. excessive weight gain of fetus
2. affects lung development
3. C-section may be warranted
121
What is the preferred treatment for a pregnant patient with gestational diabetes who is NOT responding to conservative measures?
Metformin PO
122
The adrenal glands are responsible for secreting:
1. cortisol
2. aldosterone
3. adrenal androgens
123
____ come from the medial of the adrenal gland
catecholamines
124
Where does aldosterone, androgens & cortisol come from?
Adrenal cortex
125
Give an example of a mineralocorticoid:
aldosterone
126
Where does aldosterone act?
Distal tubules of kidney
127
AlDosTerone airs on the Distal Tubules of kidney to:
1. Control intravascular volume
2. Acts on RAA system
3. Regulates sodium/water balance (affecting BP!)
128
What hormone of the adrenal cortex is responsible for increasing contractility & vascular reactivity to vasoconstriction, therefore increasing BP:
Cortisol
129
Cortisol is classified as a:
glucocorticoid
130
Cortisol antagnizes:
insulin
131
What adrenal hormone is known for:
-activating lipolysis
-stimulating gluconeogenesis
Cortisol
132
What is cortisols effect on blood sugar?
Increases sugar
133
Catecoholamines norepinephrine and epinephrine (from adrenal medulla) are responsible for:
1. fight or flight stress response
2. BP increase
3. Peripheral resistance
4. Cardiac output
134
-increased aldosterone, cortisol, androgens estrogen (isolated or in combo):
Hyperadrenalism
135
What are some symptoms of hyperaldosteronism?
1. HTN
2. hypokalemia
3. edema
136
The most common adrenal insufficiency we see is:
glucocorticoid excess
137
Glucocorticoid excess means there is too much:
cortisol
138
Cushing DISEASE is caused by:
pituitary or adrenal gland tumor
139
Cushing SYNDROME is caused by:
exogenous corticosteroids
140
Complications of glucocorticoid (cortisol) excess include:
1. DM
2. HTN
3. Weight gain
4. Moon facies
5. Buffalo hump
6. Hirsutisms
7. Acne
8. Osteoporosis
9. Heart failure
10. Delayed wound healing
11. Susceptibility to infection
12. Irregular menses
13. Insomnia
14. Peptic ulcer
15. Psychiatric disorders
16. Glaucoma
17. Cataracts
141
Describes the collection of signs & symptoms that are associated with Cushing syndrome:
Cushingoid
142
Mneumonic CUSHING GOID
C: cataracts
U: ulcers
S: striae & skin thinning
H: HTN & Hirsutism
I: immunosupresion & infections
N: necrosis of femoral heads
G: glucose elevation
O: osteoporosis & obesity
I: Impaired wound healing
D: depression & mood changes
143
-Prednisolone
-Triamcinolone
-Methylprednisolone
These are all:
Immediate-acting glucocorticoids
144
-Dexamethasone
-Betamethasone
These are:
Long-acting glucocorticoids
145
Primary adrenal insufficiency:
Addision disease
146
Addisons disease involves destruction of the adrenal cortex leading to:
LOW cortisol & HIGH ACTH
147
The following are cutaneous findings of _____
1. Hyperpigmentation of skin & mucous membranes
2. Longitudinal pigmented bands in the nails
3. Vitiligo
4. Decreased axially & pubic hair in women
5. Calcification of auricular cartilage in men
Addison's disease
148
Low cortisol & LOW ACTH:
Secondary adrenal insufficiency
149
Secondary adrenal insufficiency is caused by:
impaired/destructive pituitary disease
150
Tertiary adrenal insufficiency is caused by:
impaired function of hypothalamus
151
Most commonly a result of exogenous steroid use:
Tertiary adrenal insufficiency
152
What may be a consequence of BOTH hyperadrenalism & adrenal insufficiency?
Impaired wound healing
153
