Steroids Flashcards
Are topical corticosteroids licenced for use to treat oral mucosal lesions?
No, but they are commonly used off label by oral med practitioners.
What topical corticosteroids are available to treat oral disease, and what would they typically be used for?
Betamethasone mouthwash
Beclomethasone metered dose inhaler
Both used for apthous ulcers and lichen planus.
What should be included on the patient information leaflet for betamethasone mouthwash?
This is an accepted and proven effective treatment for the condition
Licenced for other medical conditions above 12 years of age
Explain dose range and frequency of use. Explain hazards of exceeding the standard dose
Safe to use as directed without standard steroid side effects risk – diabetes, osteoporosis, adrenal suppression, etc
No Steroid card needed if used properly
Add any known side effects – small oral candida risk
Add special instructions
MUST spit out to avoid systemic steroid effects
Do not rinse mouth after use
How should systemic corticosteroid risk be managed?
If on a prolonged course, have breaks of 2 weeks between pulses of prednisalone.
What are the risks of prolonged systemic corticosteroid use?
Adrenal suppression leading to steroid depenancy.
Cushingoid features
Osteoporosis risk
Peptic ulcer risk
Mood/sleep alteration, leading to mania/depression risk.
Skin atrophy
Diabetes
Abdominal obesity
Hypertension
Tissue specific resistance to corticosteroids
What are steroids in the human body?
Steroids are complex lipophilic molecules that have many actions in the body to regulate cellular, tissue and organ functions across the life-span.
Steroid hormones such as cortisol, aldosterone, estradiol and testosterone are synthesised from cholesterol in specialised endocrine cells in the adrenal gland, ovary and testis, and released into the circulation when required.
Describe the mechanism of action of corticosteroids.
Glucocorticoid steroids contribute to metabolic regulation as a catabolic hormone.
Steroid hormones exert the majority of their physiological effects in cells by binding to and activating glucocorticoid receptors.
Each steroid hormone is only able to bind and activate a very restricted number of receptors, and in many cases only one specific nuclear receptor protein.
They infiltrate the cell membrane, find a suitible glucocorticoid receptor near the target DNA stand, then cause the DNA to produce new proteins/hormones/AAs to affect the human body.
Describe the mechanism by which steroids can induce diabetic states.
Inappropriately elevated circulating cortisol (ie, in a ‘Cushingoid’ state) or synthetic glucocorticoids (eg, prednisolone) can stimulate excess hepatic glucose output leading to hyperglycemia and the development of diabetic states.
What effect does cotrisol have on the body?
Promoting or preparing permissive effects to respond to the stressor, such as producing glucose, increasing heart rate and neural awareness and acuity
AND
Suppressive effects, including activating defence mechanisms to prevent overshoot or damage to the body, such as anti-immune and anti-inflammatory responses. The mechanisms at play here are not entirely clear and are under active study.
How do corticosteroids trigger the adrenal glands to release cortisol?
Corticosteroids act as positive feedback molecules for the hypothalmus.
The hypothalmus stimulates the posterior pituitary gland to release ACTH, which leads to further corticosteroid release, and cortisol release.
Can dentists prescribe corticosteroids?
Only as topical agents, which is off label.
Systemic can only be prescribed by a specialist/GP.
