Steroids Flashcards
What are some functions of natural cortisol (glucocorticoid)?
maintain vascular reactivity, cause anti-inflammatory effects, maintain homeostasis during periods of stress and regulate carbohydrate, fat and protein metabolism
What are two major stressors that increase levels of endogenous cortisol?
surgery (most potent activator) and pain (thus the importance of using good pain control)-other stressors include illness, trauma, burns, fever, hypoglycemia, emotional upset
Identify indications for use for corticosteroids in medicine and dentistry.
autoimmune diseases, immunosuppressive therapy in organ transplant patients, respiratory disease management
What are some examples of steroid use for systemic disease?
replacement therapy (adrenal insufficiency, pituitary insufficiency, adrenal hyperplasia), arthritis (rheumatoid, osteoarthritis), rheumatic carditis, renal disease, collagen disease, allergic disease (anti-inflammatory effect)
Mechanism of action of steroids
anti-inflammatory effects, effect on #, distribution and function of peripheral leukocytes, inhibition of phopholipase A (decreases production of both prostaglandins and leukotrienes from arachidonic acid)
Discuss side effects associated with chronic use of corticosteroid medications.
Systemic steroids are more likely to cause adrenal suppression. Additional problems may include insomnia, peptic ulceration, osteoporosis, hyperglycemia, cataract formation, glaucoma, growth suppression, redistribution of fat, delayed wound healing.
How are corticosteroid products characterized?
Characterized by duration of action (short, intermediate, long): agents are given values in relation to those of hydrocortisone (arbitrarily assigned value of 1)
What are three short-acting oral corticosteroids?
hydrocortisone (Cortisol), prednisone (Deltasone), methylprednisolone (Medrol)
What are three intermediate-acting oral corticosteroids?
triamcinolone (often used in ointments prescribed for aphthous ulcers), prednisolone
What are three long-acting oral corticosteroids?
dexamethasone, betamethasone
What are equivalent doses of corticosteroids?
Equivalent doses are based on 20 mg hydrocortisone = amount normally secreted by an adult without stress in a day
Describe some dosing considerations with steroids
alternate day therapy is used for patients who must take steroids for longer than 1 month, daily therapy poses greater risk for adrenal suppression, any medication dosage that exceeds this amount may cause suppression
What are contraindications to steroids?
systemic fungal infections, viral infections (ex. Herpes), latent or active TB, allergy to component of medications
Based upon their side effect profile, identify patients in whom corticosteroids must be used with caution.
pregnant/lactating women (category C drugs), pediatric patients (more susceptible to suppression), geriatric patients (more susceptible to hypertension and osteoporosis side effects)
Cushing’s disease
Primary disorder of adrenal glands resulting in an excessive production of cortisol
Addison’s disease
Primary disorder of adrenal glands resulting in an insufficient production of cortisol
Distinguish between the 2 etiologies of adrenal insufficiency.
(1) Addison’s disease (primary disorder) wherein the adrenal glands do not function (2) secondary disorder = HPA axis suppressed due to taking glucocorticoid medications
Medication-induced adrenal insufficiency
A secondary disorder wherein glucocorticoid medications (exogenous steroids) suppress the body’s own production of endogenous steroids. This is more common than Addison’s disease and is associated with chronic steroid use and does not usually produce symptoms unless the patient is significantly stressed (or does not have enough circulating cortisol)
What are five key signs and symptoms of adrenal crisis?
profuse sweating, hypotension, weak pulse, dyspnea, cyanosis
What severe effects may occur to patients suffering from adrenal crisis who do not receive emergency assistance?
severe hypotension, circulatory collapse (shock), hypothermia, hypoglycemia, death
What are the appropriate treatment interventions used to manage adrenal crisis?
Call 911 (EMS transport and medical intervention is required), elevate feet above head, IV glucocorticoids, fluid and electrolyte replacement, administration of vasopressors (epi)
What patients are more at risk for adrenal crisis?
Pediatric patients (extreme caution must be used because children are more susceptible to suppression with topicals and even 5 mg may limit growth)
What are characteristics of topical corticosteriod medications?
topical administration is the most common route in dentistry (high potentcy drugs limited to 2 weeks only), ointments/gels applied directly to lesions with cotton-tip, and rinses are used 2 to 4 times a day for 30 seconds each rinse
What are characteristics of systemic corticosteriod medications?
oral steroids may be used before, during and after oral surgery to reduce swelling and pain postoperatively and to treat oral lesions.
