3 - Steroids Flashcards
What are the functions of natural cortisol?
- Regulation of carbohydrate, fat and protein metabolism
- Maintenance of vascular reactivity
- Anti-inflammatory
- Homeostasis during stress
What is the most potent activator of stress?
Surgery
& pain cause an increased level of endogenous cortisol
What are the diseases of excess and insufficient cortisol production?
- Excess
- Cushing’s disease (primary)
- Insufficient
- Addison’s disease (primary)
- Secondary = HPA axis suppressed from taking glucocorticoids
What causes a secondary disorder of adrenal insufficiency?
Secondary = HPA axis suppressed from taking glucocorticoids
What are the common signs of adrenal crisis?
- Profuse sweating
- Hypotension
- Weak pulse
- Dyspnea
- Cyanosis
What are synthetic glucocorticoid medications indicated for?
- Autoimmune diseases
- Immunosuppressive therapy - organ transplant
- Respiratory disease management
What’s the mechanism of action of steroids?
- Anti-inflammatory effects
- Peripheral leukocytes decrease
- Inhibits phospholipase A
- Lowers prostaglandins and leukotrines
How are steroids rated?
As to potency compared to hyrdocortisone equivalent dose
The more potent the steroid - The…?
- lower the dose
- higher the risk for adrenal suppression
How are equivalent doses based?
On 20mg hydrocortisone = amount normally secreted daily by an adult without stress
What are the short acting corticosteroids?
- hydrocortisone
- prednisone
- methylprednisolone
What are the intermediate acting corticosteroids?
- triamcinolone
- prednisolone
What are the long acting corticosteroids?
- dexamethasone
- betamethosone
What is alternate day therapy used with steroids used for?
Patients who must take steroids for longer than 1 month
Any medication that exceeds the normal adrenal output amount of cortisol may cause suppression, what is that dosage?
20-30 mg
What are the contraindications with steroids?
- Systemic fungal infections
- Viral infections - oral herpes lesions
- Latent or active TB
- Allergy
How are steroids used in dentistry?
- Reduction of pain and swelling
- Treatment of inflammatory pathologies of oral mucosa
What is the most common route of delivery of steroids in dentistry?
Topical
How long can you use high potency topicals?
Only for 2 weeks
What are some steroids ointments/topicals used?
- traimcinolone (Kenalog in Orabase)
- fluocinonide (lidex) - lichen planus
- clobetasol proprionate (Temovate) - oral inflammation
- betamethasone
What are the preps of topical rinses of steroids?
- dexamethasone (Decadron) elixer
- prednisolone syrup
What are some special considerations of oral steroids?
- Avoid in pregnant/lactating women - Category C
- Extreme caution with pediatric patients
- Geriatric patients more susceptible to hypertension and osteoporosis side effects
What are the common oral side effects of steroids?
- Candidiasis - most common
- Poor wound healing
- Masking of oral infections
- Xerostomia
What are the 4 important factors that increase risk for adrenal crisis perioperatively?
- Severity of surgery
- Drugs administered
- Overall health
- Extent of pain control
Why do you wait 2 weeks after steroids are discontinued prior to intiating any invasive procedure?
To ensure HPA axis is functioning normally
Persists up to 2 years, following as little as 2 weeks of steroid therapy - stress response returns after 2 weeks
How do you treat a patient that is currently taking steroids?
- Patient takes usual dose
- Schedule first thing in morning
- Stress reduction protocol
- Monitor blood pressure
