Adrenal/HIV/Allergy/Diabetes/Pregnancy/Thyroid Flashcards
Cortisol increases blood levels and use of —–, increases —-, and has —- actions = homeostasis
glucose
blood pressure
anti-inflammatory
—- releases
•
corticotropin-releasing hormone
Hypothalamus
—- first reason for releasing cortisol.
Surgical stress
——- produces and secretes
•
adrenocorticotropic hormone
Pituitary
—— stimulates adrenal cortex to
•
produce and release cortisol
ACTH
Primary Adrenocortical Insufficiency
addison’s disease
Adrenal cortex destroyed or removed - Medical management
Manage the adrenal disease
Glucocorticoid replacement corresponds to normal output ~20mg/day
Hydrocortisone
Secondary Adrenocortical Insufficiency
Pituitary disease or adrenals unresponsive to ACTH
2ndary adrenocortical insufficiency - Medical management
Glucocorticoid replacement Hydrocortisone 10-20mg/day
Tertiary Adrenocortical Insufficiency
Treat autoimmune and inflammatory diseases AND long- term immunosuppression for organ transplant and joint replacement
Sluggish hypothalamus
Regimens aimed at being therapeutic at the least dose to prevent adrenal suppression
•
•
•
Topical, locally injected, inhaled
•
not of concern
•
HPA axis regains responsiveness and functional 14d after DC of steroid
Increased cortisol levels during and after —-
surgery
Plasma cortisol peaks 2 to 10-fold between —— hours after surgery
4 and 10
Cortisol level returns to baseline —– hours post-op
24-48
Adrenal Crisis
Life-threatening emergency characterized by
Hypotensive collapse, abdominal pain, myalgia, fever
Adrenal crisis - Immediate treatment in the ED
100mg hydrocortisone bolus
Fluids & electrolytes
Primary adrenal insufficiency =
supplement
Secondary adrenal insufficiency =
daily therapeutic dose
Hypotension first sign of
acute adrenal crisis
With acute adreanl crisis,
ems immediately, bls
True allergy symptoms:
Urticaria Swelling
Skin rash Chest tightness Dyspnea, SOB Rhinorrhea Conjunctivitis
Angioedema
Edema in deeper planes
Diffuse enlargement of lips, infraorbital tissues, larynx, tongue
Anaphylaxis —- depression
respiratory and CV
Anaphylaxis with Depressed/absentee vital sign—
0.3-0.5ml 1:1000 epinephrine IM Q5min and CPR prn
Risk of stroke & CAD death —- higher in diabetics MI leading cause of death in —– diabetics
2-4x
Type 2
ESRD ———-
—— more likely to acquire vs. those without diabetes Leading cause of death in those with ——diabetes
end stage renal disease
25x
Type 1
HbA1c
Amount of sugar attached to hemoglobin
HbA1c
Indicates level of glycemic level over last —- months
Monitors patient’s progress —— if controlled —– is uncontrolled
2-3
2x/year
4x/year
HbA1c
Non-diabetic patients,
Diabetic patients,
<6%
<7%
For type 1 diabetics - Long acting replace —- level. Short acting covers ——
basal
carbs.
External Insulin Pumps for
Type 1
Type 2 diabetics - Drug therapy
1 or more hypoglycemics +/- injectables
Dental Treatment Concerns with Uncontrolled Diabetics
Infection
aggressive management, strict glycemic control
Poor wound healing avoid elective surgery
Systemic risk
HTN, CAD, stroke
Type 1 diabetics -
disease responds a bit differently. Always be concerned about type 1 diabetics. Uncontrolled vs brittle - not just compliance. Some people just can’t get consistent glucose levels.
Management of Acute Infection
DDS: ——–
MD: ——
treat odontogenic infection
Extraction, I&D, antibiotics
glycemic controlSliding scale insulin
I&D:
Incisions and drainage
Tx of insulin reaction
if conscious, sugar. if unconscious, EMS and glucagon injection - bls prn
Preventing Insulin Shock
- Instruct patients to follow normal insulin regimen and eat normally around appointment
- Morning appointment
- Confirm that they ate and took insulin/hypoglycemics
- Instruct patient to notify you of symptoms during the office visit
- Source of sugar in the office
HIV Target cells:
dendritic cells, macrophages, CD4+ T cells
Blood HIV viral load correlates with
risk of transmission of the virus; patients with early HIV infection are highly contagious
Progressive depletion of CD4+ lymphocytes
pancytopenia
immune dysfunction
CD4+ drops to
200
Prophylaxis for opportunistic infections with
low CD4+ counts
CD4+ count at time of HIV diagnosis Every—–months after
3-4
Asymptomatic HIV Infection
Asymptomatic patients have OK CD4+ count
Low viral load
Normal platelets and WBCs
No S/S (wouldn’t know of disease if they did not endorse)
Asymptomatic HIV Infection - dental care
good to go
Asymptomatic, HIV-Infected Patient with Decreasing CD4+ Count
May be developing immune suppression increased risk of infection (decreased WBCs)
increased bleeding (decreased platelets)
Invasive surgical procedures: obtain WBC & platelet counts
Asymptomatic, HIV-infected patient with decreasing CD4+ count - ——- dentistry ok
Routine & complex restorative
AIDS Patients (CD4+ <200)
Significant ——-
——- dental care only
With invasive procedures must prepare for :
—— antibiotic prophylaxis for patient with WBC <500uL
———platelets must be >50,000 for treatment
Check drug interactions with —-
immunosuppression
Emergency care and preventive
Infection
Excessive bleeding
ART
Most dental drugs (prego) are
category C
Prego - Analgesics:
Acetaminophen
NO NSAIDs (ibuprofen or aspirin)
Consult for narcotics
Amount of drug excreted in milk —– of maternal dose
~1-2%
Breast feeding timing w/drug
Timing
Consume right after breast feeding Supplement with formula
Thyroid hormone (thyroxine + triiodothyronine) influences
Regulate ——
Regulated by a ——–
metabolism or the way that the body uses energy
feedback loop
Secretion of Thyroid Hormone
Feedback mechanism mediated by
hypothalamic- pituitary-thyroid axis
•
Hyperthyroidism
Excess
T3 and T4 in the blood
Thyrotoxicosis
Graves’ disease (most common)
Autoimmune
Hyperthyroidism - symptoms
Anxiety, fatigue, rapid HR, heat intolerance, weight loss, exopthalmous
Antithyroid agents
Propylthiouracil, 18 months
Radioactive iodine
Surgery
Hypothyroidism
Inadequate amount of
T3 and T4
Slow physical/mental activity, sensitivity to cold, weight gain
Hypothyroidism managed with
synthetic T4
Well-Controlled Thyroid Disease can do
Any routine dental treatment
Thyroid
Physician consultation for assistance in management of acute infection or in anticipation of significant surgical stress
Increased —-
metabolic demand
—– is most common thyroid issue
Hypo
