Adrenocorticosteroids Flashcards
What naturally secretes adrenocorticosteroids?
adrenal cortex
what are the 4 steps that lead to the release of adrenocorticosteroids?
what is this an example of?
1- A stimulus (stress) causes the hypothalamus to release the corticotropin-releasing hormone (CRH)
2- CRH acts on the pituitary gland which in turn releases adrenocorticotrophic hormone (ACTH)
3- ACTH acts on the adrenal cortex to release hydrocortisone
4- Hydrocortisone acts on the pituitary gland and the hypothalamus to inhibit the release of the CRH and ACTH
-example of negative feedback
what are the 2 groups adrenocorticosteroids are divided into?
1- glucocorticoids (affect carbohydrate metabolism)
2- mineralcorticoids (affect water and electrolyte composition in the body)
What is the main use of adrenocorticosteroids?
is their use mainly palliative or curative?
- They are used for their anti-inflammatory action and suppression of allergic reactions.
- They also suppress the immune response.
- Corticosteroids are palliative rather than curative.
What are the effects of glucocorticosteroids?
BROAD EFFECTS:
- decrease carbohydrate metabolism
- Anti-inflammatory
- Antiallergenic
- increases enzyme action
SPECIFIC EFFECTS:
- Increase protein catabolism
- Decrease growth
- Decrease bone density
- Decrease resistance to infection
What are the effects of mineralcorticosteroids?
- Increase sodium retention (hypernatremia)
- Increase potassium loss (hypokalaemia)
- Oedema and hypertension
What can cause adrenocorticosteroids to give adverse reactions?
The adverse reactions of the corticosteroids are proportional to the dosage, frequency and time of administration and the duration of treatment. With prolonged therapy and high enough doses
What are 10 adverse reactions to adrenocorticosteroids?
1- metabolic changes: give patient’s Cushing’s syndrome appearance. Moon face, hump, weight gain, muscle wasting
2- infections: decrease resistance to infection. Because of their anti-inflammatmory action, they may also mask its symptoms
3- CNS effects: Changes in behaviours/mood
4-peptic ulcer: stimulate an increase in production of stomach acid and pepsin they may exacerbate peptic ulcers
5-anti-inflammatory effect: use of steroids results in an increase in the concentration of neutrophils and a decrease in the lymphocytes (T and B cells), monocytes, eosinophils and basophils. also inhibit interleukin-2, migration inhibition factor, and macrophage inhibition factor.
6- impaired wound healing and osteoporosis: impaired synthesis of collagen impairs wound healing. This same process can cause osteoporosis or impair growth in children.
If osteoporosis affects the alveolar bone, it could result in tooth loss. Thinning bones can also result in fractures in patients on long term steroid use. Muscle wasting, bruising
7- opthalmic effects: corticosteroids can increase intraocular pressure, glaucoma may be exacerbated
8- electrolyte and fluid balance: possess some mineralocorticoid action can produce sodium and water retention
9- adrenal crisis: if patient undergoes a stressful situation, adrenal crisis could result. The adrenal gland is unable to respond with additional steroid in this situation.
10- dental effects: mucosal surfaces heal more slowly and are more likely to become infected. steroid inhalers are used, oral candidiasis may result
what are the 3 general medical uses of corticosteroids?
1- replacement of adrenocorticoid function.
-Patients with hypofunction of the adrenal cortex (Addison’s disease).
Patients with a hyperfunctioning adrenal cortex (Cushing’s’ syndrome) may have a majority of the gland removed surgically. In this case replacement therapy is needed after surgery.
2-emergencies
-emergency situations for the treatment of shock or adrenal crisis.
3- anti-inflammatory effects
-most extensive use is in the treatment of a wide variety of inflammatory and severe allergic conditions.
These agents are not curative but merely ameliorate symptoms because of their anti-inflammatory activity.
(rheumatoid arthritis)
What are some of the medical conditions adrenocortisteroids are used to treat?
- Chronic systemic diseases such as asthma, arthritis (including TMJ, arthritis)
- Addison’s disease
- Cushing’s Syndrome (if adrenal gland has been removed)
- Rheumatic fever
- Systemic lupus erythematous
- Scleroderma
- Inflammation of the joints and soft tissues
- Acute allergic reactions
- Severe dermatological conditions
what is the most common oral adrenocorticosteroid?
Prednisolone is the most common corticosteroid used orally
what are the topical uses for the mouth of adrenocorticosteroids?
- Erythema multiforme
- Lichen planus
- Pemphigus Vulgaris
- Benign mucous membrane pemphigoid
- Apthous Ulceration
What 3 dental situation would you use adrenocorticosteroids?
1- oral lesions (must be a non-infectious inflammatory disease) lichen planus, erythema multiforme
2- TMJ arthritis (intra-articular injection)
3- apthous ulceration (mineral oil gel)
What is the major glucocorticoid found in the body?
hydrocortisone
What are some dental implications of steroid therapy?
- can exacerbate hypertension
- can mask the symptoms of an infection or decrease the patient’s resistance to infection
- delayed wound healing
- osteoporosis (bone loss on radiographs observed)
