Adrenocorticosteroids

Question 1

What is the mechanism of release of naturally occuring steroids?

Answer 1

Stimululs

• hypothamalmus releases adrenocorticotripin (glucocorticoids/ mineral corticoids) releasing factor in blood
• acts on pituitary gland which releases adrenocorticotropic hormones (ACTH)
• Acts on adrenal cortex to release hydrocortisone
• Acts on pituitary gland & hypothalamus to inhibit release of releasing factor & ACTH

This is an example of negative feedback

Question 2

What are adrenocoticosteroids ?

Answer 2

Group of agents secreted naturally by the adrenal cortex.

Question 3

How does long term use of steroids affect the body?

Answer 3

Long term use of steroids results in adrenal gland atrophy due to negative feedback repressing natural steroid production.

Question 4

What happens if someone taking steroids for a long time suddenly stops taking exogenous steroids?

Answer 4

Steroid crisis: body is deficient of steroid when under stress because the adrenal gland has been suppressed.

Question 5

What are the classifications of adrenalcocorticosteroids?

Answer 5

• Glucocorticoids - affect carbohydrate metabolism

- Mineralocorticoids - affect water and electrolyte composition in body

Question 6

What is the major glucocortisone in the body?

Answer 6

Hydrocortisone

Question 7

How much hydrocortisone do we produce daily?

Answer 7

20mg

Question 8

What are the pharmacological effects of corticosteroids?

Answer 8

• anti-inflammatory action
• suppression of allergic reactions
• suppress immune response

Palliative not curative

Question 9

What are the glucocorticoid effects?

Answer 9

• Respond to stress
• Release of cytokines (IL-1)
• which causes cortisol level to rise thereby mobilising the body’s glycogen and fat stores.

Question 10

What are the broad effect of glucocorticoids?

Answer 10

• Carbohydrate metabolism
• Anti-inflammatory
• Antiallergic
• Enzyme action
• Membrane functuin
• Nucleic acid synthesis

Question 11

What are the specific effects of glucocorticoids?

Answer 11

• Increase gluconeogenesis
• Decrease glucose use
• Inhibit protein synthesis
• Increase protein catabolism
• Decrease growth
• Decrease bone density
• Decrease resistance to infection

Question 12

Mineralocorticoid effect?

Answer 12

• Increase sodium retention (hypernatremia)
• Increase potassium loss (hypokalaemia)
• Oedema and hypertension

Question 13

List the adverse side effects of corticosteroid use

Answer 13

Metabolic changes
Infections
CNS effects
Peptic ulcer
Anti-inflammatory effect
Impaired wound healing & Osteoporosis
Ophthalmic effects
Electrolyte and fluid balance
Adrenal crisis
Dental effects

Question 14

When are adrenocorticosteroids used in medicine

Answer 14

Replacement of adrenocorticoid function
Emergencies
Anti-inflammatory effects

Question 15

Where are steroids used in medicine?

Answer 15

Chronic diseases (asthma, arthritis including TMJ)
-Addison’s disease
Cushing’s syndrome(if adrenal gland has been removed)
-Rheumatic fever
-Systemic lupus erythematous
-Scleroderma
-Inflammation of joints and soft tissues
-Acute allergic reactions
-Severe dermatological conditions

Question 16

When are steroids used topically in the mouth?

Answer 16

• Erythema multiform
• Lichen planus
• Pemphigus Vulgaris
• Benign mucous membrane permphigoid
• Apthous Ulceration

Question 17

When are steroids used in dentistry?

Answer 17

-ORAL LESIONS: associated with non-infectious inflammatory disease including lichen planus, erythema mulitform, pemphigus, desquamative gingivitis and benign mucous membrane pemphigoid. infectious etiology needs to be riuled out!

-TMJ ARTHRITIS
if this is the only joint affected intra-articular injection can be given to decrease pain and iprove joint movement

-APTHOUS ULCERATION
triamcinolone acetonide in orabase (mineral oil gel) is used.

Question 18

What are the dental implications of steroid therapy?

Answer 18

• exacerbate hypertension
• mask symptoms of an infection or decrease a patients resistance to infection
• High dose = euphoria
• Low dose = depression
• Osteoporosis seen on radiograph if 50% bone loss has occurred
• Delay wound healing-special precautions required for surgical procedures
• Adrenal crisis - patient may not be able to respond to stress witht he release of endogenous hydrocortisone

Question 19

What is the dose of steroid in an adrenal crisis?

Answer 19

100MG hydrocortisone sodium succinate IM/IV

Question 20

Following a systemic review of the literature in 2008 what are the outcomes involving perioperative steroid in therapy?

Answer 20

• Pt receiving theraputic doses of cortiocosteroids who undergo a surgical procedure do not require stress dose of corticocosteroids as long as they receive their daily dose
• Adrenal function testing is not required as tests are overly sensitive thus do not predict when someone will have adrenal crisis
• Patients reieving physioloigc replacement doses owing to primary disease of hypothalamiv-pituitary-adrenal axis do require supplemental doses in the perioperative period

Question 21

What is the dose for patietns that require perioperative cover? What else needs to be monitored?

Answer 21

25-50mg hydrocortisone sodium succinate IV immediately prior to surgery

BP monitoring throughout perioperative period and venous access prior to facilitate addition corticosteroid administration if necessary.

Question 22

What are the dental effects of adrenocorticosteroids ?

Answer 22

Mucosal surfaces more likely to be infected

• More friable
• steroid inhalers = oral candidiasis