Corticosteroids Flashcards
Name a disease which occurs when circulating levels of steroids is too high
Cushing’s disease
Name a disease which occurs when circulating levels of steroids is too low
Addison’s disease
Describe the HPA axis
- Stress and circadian rhythm influences hypothalamus
- CRH from hypothalamus signals pituitary
- ACTH produced which signals adrenals to produce cortisol
- Cortisol has tissue actions
- Cortisol levels provide negative feedback at pituitary and hypothalamic levels
Name 2 main types of steroids
- Glucocorticoids
2. Mineralocorticoids
What is an example of a glucocorticoid?
Hydrocortisone
What is an example of a mineralocorticoid?
Aldosterone
Give an overview of the function of mineralocorticoids
- Bind to mineralocorticoid receptor expressed in kidney and epithelial cells of colon and bladder
- Regulate electrolyte balance
Describe 2 physiological outcomes caused by mineralocorticoids
- Increased sodium reabsorption in DCT
2. Increased potassium and hydrogen excretion
Where are steroid hormone receptors found in the cell?
Cytosol
How do activated glucocorticoid receptors identify target genes in the nucleus?
GC receptor dimers bind to specific hormone response elements (HREs) on target genes
Name 3 actions of glucocorticoids and drugs used for these purposes
- Metabolic (hydrocortisone)
- Anti-inflammatory (prednisolone)
- Immunosuppressive (dexamethasone)
What is the function of the metabolic effects of glucocorticoids?
Protecting glucose dependent tissues from starvation
Describe how metabolic effects of glucocorticoids affect the liver
- Decrease glucose uptake
- Decrease glucose utilization
- Increase gluconeogenesis
Describe how metabolic effects of glucocorticoids affect muscle
- Decreased protein synthesis
- Increase protein breakdown
Name 4 clinical uses of glucocorticoids
- Replacement therapy for Addison’s disease
- Anti-inflammatory
- Autoimmune disease
- Transplant patients
Describe how corticosteroids reduce inflammation
- Suppress all phases of early inflammation
- Decrease number of activated macrophages and T cells
- Decreased IL-1 and IL-2 production
- Decreased transcription of COX-2 and PLA2
Describe Addison’s doosease
Primary hypoadrenalism
What is the general rule for supplement steroid dose in dentistry for patients using long term steroids?
- Generally do not supplement for routine dental procedures
- May need to supplement for general anaesthetic or implant insertion
Name 5 therapeutic uses of steroids in dentistry
- Oral ulceration
- Post operative pain
- Pulp inflammation
- Pain from TMJ
- Bell’s Palsy
Name 3 oral mucosal lesions which steroids may be used to treat
- Erosive lichen planus
- Erythema multiforme
- Pemphigus
Name 3 types of steroidal therapies used for oral ulceration
- Topical
- Injection into lesion
- Systemic
Name 2 types of oral surgery steroids will be used post operatively
- Post impacted 3rd molar removal
2. Post orthognathic surgery
How are steroids administered for a patient with TMJ pain?
Intra-articular injecitons
Name 4 major side effects of corticosteroid therapy
- Euphoria
- Cataracts
- Increased abdominal fat
- Poor wound healing
How does Cushing’s syndrome arise?
Excess circulating glucocorticoids
Name 2 treatments for Cushing’s disease
- Metyrapone
2. Ketoconazole
What tends to cause excess glucocorticoids in Cushing’s disease?
Increasing circulating levels of GC or ACTH
Where are thyroid hormone receptors found?
Cytosol of a cell
What ion is required for the release of thyroid hormone?
Iodide
How is iodide taken into the body?
Diet from fish, seaweed or dairy
Name 4 functions of thyroid hormones
- Growth and development
- Calorigenic (heat generating)
- Metabolic (carbohydrate metabolism)
- Cardiovascular (increased HR)
What is hypothyroidism?
Insufficient production of thyroid hormones
What is the treatment for hypothyroidism?
Levothyroxine
What are the symptoms of hypothyroidism in babies?
Severely shunted physical and mental growth
What is hyperthyroidism?
Excess production of thyroid hormones causing Goitre
Name 4 symptoms of hyperthyroidism
- Bulging eyeballs
- Muscle weakness
- Anxiety
- Increased HR
Name 2 pharmacological treatments of hyperthyroidism
- Thyioureylenes
2. Potassium perchlorate
How does potassium perchlorate function?
Inhibit iodine uptake in thyroid
What is the major side effect of thyioureylenes?
Leucopenia
