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Pharm Part II > E3: I'M NOT ON STEROIDS! > Flashcards

E3: I'M NOT ON STEROIDS! Flashcards

1
Q

Which hormone and class is for the maintenance of homeostasis during periods of STRESS…Maintains stability during Emotional stress and/or Physical stress

A

Cortisol (a glucocorticoid)

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2
Q

What are the 4 main effects of Natural Cortisol?

A

1.Metabolism 2.Vascular Reactivity 3.Anti-Inflammatory 4.Homeostasis in stress

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3
Q

WHAT IS THE MOST POTENT ACTIVATOR of endogenous cortisol? What is the secondary activator?

A

SURGERY…pain

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4
Q

What is the name of EXCESSIVE cortisol disease? also it is a disorder of what body organ?

A

Excessive: CUSHING’s disease…disorder of the Adrenal Gland

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5
Q

What is the disease of INSUFFICIENT production of cortisol in the adrenal glands?

A

Addison’s Disease

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6
Q

What is SECONDARY adrenal gland disorder caused by?

A

secondary disorder = HPA axis is suppressed due to taking glucocorticoid medications

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7
Q

What is more common? Addison’s disease or Secondary Adrenal Insufficiency?

A

2ndary

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8
Q

Secondary Adrenal Insufficiency is associated with:

A

Chronic STEROID use

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9
Q

What is the most dangerous aspect about secondary adrenal insufficiency in the dental practice? But thank God it is relatively ______ to have a medical emergency!

A

It does not usually produce symptoms unless the Pt is highly stressed!..>RARE

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10
Q

What is the main sign of an acute secondary adrenal insufficiency in the dental operatory?

A

Hypotension

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11
Q

What are the three things that a patient could die from in an acute adrenal insufficiency?

A

1.Hypotension 2.Hypoglycemia 3.Hypothermia

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12
Q

What are the three things you would administer to a patient in a emergency adrenal insufficiency situation?

A

1.Glucocorticoids 2.Glucose 3.Epinephrine

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13
Q

What are the 3 main indications for Synthetic Glucocorticoids in medicine?

A

1.Autoimmune diseases 2. Organ Transplants (immunosuppresive) 3.Respirtatory disease

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14
Q

Besides the more obvious uses for steroid use in systemic disease (like ARTHRITIS) what are the five other indications?

A

1.Replacement therapy (adrenal insufficiency) 2.Rheumatic CARDITIS 3.Renal Diseases 4.Collagen Diseases 5.Allergic diseases

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15
Q

I freaking love MECH of ACTION’s…Steroids-Steroid-receptor complex TRANSLOCATES into the ______ and alters _________

A

nucleus….gene expression

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16
Q

??I freaking love MECH of ACTION’s…Steroids-Other effects of glucocorticoids are mediated by __________…producing vasodilation or bronchodilation

A

catecholamines

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17
Q

What is the main mechanism of action for steroids? What are the 3 ways it takes care of this action?

A

ANTI-Inflammatory–1.Effecting Peripheral Leukocytes (increase neutrophils, decrease everything else) 2.Inhibit phospholipase A 3.inhibit IL’s n stuff

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18
Q

Adverse reactions of Steroid use are proportional to ____, frequency, time of administration and ______ of treatment

A

dose…duration

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19
Q

Steroid treatment is _______ rather than curative

A

palliative

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20
Q

Potency: Each steroid is rated as to potency as compared to a ________ equivalent dose

A

hydrocortisone

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21
Q

WHICH type of steroid administration/application is least likely to cause ADRENAL SUPPRESSION? Therefore, _______ steroids are more likely to cause adrenal suppression.

A

Topical Application…systemic steroids more likely

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22
Q

How are coritcoSteroid Products CHARACTERIZED?

A

Duration of Action

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23
Q

Relative anti-inflammatory activity and equivalent oral dose, with _________ arbitrarily assigned the value of 1

A

HYDRO-CORTISONE (cortisol)

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24
Q

What are the 3 types of SHORT acting corticosteroids?

A

1.HydroCortisone 2.Prednisone 3.MethylPrednisone

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25
Q

Prednisone = anti-inflammatory activity of __…Prednisone has ___ times the anti-inflammatory action of __________

A

4…4….hydrocortisone(cortisol)

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26
Q

Equivalent doses are based on _____ mg hydrocortisone = amount normally secreted daily by an adult WITHOUT STRESS

A

20 mg

27
Q

What are the two examples of INTERMEDIATE acting corticosteroids?

A

1.TRI-AM-CIN-OLONE 2.Prednis-OLONE

28
Q

What are two examples of LONG acting corticosteroids?

A

1.DEXA-meth-a-sone 2.BETA-meth-a-sone

29
Q

Dosing corticosteroids: drugs are taken in what part of the day? With what type of daily pattern? (used for pts on these drugs for more than ____ in time)

A

MORNING….alternate day pattern…(longer than 1 month)

30
Q

What does the “alternate day therapy” do for the adrenal gland function?

A

Allows adrenal gland to function normally on the off day of the drug.

31
Q

VERY INTERESTING: during stress adrenals may secrete up to ____ mg of hydrocortisone equivalent!

A

300 mg

32
Q

Any medication that EXCEEDS the amount of ___-___ mg hydrocortisone equivalent may cause adrenal gland suppression.

A

20-30 mg hydrocortisone equivalent

33
Q

When on coritosteroids, AVOID aspirin and NSAIDS for consequence of ________

A

peptic ulcerations

34
Q

What are 3 (of 10) common side effects of chronic steroid use?

A

1.MOON FACE 2.CATARACTS 3.OSETEOPEROSIS(*leading risk factor)

35
Q

What are the 4 ORAL side effects of steroids?? whats MOST common?

A

1.Candidiasis(MOST COMMON) 2.Poor wound healing 3.masking of oral infections 4.Xerostomia

36
Q

What are the 4 contraindications to steroids? (haha besides peptic ulcers/other side effects)

A

1.Systemic Fungal Infections 2.Viral INfections 3.Latent/active TB 4.Allergy to meds

37
Q

BIG FlashCard!!!! WHAT ARE THE 2 MAIN INDICATIONS for Steroid use in Dentistry? What are the 2 mechanisms by which it does this?

A

1.Reduce pain and swelling 2.tx inflammatory path of oral mucosa….1.suppress migration of PMNs 2.Reverse capillary permeability

38
Q

So, one of the indications for steroid use in dentistry is tx of oral inflammatory conditions, what are 3 (of the 6) examples?

A

1.Lichen Planus 2.Apthous Ulcers 3.TMJ disorders

39
Q

What is the most common route of delivery for corticosteroids in dentistry? What is the max duration of use?

A

Topical…for 2 weeks.

40
Q

When teaching Pts about topical steroid use: use a _____ tip, put on after _____, and don’t do anything oral for ___ minutes

A

cotton tip…..brushing/eating/drinking/bedtime…30 minutes

41
Q

Everyone should know What is the corticosteroid that Crest added adhesive for prolonged oral contact?

A

TRI-AM-CIN-OLONE (KEN-A-LOG in ORA-BASE)

42
Q

An inflammatory lesion being treated with a topical corticosteroid should respond in ___ to ___ days.

A

7-14 days

43
Q

“Other Topical Ointments”: For Mild lichen planus, recurrent aphthous stomatitis- use:

A

FLU-O-CIN-O-NIDE

44
Q

“Other Topical Ointments”: Fororal inflammation; apply with Q-tip- use: (its tot’s popular)

A

CLO-BETA-SOL PRO-PRI-ON-ATE

45
Q

“Other Topical Ointments”: Apply with Q-tip- use:

A

BETA-METHA-SONE

46
Q

Topical Rinses: elixer-

A

DEXA-METHA-SONE

47
Q

Topical Rinses: syrup-

A

PRED-NIS-OLONE

48
Q

Ranking Steroid Potency: What are the 2 low potency preparations?

A

hydrocortisone cream 1% (OTC) and 2.5% (Rx)

49
Q

Ranking Steroid Potency: What is the 1 moderate prep?

A

1.TRI-AM-CIN-OLONE acetonide (0.025% and 0.1%)

50
Q

Ranking Steroid Potency: What are the 3 HIGH preps?

A

1.TRI-AM-CIN-OLONE acetonide (0.5%) 2.FLU-O-CIN-O-NIDE (0.05%) 3.CLO-BETA-SOL (0.05%)

51
Q

What are the two methods of INJECTED steroids?

A

1.IntraLesional (no systemic effects) 2.Intra-articular (bone path)

52
Q

What are the two examples of orally taken steroids used before, during and after oral surgery?

A
  1. Methyl-Pred-Nis-O-Lone 2.Pred-nis-one
53
Q

CORTICOSTEROIDS ARE A PREGNANCY CATEGORY ___ DRUG. AVOID.

A

C

54
Q

USE CORTICOSTEROIDS WITH EXTREME CAUTION IN _______ PATIENTS. They are more susceptible to suppression with Topicals and 5 mg can limit ______

A

PEDIATRIC…growth

55
Q

Corticosteriods: Geriatric patients are more susceptible to _______ and _______ side effects.

A

hypertension and osteoperosis

56
Q

Other than _____________, few DENTAL procedures warrant use of supplemental steroids before, during, or after the operative period

A

major surgical procedures (Routine dental procedures do not stimulate cortisol production at levels comparable to those produced at time of surgery)

57
Q

Cortisol increases are not typically seen BEFORE or DURING the procedure: increase in postoperative period __ to _______ after procedure has begun…Correlates with loss of _________….Improves with use of analgesics and anti-anxiety meds


A

1 to 5 hours…local anesthesia

58
Q

4 Factors that increase risk for POST OP Adrenal Crisis: Wait. 2 additional factors :)

A

1.Severity of surgery 2.Drugs administered 3.overall health of Pt. 4.extent of pain control….5. blood loss 6.fasting

59
Q

WHAT ARE THE NUMBERS THAT REPRESENT HYPOTENSION????

A

Systolic less than 100mmHg, Diastolic less than 60mmHg

60
Q

What are three types of tests we can use for Pts with a Hx of steroid use?

A

1.Plasma ACTH & Cortisol Levels 2.urine 3.Stimulation

61
Q

For a Pt currently on steroids: Patient takes usual daily ____….Schedule patient _________….______ reduction protocol (Pain control, Anxiety control)….Monitor blood pressure

A

dose…first thing in morning…Stress

62
Q

Do I SUPPLEMENT Steroids? Routine dental procedures (excluding extractions)—Patients currently taking steroids: _____,Use good pain and anxiety control……Patients with history of regular steroid use: _____……..Patients currently using topical or inhaled steroids: _____

A

None, None, and None :)

63
Q

Target dose of ____ mg hydrocortisone per day for minor oral and PERIODONTAL surgery

A

25 mg

Pharm Part II (28 decks)

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