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MED COMP PTS > endocrine > Flashcards

endocrine Flashcards

1
Q

products of the adrenal glands

A
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2
Q

zones of adrenal glands and their products

A
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3
Q

HPA axis

A
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4
Q

adrenal and kidney BP regulation

A
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5
Q

aldo actions

A
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6
Q

cortisol actions
BP?
insulin?
lipids?
gluconeogenesis?
mm
IS
Ca?
appatite? sleep? emotion? memory?
IOP?

A

roles

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7
Q

Hyperadrenalism

A
  • ↑Aldosterone, cortisol, androgen, estrogen isolated or in combination
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8
Q

most common excess adrenal hormone

A

cortisol; cushing dx (pit or adrenal tumor) or cushing syndrome (exogenous steroids)

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9
Q

complcations of excess cortisol

A

o Diabetes
o Hypertension
o Weight gain
o Moon facies
o Buffalo hump
o Hirsutism
o Acne
o Heart failure
o Osteoporosis
o Delayed wound healing
o Susceptibility to infection
o irregular menses Insomnia
o Psychiatric disorders
o Peptic ulcers
o Glaucoma and cataracts

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10
Q

pnemonic for cushing signs and symptoms

A

cushingoid

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11
Q

common glucocorticoids

A
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12
Q

importance of Rx glucocorticoids

A

much more potent then endogenous glucocorticoids, must monitor HPA

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13
Q

forms of adrenal insuff

A
  • Tertiary > Secondary > Primary
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14
Q

addison dx

A

➢ Destruction of adrenal cortex
o ↓Cortisol and ↑ACTH (adrenocorticotropic
hormone)

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15
Q

addison dx etiology

A

o Most commonly autoimmune
o Chronic infectious disease and sepsis
❑ HIV, CMV, fungal infection
o Drugs

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16
Q

adrenal crisis of addison dx

A

Cannot tolerate stress (emotional or physical), no cortisol

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17
Q

addison dx tx
o Surgery and stress may require?
o Pain control?

A

➢ Requires cortisol replacement
o Surgery and stress may require supplemental corticosteroids
o Pain control is important

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18
Q

cutaneous findigs of addisons
skin
mucus membranes
nails
hair
casrtilage

A

d

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19
Q

addisons features
pain?
electrolytes?
hypotension?
weight?
fatique?
if untx?

A
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20
Q
  • Secondary adrenal insufficiency
A

➢ Impaired/destructive pituitary disease
➢ ↓Cortisol and ↓ACTH; aldosterone unchanged
➢ Lower dose replacement therapy

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21
Q

Tertiary adrenal insufficiency
➢ Impaired function of?
➢ Most commonly a result of?
➢ therapy?

A

➢ Impaired function of hypothalamus
➢ Most commonly a result of chronic exogenous steroid use
➢ Lower dose replacement therapy

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22
Q

Hyperpigmentation and adrenal crisis with secondary and tertiary adrenal insufficiency?

A

Hyperpigmentation and adrenal crisis do not usually occur/less likely with secondary and tertiary adrenal insufficiency

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23
Q

Undiagnosed patient with signs and symptoms of adrenal disease?

A

Undiagnosed patient with signs and symptoms of adrenal disease should be promptly be
referred to their primary physician for comprehensive work-up

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24
Q

Hyperadrenalism
➢ BP and glucose levels?
➢ drugs to avoid? why?
➢ bone complications?

A

➢ increased BP and glucose levels
➢ Avoid NSAIDs and aspirin → peptic ulcers, GI bleed
➢ If osteoporosis and osteopenia
o More prone to periodontal bone loss - monitor
o May have history of bisphosphonate use

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25
Q

what can be impaired in both hyper and hypoadrenalism

A

Impaired wound healing may be a consequence of both hyperadrenalism and adrenal insufficiency

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26
Q

Necessity for supplemental corticosteroids?
o Depends on?

A

Discuss dosage w/physician
o Depends on?
✓ Type
✓ Severity/ stability/ medical status
✓ Dental procedure being performed (long: >1hr or invasive) /type of stress/dental infectio

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27
Q

signs of adrenal crisis
what to do?

A

o Hypotension - Monitor BP – vasopressors, patient position, fluid replacement
o Abdominal pain
o Myalgia
o Fever
o Supplement with 100 mg of hydrocortisone and send to ED

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28
Q

Pain control with adrenal insuff

A

o Adequate anesthesia, long-acting agent at end of procedure
o Good post-up pain control

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29
Q

Thyroid function

A
  • Involved in developmental and metabolic processes
  • Depends on iodide
  • Thyroid produces 3 hormones
    ➢ T3 and T4
    o Controlled by TSH (pituitary)
    ➢ Calcitonin
    o Regulates circulating calcium and phosphorus levels
    o Also influenced by actions of PTH and Vit D
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30
Q

Thyroid hormone effects at heart, gut, fat, mm, NS, lipoproteins, other

A
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31
Q
  • Thyroid enlargement
  • May be?
  • Most are?
  • Hyperthryoidism goiter seen in?
  • Hypothyroidism goiter seen in?
A

Goiter
* May be functional or non-functional
* Most are non-functional (euthyroid)
* Hyperthryoidism goiter – Graves disease
* Hypothyroidism goiter – Hashimoto thyroiditis

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32
Q

Thyroid nodules

A
  • Hyperplasia
  • Adenoma
  • Carcinoma
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33
Q
  • Thyroiditis
A
  • Hashimoto (autoimmune)
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34
Q

Hyperthyroidism (thyrotoxicosis)

A
  • Primary – Graves disease (auto-immune disease)
  • Secondary – Pituitary adenoma
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35
Q

Hypothyroidism (congenital or acquired)

A
  • hasimoto
  • Secondary
  • Transient
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36
Q

thyroid Neoplasias

A
  • Adenoma
  • Carcinoma (papillary, follicular
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37
Q

symptoms hyperthy

A
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38
Q

clinical findings of hyperthy

A
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39
Q

Hyperthyroidism serum levels

A

Hyperthyroidism ↑ Free T4; ↓ TSH

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40
Q

Management hyperthyroidism
consultation?
b-blocker?
propylthiouracil?
methimazole?
radioiodine?

A

w

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41
Q

Thyroid storm/crisis

A

Medical emergency
May be precipitated by oral infection or surgical procedure in a patient who is poorly controlled

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42
Q

hypothy symptoms

A
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43
Q

clinical findings and complication hypothy

A
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44
Q

Hypothyroidism serum

A

Free down T4; ↓ TSH or up TSH

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45
Q

related features of hypothy
tongue?
wounds?
nose?
lips?
eyelids?
congential?
coma?

A

e

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46
Q

management hypothy

A
47
Q

Hyperthy dental implications (effects on tissues)

A
  • Increased periodontal bone loss
  • Increased susceptibility to caries
48
Q

Hypothy dental implications

A
  • Delayed tooth eruption and altered bone formation
  • Macroglossia
  • Dysgeusia and burning mouth
  • Salivary gland enlargement
  • Oral lichen planus
49
Q

hyper and hypothy with infection

A

both can be more sus to infection, tx aggressively

50
Q

Patients with uncontrolled, poorly controlled, suspected hyperthyroidism or hypothyroism

A

Patients with uncontrolled, poorly controlled, suspected hyperthyroidism or
hypothyroism SHOULD NOT receive dental care until disease is under control

51
Q

risks of tx uncontrolled thyroid pts
* risk with meds for hyper?
* hyper/hypo severe events?

A
  • Agranulocytosis from medications used to treat hyperthyroidism
  • Thyrotoxic crisis/storm - hyperthyroidism
  • Myxedema coma - hypothyroidism
52
Q

procedure with thy strom

A

➢ CPR and vital signs
➢ Ice packs or wet packs
➢ Administer hydrocortisone 100-300 mg
➢ IV glucose
➢ Administer propylthiouracil
➢ Send to ED

53
Q

procedure with myxedma coma

A

➢ CPR and vital signs
➢ Conserve body heat – blanket
➢ Administer hydrocortisone 100-300 mg
➢ IV saline and glucose
➢ Administer thyroxine
➢ Send to ED

54
Q

Drug interactions/side effects in hyperthy
NSAIDS/ASA
cirprofloaxcin
epi

A
  • Caution with aspirin and NSAIDS- can increase T4
  • Ciprofloxacin contraindicated – decreases absorption of thyroid hormone
  • Avoid local anesthestics containing epinephrine and ginigval retraction cord with epinephrine in poorly controlled patients
55
Q

drug interactions in hypothy
narcotics, barbituates, sedatives?
phenytoin, carbamazepine, and rifampin?

A
  • Avoid CNS depressants (narcotics, barbituates, sedatives) if patient is poorly controlled
  • Cytochrome p450 inducers (phenytoin, carbamazepine, and rifampin) should be avoided – increases metabolism of levothyroxine
56
Q

diabetes
* Proper terminology is?
* Related to lack of?
* def needed for?
* Results in?

A
  • Proper terminology is “diabetes mellitus” aka
    diabetes
  • Related to lack of beta cell pancreatic production of
    insulin
  • Insulin needed for sugar absorption into cells; leads
    to increased serum glucose aka hyperglycemia
  • Results in undernourished tissues which have
    multiple effects on systemic health
57
Q

types of DM

A
  • Type 1
  • Type 2
  • Gestational Diabetes occurs in 2-10% of pregnancies
58
Q

Type 1 diabetes (T1D)

A
  • Aka juvenile diabetes
  • Insulin dependent
  • ~10-20% of diabetics
  • Autoimmune disease
  • Destruction of pancreatic β-cells → insulin deficiency
  • Non-obese children and adults <40 years old
59
Q

stages of type 1 DM onset

A
60
Q

microvascular complications of DM

A
  • Neuropathy – extremities, impotence, bladder dysfunction, gastroparesis
  • Retinopathy – cataracts, blindness
  • Nephropathy
61
Q

macrovascular complications of DM

A
  • Peripheral vascular disease, congestive heart failure – hypertension
  • Myocardial infarction – diabetes accelerates atherosclerosis
  • Strok
62
Q

complications of imparied healing and infection with DM

A
  • Neutrophilic dysfunction, increased M1:M2 ratio
  • Increased pro-inflammatory cytokines and increased MMPs
  • Impaired angiogenesis and endothelial dysfunction
63
Q

Type 2 Diabetes

A
  • Aka adult onset diabetes; non-insulin dependent
    diabetes
  • Pancreas produces insulin but it is in low titers or it
    does not work properly
  • ~80-90% of diabetics
64
Q

do the dif DM types have different micro/macrovascular and wound healing effects

A

NO

65
Q

tests for DM
WNL, pre-diabetic, diabetic

A
66
Q

DM test goals

A
67
Q

perio dx and diabetes

A

Higher prevalence of severe periodontal disease in poorly controlled diabetics - HbA1c>9%

68
Q

Controversial effect of periodontal therapy on glycemic control in patients with Type 2 DM

A

Consensus report: short-term reduction in HbA1c levels at 3-4 months after periodontal intervention, no confirmation that this is sustained long-term. [Sanz et al. J Clin Periodontol (2018)]

69
Q

perio dx correlations with DM affects
* retinopathy correlation
* renal complications/ cardiovascular complications
* neuropathic foot?

A
  • Severity of periodontitis and severity of retinopathy correlation
  • Periodontitis + Diabetes → more renal complications and cardiovascular complications
  • Severe periodontitis - association with neuropathic foot ulceration
70
Q

DM tx targets

A

Decrease in gluconeogenesis
Increase in insulin secretion
Sensitization to insulin
Decrease in glucagon secretion
Intestinal and renal absorption of glucose

71
Q

drugs to decrease gluconeagenesis

A

Biguanide – metformin
Insulin – rapid (lispro), short (regular -Novolin), long-acting (glargine)

72
Q

drugs to increase insulin secretion

A
  • Sulfonylureas –glipizide
  • Glucagon-like peptide 1 (GLP1) receptor agonist – exenatide, liraglutide
73
Q

drugs to sensitize to insuiln

A
  • Thiazolidinediones – pioglitazone
74
Q

drugs to Decrease in glucagon secretion

A
  • Dipeptidyl peptidase 4 (DPP4) – sitagliptin
  • GLP1 receptor agonist – exenatide, liraglutide
75
Q

drugs to inhibit Intestinal and renal absorption of glucose

A
  • Sodium-glucose cotransporter-2 inhibitors – canagliflozin
  • 𝛼-glucosidase inhibitor – acarbose
76
Q

Diabetes oral s/s

A
  • Xerostomia/dry mouth
  • Oral burning (different from burning mouth, secondary)
  • Infections (bacterial, fungal, viral)
  • Poor wound healing
  • Increased caries
  • Increased severity risk of periodontal disease
77
Q

concerns with DM oral signs

A

Poor wound healing and infection
Control of comorbidities and drug interaction

78
Q

when is elective tx defered with DM pts (glucose levels)

what if there is an emergency?

A
  • If 2hr after meal glucose or fasting glucose reading < 70 or > 200mg/dl or HbA1c > 8.0%
  • Defer elective treatment
  • If emergency/active infection, consider referral to
    hospital/specialized setting
  • Send medical consultation
79
Q
  • If DM patient not being closely followed by physician (> 6 months),
A

refer

80
Q

DM antibiotic prophylaxis

A

CONTEXT-DEPENDENT

81
Q

what drugs should be avoided with diabetes? interactions with insulin?

A
  • Tetracyclines (including doxycycline) with insulin– hypoglycemia
  • fluoroquinolones ciprofloxacin (Cipro), levofloxacin (Levaquin), etc. with insulin– hypoglycemia
  • Aspirin with sulfonylureas– hypoglycemia
    Be aware that sulfonylureas may cause thrombocytopenia
82
Q

time of day appt for DM

A

Early morning appointments
* Eat normal meal and take medication(s) prior to appointment
* Be aware of and have patient communicate symptoms of hypoglycemia
* Have high-concentration sugar products readily available (orange juice, cake icing, soft drinks (non-diet, non-zero)

83
Q

oral sedation with DM

A

Oral sedation not recommended as fasting is necessary

84
Q

Gestational Diabetes
* occurs in % of pregnancies
* Fetus can have?
* Affects development of?
* Delivery may require what delivery method?
* Treated similar to?

A
  • occurs in 2-10% of pregnancies
  • Fetus can have excess weight gain
  • Affects lung development
  • Delivery may require cesarean section
  • Treated similar to Type 2 diabete
85
Q

preg time cycle

A

Pregnancy = 40 weeks: From the 1st day of last menstrual cycle.
➢ First trimester: 0-12 weeks (12 wks)
➢ Second trimester: 13-28 weeks (16 wks)
➢ Third trimester: 29-40 weeks (12 wks)

86
Q

how can dental tx affect the fetus

A
  • Dental procedures could harm the developing fetus through the effects of:
    ➢Ionizing Radiation
    ➢Drugs- continues post-partum from transmission of drugs via breast milk
    ➢Stress
87
Q
  • Common Pregnancy Discomforts
A

➢Nausea and vomiting- hormonal imbalances, stress (physical and emotional) and hyperacidity
➢Indigestion- difficulties digesting foods rich in fats, sugars, acids can lead to nausea and vomiting
➢Headaches
➢Polyuria
➢Lumbar pain
➢Perspiration
➢Breast tenderness

88
Q

when to provide dental care to preg pts

A
  • Avoid elective dental care during the first
    trimester
  • Second trimester is the best time to perform dental
    treatment on a pregnant patient
  • After the middle of the third trimester, elective dental
    care is best post-poned
  • Dental treatment can be safely performed in all
    trimesters
89
Q
  • Lack of proper oral health care during pregnancy could:
A
  • Lack of proper oral health care during pregnancy could harm the developing fetus and affect the time of delivery
90
Q

radio with women of childbearing age

A

ask if possibly preg

91
Q
  • Radiographs and pregnancy: dose to fetus w Pb apron and 2 PAs
A
  • The gonadal/fetal dose incurred with 2 periapical images when a Pb apron is used is 700 times less than that for 1 day exposure to natural background radiations in the US
92
Q

when should preg pts recieve radiographs

A

only in emergencies that are for standard of care to prevent harm to mother/child

93
Q

Emergency Dental Treatment during Pregnancy
* Maybe provided when?
* what actions should be performed?
* Emergency dental treatment may require a consult with? why?
* Untreated dental infections may pose a risk to?
* Dental radiographs as needed?

A
  • Maybe provided as needed any time during pregnancy.
  • Pain control and elimination of infections should be performed.
    These can stress mother and endanger the fetus.
  • Emergency dental treatment may require a consult with the
    obstetrician, if there is a concern about medications or effect of
    emergency treatment on the fetus.
  • Untreated dental infections may pose a risk to the developing fetus
    → Fever and sepsis may precipitate a spontaneous abortion
  • Dental radiographs as needed to establish a diagnosis
94
Q

why is the supine postion avoided in later stages of pregnancy

A

compression of IVC

95
Q
  • Supine hypotension syndrome manifests how
A
  • Fall in blood pressure
  • Bradycardia
  • Sweating
  • Nausea
96
Q

dealing with supine hypotension in preg pts

A

Patient can rotate to their
side to allow venous return
to recover (roll left)

97
Q

drugs and preg pts

A

All drugs should be avoided during pregnancy, if possible. Benefit should outweigh potential risks.

98
Q

common dental drugs and preg

A
  • Most common dental drugs can be safely used in pregnant patients
  • Do not exceed maximum dose of LA – lido w/ or w/o epi is safe
99
Q

Avoid aspirin and other NSAIDs with preg

A
  • Closure of the ductus arteriosus
  • Risk of post-partum hemorrhage and delayed labo
100
Q

preffered analgesic of pregnancy

A

acetaminophin

101
Q

opiods and preg

A

Opioids should be avoided
* Only when absolutely necessary and in consultation with the physician –codeine with acetaminophen (APAP) is usually the preferred agent

102
Q

Antibiotics and preg pts which can and cannot be used?

A
  • Amoxicillin, clindamycin, azithromycin, metronidazole and erythromycin are common antibiotics that may be used in pregnant patients
  • Tetracycline and doxycycline are CONTRAINDICATED in pregnant patients → teratogenic
103
Q

preg pts and sedation
* preferred?
* If absolutely necessary?
* Pt should with multiple appointments or extended appointment?
* Avoid when? what to do after sedation?
* Benzos?
* If plan is to proceed with any type of sedation, even nitrous, what is needed?

A
  • No pharmacologic sedation is preferred
  • If absolutely necessary, nitrous oxide may be used for < 30 min and with at least 50% oxygen
  • Pt should not have multiple appointments or extended appointment with nitrous oxide sedation as cumulative effects are a point for concern.
  • Avoid during first trimester. As always, appropriate oxygenation after nitrous is necessary to avoid diffusion hypoxia.
  • Benzos should be avoided.
  • If plan is to proceed with any type of sedation, even nitrous, consultation with the physician is necessary
104
Q

female occupational exposure to
Nitrous oxide

why?

A

Women of child-bearing age should not be chronically exposed to nitrous in occupational capacity for more 3 hours/week without scavenging equipment.
* Risk for decreased fertility and greater rates of spontaneous abortion.

105
Q

female x ray occupational exposure

A

Pregnant radiation workers should wear shall be given personal dosimeter monitoring devices to monitor occupational dose limits and assure that the annual effective dose is < 1mSv/yr

106
Q
  • For lactating mothers:
  • Most drugs are?
  • Do not prescribe drugs known to be?
  • Medications should be taken?
A
  • For lactating mothers:
  • Most drugs are of little pharmacologic significance to
    lactation
  • Do not prescribe drugs known to be harmful
  • Medications should be taken just after breast feeding
107
Q

pregnancy effect on gums

A

Can range from mild inflammation to severe overgrowth. The hormonal increase can exaggerate the gum tissue’s response to bacterial plaque.

108
Q

tooth mobility and preg

A
  • Tooth mobility may be present
109
Q

importance of orla health in preg pts or those who want to be

A
  • Prevention, good oral health, and periodontal
    maintenance is important for your pregnant
    patients or those considering becoming
    pregna
110
Q

preg and perio dx

A
111
Q

most common oral condition in preg

A

gingivitis 60-75%

112
Q

Pregnancy Gingivitis and Exacerbated Periodontitis affected by:

A
  • Lack of attention to Oral Hygiene
  • Increased systemic fluid levels from increased progesterone and estrogen exacerbate any existing gingival/periodontal condition
113
Q

Pyogenic granuloma/ Epulis gravidarum/ Pregnancy Tumor

A
  • not an actual granuloma as there is proliferation of vascular tissues as well proliferation of fibrous tissue
  • forms submucosally and takes the shape a nodular growth
  • in pregnancy, it is an exacerbated response to plaque and bacteria precipitated by the changes in progesterone and estrogen hormonal levels –
114
Q

Pyogenic granuloma/ Epulis gravidarum/ Pregnancy Tumor

A
  • not an actual granuloma as there is proliferation of vascular tissues as well proliferation of fibrous tissue
  • forms submucosally and takes the shape a nodular growth
  • in pregnancy, it is an exacerbated response to plaque and bacteria precipitated by the changes in progesterone and estrogen hormonal levels –

MED COMP PTS (9 decks)

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