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Dental Mgmt of Medically Compromised Pts > Endocrine Disease > Flashcards

Endocrine Disease Flashcards

1
Q

When is the highest levels of cortisol produced?

A

in the morning

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2
Q

How does aldosterone regulate bp?

A

Fluid and sodium retention

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3
Q

Action of ______
Kidneys –distal tubules
Intravascular volume and RAA system
Regulates Na and H20 balance –affects BP

A

Aldosterone

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4
Q

Action of ______
• Increases contractility and vascular reactivity to vascoconstriction
(results in BP)
• Antagonizes insulin
• Activates lipolysis –increased FFA
• Stimulates gluconeogenesis - (results in sugar, insulin
intolerance and cholesterol)
• Muscle catabolism –increases glucose
• Decreases calcium absorption and activates osteoclasts
- (results in osteoporosis)
• *Inhibits PLA2 and mobilization, migration, function of leukocytes -
- (results in immune response)
• Increases appetite, suppresses sleep, regulates emotion and
memory
• Increases intraocular pressure

A

Cortisol

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5
Q

Action of _______
Fight or flight - stress response
Increases BP, peripheral resistance, cardiac output

A

Norepi and Epi

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6
Q

• ↑Aldosterone, cortisol, androgen, estrogen isolated or in combination

A

Hyperadrenalism

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7
Q

• Hypertension, hypokalemia, edema

A

Hyperaldosteronism

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8
Q 
Glucocorticoid excess 
• MOST COMMON
• High levels of cortisol
➢ Cushing disease (pituitary or adrenal tumor) 
➢ Cushing syndrome (exogenous corticosteroids)
➢ Complications 
Jameson et al.  Harrison’s Principles of Internal Medicine 20th ed. (2018)
oDiabetes
oHypertension
oWeight gain
oMoon facies
oBuffalo hump
oHirsutism
oAcne
oHeart failure
Adrenal
oOsteoporosis
oDelayed wound healing
oSusceptibility to infection
oirregular menses Insomnia
oPsychiatric disorders
oPeptic ulcers
oGlaucoma and cataracts
oStunted growth
A

Glucocorticoid excess

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9
Q

Findings in ______:
Increased central adiposity (moon facies and buffalo hump) with thinning of extremities
- Diabetes
- Hypertension
- Osteoporosis
- Irregular menses
Management:
-Appropriate endocrine and surgical consultation
- Surgical removal of pituitary or adrenal tumor
- Adrenal enzyme inhibitors
- Radiation therapy

A

Cushing syndrome

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10
Q 
The following drugs are used to treat\_\_\_\_\_\_\_\_:
Prednisolone
Triamcinolone
Methylprednisolone
Dexamethasone
Betamethasone
A

Cushings

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11
Q 
➢ Destruction of adrenal cortex
o↓Cortisol and ↑ACTH (adrenocorticotropic 
hormone)
➢ Etiology 
oMost commonly autoimmune
❑ What does this mean?
oChronic infectious disease and sepsis
❑ HIV, CMV, fungal infection
oDrugs
➢ Cannot tolerate stress (emotional or physical)
oAdrenal crisis
➢ Requires cortisol replacement
oSurgery and stress may require 
supplemental corticosteroids
oPain control is important
A

• Addison Disease

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12
Q

Related features of _____:

  • Postural hypotension
  • Anorexia and weight loss
  • Fatigue
  • Shock, coma, and death, if untreated
  • Hyperpigmentation of skin and mucous membranes
A

Addison’s

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13
Q

Hyperpigmentation and adrenal crisis do not usually occur/less likely with
______ and ________ adrenal insufficiency

A

secondary and tertiary

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14
Q

Can hyperadrenalism pts be given NSAIDs or aspirin?

A

No

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15
Q

_________ may be a consequence of both hyperadrenalism and

adrenal insufficiency

A

Impaired wound healing

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16
Q

signs of ________
oHypotension - Monitor BP –vasopressors, patient position, fluid
replacement
oAbdominal pain
oMyalgia
oFever
oSupplement with 100 mg of hydrocortisone and send to ED

A

adrenal crisis

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17
Q 
• Involved in developmental and 
metabolic processes
• Depends on iodide
• produces 3 hormones
➢ T3 and T4
oControlled by TSH (pituitary)
➢ Calcitonin
oRegulates circulating calcium 
and phosphorus levels 
oAlso influenced by actions of 
PTH and Vit D
A

Thyroid function

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18
Q

oRegulates circulating calcium
and phosphorus levels
oAlso influenced by actions of
PTH and Vit D

A

Calcitonin

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19
Q 
\_\_\_\_\_\_\_ functions:
Heart
-Increases number of B-adrenergic rcs
- Enhanced responses to circulating catechloamines
-Increased contraction
Adipsoe tissue
-Stimulates lipolysis
Muscle
-Increased protein breakdown
Bone
-Promote normal growth and skeletal development
Lipoprotein
Formation of LDL receptors
Other 
-Stimulates oxygen consumption by metabolically active tissues
A

Thryoid

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20
Q

Hyperthryoidism goiter

A

–Graves disease

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21
Q

Hypothyroidism goiter –

A

Hashimoto thyroid

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22
Q 
Symptoms of \_\_\_\_\_\_\_\_:
Unintentional weight loss
Heat intolerance/ sweating
Multiple daily loose stools
Weakness
Oligomenorrhea
C
A

Hyperthyroidism/ Graves

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23
Q

Clinical findings and complications of _______:
Goiter
tachycardia
Atrial fibrillation
Fine tremor
Ophthalmopathy
Thyroid storm with fever, confusion, dehydration, and possible death

A

Hyperthyroidism

24
Q

What drug is used to inhibit thyroid hormone metabolism and conversion from t4 to t3

A

Propylthiouracil (B-blocker)

25
Q 
\_\_\_\_ symptoms:
Unexplained weight gain
Lethargic
Cold intolerance
Constipation
Muscle weakness
Decreased body temp
A

Hypothyroidism

26
Q 
Clinical findings and features:
Goiter
Bradycardia
Coma and death without treatment
Slowing down function
A

Hypothyroidism

27
Q

Oral findings in _____:
• Increased periodontal bone loss
• Increased susceptibility to caries

A

Hyperthyroidism

28
Q 
Oral findings in \_\_\_\_\_\_;
• Delayed tooth eruption and altered bone formation 
• Macroglossia
• Dysgeusia and burning mouth 
• Salivary gland enlargement
• Oral lichen planus
A

• Hypothyroidism

29
Q 
Thyroid issue:
➢ CPR and vital signs 
➢ Ice packs or wet packs
➢ Administer hydrocortisone 100-300 mg 
➢ IV glucose 
➢ Administer propylthiouracil
➢ Send to ED
A

Thyrotoxic crisis/storm - hyperthyroidism

30
Q 
Thyroid issue:
➢ CPR and vital signs 
➢ Conserve body heat –blanket 
➢ Administer hydrocortisone 100-300 mg 
➢ IV saline and glucose 
➢ Administer thyroxine 
➢ Send to ED
A

Myxedema coma - hypothyroidism

31
Q

In _________
• 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 (since already tachycardic)

A

Hyperthyroidism

32
Q

In _________
• 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

A

hypothyroidism

33
Q

According to the graph in lecture, about ___% of b cells need to be destroyed before T1DM is symptomatic

A

80%

34
Q

What is the best metric for diabetes since most stable?

A

HbA1C (>5.7%)

35
Q

Higher prevalence of ________ in poorly

controlled diabetics - HbA1c>9%

A

severe periodontal disease

36
Q

If there is severe periodontal issues in a pt, how does this typically correlate to the other systemic efects of DM like nephropathy, retinopathy, CV complications

A

Usually means they are present and bad

37
Q

What do sulfonylureas do?

A

Increase insulin secretion

38
Q

What does metformin do?

A

Decreases gluconeogenesis

39
Q

The following ar oral manifestations of __________:
• 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

A

DM

40
Q

If a DM pt has an A1C of over 8%, how do you treat them?

A

Defer treatment until under control

41
Q

Do you prophylactically treat with ABX for DM?

A

Case dependent

42
Q

are the following meds indicated or contraindicated in DM pts?
• Tetracyclines (including doxycycline) with insulin
• fluoroquinolones ciprofloxacin (Cipro), levofloxacin (Levaquin), etc. with
insulin
• Aspirin with sulfonylureas

A

Contraindicated

43
Q

Should DM pts fast before dental treatment?

A

NO; could cause major hypoglycemia

44
Q
  • 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 diabetes
A

Gestational diabetes

45
Q

Which trimester is the longest?

A

2nd

46
Q

Which trimesters are routine dental treatment indicated in?

A

2nd

1st half of 3rd

47
Q 
Common \_\_\_\_\_\_ Discomforts 
➢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
A

Pregnancy

48
Q

Radiographs are _____ in all pregnancies unless emergent care is needed; must have lead shield

A

Contraindicated

49
Q 
\_\_\_\_\_\_\_\_\_\_ occurs in late 
(3rd trimester) pregnancy
• Due to compression of the inferior 
vena cava that results in impaired 
venous return to the heart. 
• Manifests as:
• Fall in blood pressure
• Bradycardia
• Sweating
• Nausea
Patient can rotate to their side to 
allow venous return to recover. 
Studies indicated that the LEFT side 
is the best.
A

Supine hypotension syndrome

50
Q

Can pregnant pts take NSAIDs and aspirin?

A

No; can take acetaminophen

51
Q

Can opioids be used in pregnant pts?

A

No

52
Q

T/ F: Amoxicillin, clindamycin, azithromycin, metronidazole and
erythromycin are common antibiotics that may be used in pregnant
patients

A

True

53
Q

Can tetracyclines and doxycycline used in pregnant pts?

A

No

54
Q

Can benzodiazepenes be given to pregnant pts?

A

No

55
Q

Are most drugs ok to be taken while lactating?

A

Yes; take just after breast feeding

56
Q

________ is the most common oral condition in pregnancy, 60-75% of
pregnant women.
- Lack of attention to Oral Hygiene
- Increased systemic fluid levels from increased progesterone and
estrogen exacerbate any existing gingival/periodontal condition

A

Gingivitis

57
Q

• 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 –

A

Epulis gravidarum

Dental Mgmt of Medically Compromised Pts (12 decks)

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