Exam 3 Steroids

Question 1

2 uses in dentistry for steroids

Answer 1

1. reduction of pain and swelling

2. tx of inflammatory pathologies of oral mucosa

Question 2

8 uses in medicine for steroids

Answer 2

1. autoimmune diseases
2. immunosuppressive therapy in organ transplant patients
3. respiratory disease management
4. replacement therapy (adrenal insufficiency)
5. arthritis
6. rheumatic carditis
7. allergic diseases (for anti-inflam. effect)
8. collagen diseases (lupus erythematosus)

Question 3

In dentistry, when steroids are used for the treatment of inflammatory pathologies of oral mucosa, specificially, what are 2 effects of this?

Answer 3

1. suppress migration of PMNs

2. decreased capillary permeability

Question 4

9 side effects of corticosteroids (non oral)

Answer 4

1. insomnia
2. peptic ulceration
3. osteoporosis
4. hyperglycemia
5. cataract formation
6. glaucoma
7. redistribution of fat pads (moon face)
8. growth suppression
9. delayed wound healing

Question 5

4 oral side effects of corticosteroids

Answer 5

1. candidiasis (most common)
2. poor wound healing (long term)
3. masking of oral infections (bc its anti-inflam)
4. xerostomia

Question 6

9 populations most at risk for adverse effects of steroids

Answer 6

1. CV disease/hypertension
2. peptic ulcer/gastritis/esophagitis
3. osteoporosis
4. diabetes mellitus
5. TB/infections
6. psychological difficulties
7. glaucoma
8. pregnancy (category C)
9. young/elderly

Question 7

biggest complication associated with long term use of corticosteroids

Answer 7

poor wound healing

Question 8

____ patients more susceptible to hypertension and ____ side effects, check to ensure adequate ___ function, and lower dose to limit ___ and ___ damage

Answer 8

Geriatric
osteoporosis
liver
liver
kidney

Question 9

Use with extreme caution in ___ patients, more susceptible to suppression with _____. __ mg can limit growth

Answer 9

pediatric
topicals
5mg

Question 10

What are the 2 etiologies of adrenal insufficiency?

Answer 10

1. excessive production of cortisol

2. Insufficient production of cortisol

Question 11

What is the primary disorder that causing excessive production of cortisol?

Answer 11

cushing’s disease

Question 12

What is the primary disorder that causing insufficient production of cortisol?

Answer 12

Addison’s disease - glands do not function

Question 13

What is the secondary disorder that causes insufficient production of cortisol?

Answer 13

HPA (hypothalamic-pituitary adrenal) axis is suppressed due to taking glucocorticoid medications

Question 14

Taking glucocorticoid medications (exogenous steroids) suppresses the body’s own production of ____ ____. More common than ____ disease. Associated with ____ steroid use. 60 cases per 1 million adults per year. Avg dental practice with 2000 patients will have at least __ patients who are chronic steroid users who have the potential for ____ ____. Condition usually does not produce symptoms unless the pt is significantly ____.

Answer 14

exogenous steroids
Addison's
chronic
50
adrenal insufficiency
stressed

Question 15

13 signs/symptoms of adrenal crisis

Answer 15

1. sunken eyes
2. profuse sweating
3. hypotension
4. weak pulse
5. dyspnea
6. cyanosis
7. headache
8. dehydration
9. fever
10. myalgias
11. arthralgias
12. hyponatremia
13. eosinophilia

Question 16

Without treatment, adrenal crisis will continue to decline and lead to what 5 things?

Answer 16

1. hypothermia
2. severe hypotension
3. hypoglycemia
4. circulatory collapse (SHOCK)
5. death

Question 17

Treatment for adrenal crisis, name 5 things

Answer 17

1. elevate patients feet above head
2. IV glucocorticoids
3. Fluid and electrolyte replacement therapy
4. Administration of vasopressors (epi)
5. Monitor BP carefully

Question 18

4 important factors in risk for adrenal crisis when trying to manage treatment in a dental office

Answer 18

1. severity of surgery
2. drugs administered during procedure
3. overall health of the patient
4. extent of pain control
   (additional factors
5. amount of blood loss - hypotention
6. fasting state - hypoglycemia)

Question 19

3 clinical considerations when planning a dental surgery on a pt with adrenal insufficency

Answer 19

1. surgeries that last longer than 1 hour
   2, blood and fluid loss exaverbate hypotension
2. Monitor BP (

Question 20

5 routes of delivery for steroids

Answer 20

1. topical
2. ointments/gels
3. rinses
4. injected
5. systemic oral

Question 21

____ - most common delivery route in dentistry, when used for

Answer 21

Topical
adverse effects
 2 weeks
adrenal suppression
least

Question 22

Ointments/gels - applied _____ with a cotton tip to reduce cross contamination. Apply after brushing, ____/____ and at bedtime. Do not take anything by mouth for at least ___ minutes following application. Can also be placed in ____ to prolong contact with lesion. ___ adheres best. Lesions usually respond in_____ days Ointments are usually mixed with _____ adhesive to prolong contact.

Answer 22

intraorally
eating/drinking
30
mouthguards
gel
7-14 
tissue

Question 23

Name the 4 intraoral steroid gels/ointments discussed in class

Answer 23

1. triamcinolone (Kenalong in Orabase)
2. flucinonide (Lidex)
3. clobetasol proprionate (Temovate)
4. betamethasone valerate (Valisone)

Question 24

Which steroid gel treats mild lichen planus and recurrent aphthous stomatitis?

Answer 24

fluocinonide (Lidex)

Question 25

What topical rinses is used 2-4x per day and rinsed for 30 seconds at a time?

Answer 25

dexamethasone (Decadron) elixir or prednisolone syrup

Question 26

2 types of injected steroids

Answer 26

1. intralesional - used intermittently with no systemic complications 2. Intra-articular - used at 3 week intervals to treat bone pathologies

Question 27

____ - most likely to cause adrenal suppression. Used before during and after oral surgery to ___ ___.

Answer 27

Systemic | reduce swelling

Question 28

Name 2 oral steroids used in dentistry

Answer 28

1. methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) | 2. prednisone (Prednisone Intensol, Sterapred)

Question 29

Cortisol increases are not typically seen ___ or ___ the procedure. Increase in postoperative period __ to __ hours after procedure has begun, most likely a response to ___, correlates with loss of local ____, improves with use of _____ and anti-anxiety meds.

Answer 29

``` before or during 1 to 5 pain anesthesia analgesics ```

Question 30

If patient has a history of steroid use and a large surgery is planned, what 2 things should be done?

Answer 30

Physician consult | Lab testing

Question 31

what 3 tests are looked for when testing for adrenal sufficiency before an invasive surgery?

Answer 31

1. basal plasma ACTH & cortisol levels 2. urine tests 3. stimulation tests If adrenal insufficient, implement steroid supplementation

Question 32

If a patient is currently taking a steroid and minimally invasive procedure is planned, what 4 things should be done?

Answer 32

1. pt takes usual daily dose 2. schedule pt first thing in morning 3. stress reduction protocol 4. monitor BP

Question 33

2 things that can be done to help reduce stress in a patient taking steroids?

Answer 33

1. nitrous oxide 2. benzodiazepines (valium) (these drugs have no effect on cortisol levels)

Question 34

What is the target dose of hydrocortisone per day for minor oral surgeries and major surgeries involving general anesthesia?

Answer 34

Minor - 25 mg | Major 50-100 mg