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Dental Management of the Medically Complex Patient > Lecture 4- Endocrine and Metabolic Disease > Flashcards

Lecture 4- Endocrine and Metabolic Disease Flashcards

1
Q

The hormones of the adrenal cortex are to maintain:

A

BP

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2
Q

Related to lack of metal cell pancreatic production of insulin:

A

DM

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3
Q

Up to 90% of DM cases are:

A

Type 2

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4
Q

For those that are pregnant, there is a 2-10% risk of getting:

A

gestational diabetes

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5
Q

For pregnant patient who gets gestational diabetes, they are at an increased risk of ___ in the future

A

Type 2 DM

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6
Q

Insulin is needed for ___ into cells

A

sugar absorption

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7
Q

A lack of insulin leads to increased ___, AKA ____

A

serum glucose

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8
Q

What does hyperglycemia result in?

A

undernourished tissues

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9
Q

What is responsible for producing insulin?

A

beta cells of pancreas

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10
Q

T/F: You can get Type 1 DM at the age of 64

A

True

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11
Q

How many people are type 1 diabetics?

A

10-20% of diabetics are type 1

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12
Q

Insulin dependent -

A

Type 1

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13
Q

Type 1 diabetes is considered a ___ disease

A

autoimmune

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14
Q

What leads to the insulin deficiency in type 1 diabetes?

A

destruction of pancreatic beta cells

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15
Q

Type 1 diabetes onset is broken down into 3 stages. Which stages are asymptomatic and which are symptomatic?

A

Stage 1& 2 = asymptotic

Stage 3= symptomatic

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16
Q

Describes how diabetes presents at the MICROVASCULAR level:

A
  1. Neuropathy
  2. Retinopathy
  3. Nephropathy

(microvascular = opathy’s)

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17
Q

Where are some areas that diabetics can experience neuropathy?

A
  1. extemetites
  2. bladder
  3. gastroparesis
  4. impotence (inability to achieve an erecton)
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18
Q

Describe the effects of retinopathy:

A
  1. cataracts
  2. blindness
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19
Q

Describe how diabetes presents at the MACROVASCULAR level:

A
  1. peripheral vascular disease
  2. CHF
  3. HTN
  4. MI
  5. Stroke
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20
Q

Why might a diabetic patient have an increased risk for MI?

A

Diabetes accelerates atherosclerosis

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21
Q

Describe the effects of diabetes on its the body ability to heal itself:

A

impaired wound healing and susceptibility to infection

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22
Q

Diabetics release ___ which breaks down soft tissue and contributes to the impaired wound healing ability seen in these patients:

A

collagenase

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23
Q

Reasons why diabetics struggle with wound healing:

A
  1. release of collagenase
  2. neutrophil dysfunction
  3. increased pro-inflammatory cytokines
  4. increase MMPs (Metal metalloproteinaise)
  5. impaired angiogenesis
  6. endothelial dysfunction
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24
Q

Type 2 diabetes may also be referred to as:

A
  1. adults onset
  2. non-insulin dependent
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25
Q

In this disease, the pancreas produces insulin but it is low in titers or is does not work properly:

A

Type 2 DM

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26
Q

What percentage of diabetics are type 2

A

80-90%

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27
Q

Fasting plasma glucose level-

Normal:
Pre-DM:
Type 2 DM:

A

Normal: <100mg/dl
Pre-DM: 100-125mg/dl
Type 2 DM: 126+ mg /dl

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28
Q

Oral Glucose Tolerance Test (2hr plasma glucose)

Normal:
Pre-DM:
Type 2 DM:

A

Normal: Less than 140mg/dl
Pre-DM: 140-199 mg/dl
Type 2 DM: 200+ mg/dl

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29
Q

HgA1C:

Normal:
Pre-DM:
Type 2 DM:

A

Normal: <5.7%
Pre-DM: 5.7-6.4%
Type 2 DM: 6.5%+

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30
Q

What is a random glucose value in a type 2 diabetic?

A

Greater than 200 mg/do in patients with symptoms

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31
Q

Measures the glycosylation of HmgA (the protein that connects HmgA where the glucose is attaching to)

A

A1C

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32
Q

If there is too much glucose in the blood stream, it attaches itself to ____ on the ____

A

hemoglobin; red blood cells

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33
Q

A stable measure not affected by QD glucose fluctuation:

A

A1C

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34
Q

A HbA1C measures the amount of:

A

glycosylation

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35
Q

There is a higher prevalences of ____ in poorly controlled diabetics.

A

Severe periodontal disease

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36
Q

T/F: According to study, short-term reduction in HbA1C levels at 3-4 months after periodontal intervention occurred, but there was not long term studies

A

True

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37
Q

T/F: There is a correlation between the severity of periodontitis and the severity of retinopathy

A

true

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38
Q

If someone has periodontitis + diabetes, this puts them at risk for more ___ & ___ complications

A

renal & cardiovascular

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39
Q

Severe periodontitis is associated with ____ ulceration

A

neuropathic foot

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40
Q

All of the diabetic drugs work to:

A

lower sugar in the blood stream one way or another

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41
Q

List the mechanism of the following diabetic drugs:

  • Biguanide (metformin)
  • Insulin (rapid, short, LL)
A

Decrease in gluconeogeneisis

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42
Q

List the mechanism of the following diabetic drugs:

  • Sulfonylureas (Glipizide, Chlorpropamide & tolbutamide)
  • Glucagon-like peptide 1 (GLP1) receptor agonist (eventide, lirglutide)
A

Increase in insulin secretion

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43
Q

List the mechanism of the following diabetic drugs:

  • Thiazolidinediones (Pioglitazone)
A

Sensitization to insulin

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44
Q

List the mechanism of the following diabetic drugs:

  • Dipeptidyl peptidase 5 (DPP4) (Sitagliptin
  • GLP1 receptor agnoist (Exenatides, Liraglutide)
A

Decrease in glucagon secretion

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45
Q

List the mechanism of the following diabetic drugs:

  • Sodium-glucose cotransporter-2 inhibitors- (canaglifozin)
  • alpha-glucoside inhibitor- (Acarbose)
A

Intestinal & renal absorption of glucose

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46
Q

If the body is not getting enough sugar, then it goes to he bodies reserves to get sugar, and it breaks down cholesterol and fats into glucose to provide glucose to the blood stream but there already is glucose in the blood stream, its just not being taken up properly.

A medication that slows down the biofeedback mechanism that the body is telling itself it needs more sugars from the stores even though there is sugar in the blood stream. What medication is this?

A

Metformin

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47
Q

What are some of the oral manifestations of diabetes?

A
  1. xerostomia/dry mouth
  2. oral burning (not boring mouth syndrome, secondary)
  3. infections (bacterial, FUNGAL, viral)
  4. poor wound healing
  5. increased caries
  6. increased severity risk of periodontal disease
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48
Q

One way to tell if a diabetic patient has controlled DM or not is by:

A

fungal infection in the oral cavity (everyone has Candida albicans in the oral cavity, but this becomes opportunistic in diabetics)

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49
Q

Fasting glucose (or 2 hrs post meal) = less than 70 or greater than 200 mg/dl

HbA1C is greater than 8.0%

As a dentist you should:

A
  1. DEFER elective treatment
  2. If emergent, consider referral to hospital/specialized setting
  3. Send medical consult
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50
Q

Fasting glucose (or 2 hrs post meal) = less than 70 or greater than 200 mg/dl

HbA1C is greater than 8.0%

Discuss prophylactic antibiotics with this patient:

A

Context-dependent

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51
Q

With diabetes, control of comorbidities and drug interactions include:

A
  1. HTN
  2. HLP
  3. Other CVD (angina, MI, CHF, stroke)
  4. Renal impairment
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52
Q

What antibiotics/drugs should be AVOIDED in patients with diabetes?

A
  1. Tetracyclines (including doxycycline)- hypoglycemia
  2. Fluoroquinolones (Cipro, Levo, Leva)- hypoglycemia
  3. Aspirin with sulfonylureas- hypoglycemia
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53
Q

Many antibiotics should be avoided with diabetic patients that are specifically on ____ because it will cause ____

A

insulin; hypoglycemia

  • tetracycline
  • doxycylcine
  • ciprofloxacin
  • levofloxacin
  • levalquin
  • (fluroquinolones)
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54
Q

For a diabetic patient aspirin with ____ should be avoided if they are taking insulin due to risk of ____

A

sufonylureas; hypoglycemia

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55
Q

In patient with diabetes, be aware that sulfonylreas may cause:

A

thrombocytopenia

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56
Q

What medication may be responsible for thrombocytopenia in diabetic patients?

A

sulfonylureas

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57
Q

What thing of appointments is best suited for diabetic patients?

A

Early morning-

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58
Q

Describe how diabetics patients should prepare for a morning appointment:

A

eat normal meal and take medication(s) prior to appointment

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59
Q

As a dental provider, when treating a diabetic patient you should be aware of and have your patient communicate ____.

In addition, have ____ readily available

A

symptoms of hypoglycemia; high-concentration sugar products (OJ, cake icing, soft drinks)

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60
Q

____ is not recommended for diabetics as fasting is necessary

A

oral sedation

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61
Q

In what term does gestational diabetes typically present in a pregnant patient?

A

mid term: ~24-28 weeks

Between 2nd and 3rd term

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62
Q

The ovaries are responsible for releasing:

A

estrogens & progesterone

63
Q

Pregnancy can be a stressor to:

A

oral health

64
Q

Pregnancy is ___ weeks, from the first day of last menstrual cycle

A

40 weeks

65
Q

First Trimester:

Second Trimester:

Third Trimester:

A

First Trimester: 0-12 weeks

Second Trimester: 13-28 weeks

Third Trimester: 29-40 weeks

66
Q

Dental procedures could harm the developing fetus through the effects of: (3)

A
  1. ionizing radiation
  2. drugs
  3. stress
67
Q

Drugs can harm the developing fetus and continues postpartum from transmission of drugs via:

A

breast milk

68
Q

Common pregnancy discomforts:

A
  1. nausea & vomiting
  2. indigestion
  3. headaches
  4. polyuria
  5. lumbar pain
  6. perspiration
  7. breast tenderness
69
Q

Why might a pregnant person experience nausea and vomiting?

A

hormonal imbalances, stress (physical & emotional) and hyperacidity

70
Q

Pregnant women have indigestion, especially with:

A

digesting foods rich in fats, sugars, and acids

71
Q

What is important to do regarding a pregnant womans oral health?

A

Maintain optimal oral health

72
Q

T/F: It is okay to perform elective dental care during the first trimester of pregnancy

A

False- Avoid elective dental care doing the first trimester

73
Q

T/F: Second trimester is the best time to perform dental treatment on pregnant lady

A

True

74
Q

T/F: After middle of third trimester, elective dental care is best postponed

A

True

75
Q

T/F: Dental treatment can be safely performed in all trimesters

A

true

76
Q

Lack of proper oral health care during pregnancy could:

A
  1. harm developing fetus
  2. affect the time of delivery
77
Q

When taking radiographs of a woman of a childbearing age you should inquire:

A

if the patient could possible be pregnant

78
Q

The gonadal/fetal dose incurred with 2 PA images when a lead apron is used is ____ times less than that for 1 day exposure to natural background radiation ins the U.S.

A

700 times

79
Q

Describe when a radiograph is acceptable during pregnancy:

A

Radiographs are contraindicated in ALL but EMERGENCY situations. When taken, lead shielding is mandatory

80
Q

List the guidelines for radiographing “NEW AND RECALL PREGNANT DENTAL PATIENTS” at UMKC SOD:

A

Radiographs should be postponed until post-partum

81
Q

T/F: Long term benefit to the health of the mother from new patient or recall exam radiographs. Also benefit to health of developing child.

A

First statement true
Second statement false- NO benefit to health of developing child

82
Q

When radiographing a pregnant person,

The ____ faces greater risks for mt the radiation exposure than the ____, without any benefit to their health

A

unborn child; mother

83
Q

The ______ recommends different radiation exposure thresholds for pregnant radiation workers than non-pregnant radiation workers

A

National Council on Radiation Protection and Measurements (NCRP)

84
Q

Radiation exposure thresholds for pregnant radiation workers is lowered to the same thresholds as the:

A

general population

85
Q

What guidelines does the UMKC SoD follow in regards to pregnant persons?

A

NCRP recommendations

86
Q

For emergency pregnant dental patients:

A
  1. necessary radiographs are part of the standard of care to treat and diagnose a condition that threatens the health of the other and the unborn child
  2. Lack of radiographs compromises the emergency care diagnosis and treatment (and tis will directly impact the health of the unborn child)
  3. Primary beam is NOT directed toward the child bearing area
87
Q

When is it okay to perform EMERGENCY dental care during pregnancy?

A

may be provided as needed any time during pregnancy

88
Q

What procedures should be performed on a pregnant lady to avoid stress of the mother and endangerment of the fetus?

A

pain control and elimination of infections

89
Q

When performing emergency dental treatment on a pregnant person, this may require a consult with the OBGYN, if there is:

A

a concern about medications or effect of emergency treatment on the fetus

90
Q

T/F: Untreated dental infection may pose a risk to the developing fetus

A

True

91
Q

___ & ____ may precipitate a spontaneous abortion.

A

fever & sepsis; this is why we have to treat emergent dental issues on pregnant women

92
Q

In advanced stages of pregnancy (late third trimester), avoid the ____ position for long periods

A

supine

93
Q

Why should the supine position be avoided in advanced stages of pregnancy?

A

Supine Hypotension Syndrome

94
Q

What is supine hypotension syndrome?

A

Occurs late in 3rd trimester; due to compression of the inferior vena cava that results in impaired venous return to the heart.

95
Q

Supine hypotension syndrome is due to compression for the:

A

inferior vena cava

96
Q

Supine hypotension syndrome manifests as:

A
  1. fall in BP
  2. bradycardia
  3. sweating
  4. nausea
97
Q

What happens if your patient is experiencing supine hypotension syndrome?

A

patient can rotate to their side to allow venous return to recover. (studies indicated that the LEFT side is the best)

98
Q

Discuss taking drugs during pregnancy:

A

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

99
Q

T/F: Most common dental drugs can be safely used in pregnant patients.

A

True

100
Q

Discuss use of local anesthetics in pregnant individuals:

A

Do not exceed maximum does of LA- lido with or without epi is safe

101
Q

Avoid ___ & ____ due to:
1. closure of the ductus arteriosus
2. risk of postpartum hemorrhage and delayed labor

A

aspirin and NSAIDS

102
Q

Aspirin and NSAIDs should be avoided during pregnancy due to: (2)

A
  1. closure of the ductus arteriosus
  2. risk of postpartum hemorrhage and delayed labor
103
Q

What is the analgesic of choice in a pregnant patient?

A

acetominophin

104
Q

When are opioids acceptable during pregnancy?

A

Opioids should be avoided and only used when absolutely necessary and in consultation with physician

105
Q

What is typically preferred for the effects of opioids in a pregnant patient while avoiding opioids?

A

Codeine with acetaminophen (APAP)

106
Q

ACCEPTABLE antibiotics during pregnancy: (5)

A
  1. Amoxicillin
  2. Azithromycin
  3. Clindamycin
  4. Erythromycin
  5. Metronidazole
107
Q

CONTRAINDICATED antibiotics during pregnancy: (2)

Why?

A
  1. Tetracycline
  2. Doxycycline

These antibiotics are teratogenic

108
Q

Discuss sedation during pregnancy: (2)

A
  1. No pharmacologic sedation is preferred
  2. If absolutely necessary, NO may be used for less than 30 minutes with at least 50% O2
109
Q

T/F: A pregnant patient would not have multiple appointment or extended appointment with NO sedation as cumulative effects are a point for concern

A

True

110
Q

You should avoid NO during ____ trimester. As always, appropriate oxygenation after nitrous is necessary to avoid diffusion hypoxia

A

first trimester

111
Q

T/F: Benzodiazepines are okay to take during pregnancy

A

False

112
Q

If you plan on using any type of sedation (including NO), during pregnancy, you must:

A

consult physician

113
Q

Women of child-bearing age should not be chronically exposed to nitrous in an occupational capacity for more than ____ hours per week with out scavenging equipment

A

3

114
Q

Women of child-bearing age should not be chronically exposed to nitrous in an occupational capacity for more than 3 hours per week with out scavenging equipment due to the risk for:

A

decreased fertility & greater rates of spontaneous abortion

115
Q

Pregnant radiation workers should wear dosimeter monitoring devices to monitor occupational dose limits and assure the annual effective dose is:

A

less than or equal to 1mSv/yr

116
Q

What is the occupational limit for radiation?

A

1mSv/yr

117
Q

The average dental occupational exposure is ____ although 68% of dental workers have readings BELOW the threshold of detection

A

0.2mSv/yr

118
Q

T/F: Most drugs are of little pharmacologic significance to lactation. Medications should be take just before breastfeeding

A

First true, second false

119
Q

What is another name for a pregnancy tumor?

A

Pyogenic granuloma also epulis gravidarum

120
Q

In pregnancy, this is an exacerbated response to plaque and bacteria precipitated by the changes in progesterone and estrogen hormonal levels; not an actual granuloma as there is proliferation of vascular and fibrous tissues

A

Pyogenic granuloma

121
Q

Gestational diabetes risks to fetus:

A
  1. hulk of a baby
  2. lung development
  3. c-section may be warranted
122
Q

What is the preferred treatment for a patient with gestational diabetes who is not responding to conservative measures?

A

Metformin (PO)

123
Q

The adrenal gland is responsible for secreting:

A
  1. cortisol
  2. aldosterone
  3. adrenal androgens
124
Q

_____ come from the medulla of the adrenal gland

A

catecholamines

125
Q

Where does aldosterone, androgens, and cortisol come from?

A

adrenal cortex

126
Q

Give an example of a mineralcorticoid:

A

aldosterone

127
Q

Where does aldosterone act?

A

Distal tubules of kidney

128
Q

AlDosTerone acts on the Distal Tubules of kidney to:

A
  1. Intravascular volume
  2. Acts on RAA system
  3. Regulates Na/H20 balance (affecting BP!!!)
129
Q

What hormone of the adrenal cortex is responsible for increasing contractility and vascular reactivity to vasoconstriction, therefore increasing BP?

A

cortisol

130
Q

Cortisol is classified as a:

A

glucocorticoid

131
Q

Cortisol antagonizes:

A

insulin

132
Q

What adrenal hormone is known for
- activating lipolysis
- stimulating gluconeogenesis

A

cortisol

133
Q

What is cortisols effect on blood sugar?

A

increases sugar

134
Q

Catecholamines norepinephrine and epinephrine (from adrenal medulla) are responsible for:

A
  1. fight or flight stress response
  2. BP increase
  3. peripheral resistance
  4. cardiac output
135
Q
  • Increased aldosterone, cortisol, androgens, and estrogens (isolated or in combo)
A

Hyperadrenalism

136
Q

What are some symptoms of hyperaldosteronism?

A
  1. hypertension
  2. hypokalemia
  3. edema
137
Q

What is the most common adrenal insufficiency?

A

glucocorticoid excess

138
Q

Glucocorticoid excess means there is too much:

A

cortisol

139
Q

Cushing DISEASE is caused by:

A

pituitary or adrenal gland tumor

140
Q

Cushing SYNDROME is caused by:

A

exogenous corticosteroids

141
Q

Complications of glucocorticoid excess (cortisol excess) include:

A
  1. DM
  2. HTN
  3. Weight gain
  4. Moon facies
  5. Buffalo hump
  6. Hirsutism
  7. Acne
  8. Osteoporosis
  9. Heart failure
  10. Delayed wound healing
  11. Susceptibility to infection
  12. Irregular menses
  13. Insomnia
  14. Peptic ulcers
  15. Psychiatric disorders
  16. Glaucoma
  17. Cataracts
142
Q

Describes the collection of signs and symptoms associated with bushings syndrome:

A

cushingoid

143
Q

Mnemonic: CUSHING GOID

A

C-ataracts
U-lcers
S-triae & skin thinning
H- ypertension & hirsutism (chick w a beard)
I-mmunosupressive infectons
N- ecrosis of femoral heads
G- lucose elevation
O- steoporosis & obestity
I- impaired wound healing
D- depression & mood changes

144
Q
  • prednisolone
  • triamcinolone
  • methylprednisolone

These are all:

A

Immediate-acting glucocorticoids

145
Q
  • Dexamethasone
  • Betamethasone

These are:

A

Long-acting glucocorticoids

146
Q

Primary adrenal insufficiency:

A

addison’s disease

147
Q

Addisons disease involves destruction of the adrenal cortex leading to:

A

LOW cortisol & HIGH ACTH

148
Q

The following are cutaneous findings of ____.

  1. hyperpigmentation of skin and mucous membranes
  2. longitudinal pigmented bands in the nails
  3. vitilligo
  4. Decrease axillary and pubic hair in women
  5. calcification of auricular cartilage in men
A

Addisions

149
Q

LOW cortisol & LOW ACTH:

A

Secondary adrenal insufficiency

150
Q

Secondary adrenal insufficiency is caused by:

A

impaired/destructive pituitary disease

151
Q

Tertiary adrenal insufficiency is caused by:

A

impaired function of hypothalamus

152
Q

Most commonly a result of exogenous steroid use:

A

tertiary adrenal insufficiency

153
Q

What may be a consequences of BOTH hyperadrenealism and adrenal insufficiency

A

Impaired wound healing

154
Q
A

Dental Management of the Medically Complex Patient (5 decks)

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