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Dental management of the Medically Complex Patient > Lecture 4- Endocrine & Metabolic disease > Flashcards

Lecture 4- Endocrine & 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 beta cell pancreatic production of insulin:

A

DM

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3
Q

Up to 90% of DM cases are:

A

Type II

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4
Q

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

A

Gestational diabtetes

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5
Q

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

A

Type II 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; hyperglycemia

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8
Q

What does hyperglycemia result in? (think tissues)

A

Results in 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 DN 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

In Type 1 diabetes what leads to the insulin deficiency?

A

Destruction of pancreatic beta cells (insulin producing cells)

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15
Q

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

A

Stage 1&2: asymptomatic
Stage 3: symptomatic

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16
Q

Describe 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. extremeties
  2. bladder
  3. gastroparesis
  4. impotence
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18
Q

Describe the effects of retinopathy:

A
  1. cataracts
  2. blindndess
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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 see a diabetic patient having an increased risk for MI?

A

Diabetes accelerates atherosclerosis

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21
Q

Describe diabetes affects on the bodies ability to heal itself:

A

DM causes impaired wound healing & susceptibility to infection

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22
Q

Diabetic patients release ____ which breaks down soft tissue and contribute 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 metalloproteinase)
  5. impaired angiogenesis
  6. endothelial dysfunction
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24
Q

Type 2 diabetes may also be referred to as:

A
  1. adult 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 it 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: <100 mg/dl
pre-DM: 100-125 mg/dl
Type 2 DM: 126+

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28
Q

For oral glucose tolerance test (2hr plasma glucose):

normal:
pre-DM:
Type 2 DM:

A

normal: <140 mg/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

Random glucose in patients with Type 2 DM:

A

> 200 mg/dl in patients with symptoms

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31
Q

Measures the glycosylaton of HbA (the protein than connects hemoglobin A 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

hemaglobin; RBCs

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33
Q

A stable measure not affected by QD glucose fluctuation:

A

A1C

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34
Q

An HBA1c measures the amount of:

A

gylcosylation

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35
Q

Higher prevalences of ______ in poorly controlled diabetics

A

severe periodontal disease

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36
Q

T/F: According to a 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 then at risk for more ____ & _____ complications

A

renal & cardiovascular

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39
Q

All of the diabetic drugs work to:

A

lower sugar in the blood stream one way or another

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40
Q

List the mechanism of the following diabetic drugs:

-Biguanide (metformine)
-insulin (rapid, short, LL)

A

Decrease in gluconeogenesis

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41
Q

List the mechanism of the following diabetic drugs:

-Sulfonylureas (Glipizode, Chlorpropamide, Tolbutamide)
-Glucagon-like peptide 1 (GLP1) receptor agonist (Exenatide, Liraglutide)

A

Increase insulin secretion

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42
Q

List the mechanism of the following diabetic drugs:

-Thiazolidinediones (pioglitazone)

A

Sensitization to insulin

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43
Q

List the mechanism of the following diabetic drugs:

-Dipeptidyl peptidase 4 (DPP4) (sitagliptin)
-GLP1 receptor agonist (Exenatide, Liraglutide)

A

Decrease in glucagon secretion

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44
Q

List the mechanism of the following diabetic drugs:

-Sodium-glucose co-transporter-2-inhibitors (Canagliflozin)
-Alpha-glucoside inhibitor (Acarbose)

A

Intestinal & renal absorption of glucose

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45
Q

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

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

A

Metformin

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46
Q

What are some of the oral manifestation of diabetes:

A
  1. xerostomia
  2. oral burning (not burning mouth syndrome, secondary)
  3. infections (bacterial, FUNGAL, viral)
  4. poor wound healing
  5. increased caries
  6. increased severity of periodontal risk
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47
Q

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

A

Fungal infection in the oral cavity

(everyone has Candida albicans in their oral cavity but this becomes opportunistic in diabetic patients often causing infection)

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48
Q

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

HbA1C= >8.0%

As a dentist you should:

A
  1. DEFER elective treatment
  2. If emergency, consider referral to hospital/specialized setting
  3. send medical consult
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49
Q

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

HbA1C= >8.0%

Discuss prophylactic antibiotics for this patient:

A

Context-dependent

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50
Q

With diabetes, control of comorbities & drug interactions includes:

A
  1. HTN
  2. HLP
  3. Other CVD (angina, MI, CHF)
  4. Renal impairment
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51
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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52
Q

Many antibiotics should be avoided with diabetics patients that are specifically on ____ because this may cause _____

A

insulin; hypoglycemia

-tetracycline
-doxycycline
-ciprofloxacin
-levofloxacin
-levaquin
-(fluoroquinolone)

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53
Q

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

A

sulfonylureas; hypoglycemia

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54
Q

In patients with diabetes, be aware that sulfonylureas may cause:

A

thrombocytopenia

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55
Q

What medication may be responsible for thrombocytopenia in diabetic patients?

A

Sulfonylureas

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56
Q

What timing of appointments is best suited for diabetic patients?

A

Early morning

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57
Q

Describe how diabetic patients should prepare for a morning appointment:

A

Eat normal meal and take medications prior to appointment

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58
Q

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

In addition, have _____ readily available

A

Symptoms of hypoglycemia; high-concentration sugar products (orange juice, cake icing, soft drinks)

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59
Q

____ is not recommended for diabetics as fasting is necessary

A

oral sedation

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60
Q

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

A

Presents at mid term - 24-28 weeks

between second & third trimester

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61
Q

The ovaries are responsible for releasing:

A

estrogens & progesterone

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62
Q

Pregnancy can be a stressor to:

A

oral health

63
Q

Pregnancy duration = ______ form the 1st day of the last menstrual cycle

64
Q

First trimester:

Second trimester:

Third trimester:

A

First trimester: 0-12 weeks (12 weeks)

Second trimester: 13-28 weeks (16 weeks)

Third trimester: 29-40 weeks (12 weeks)

65
Q

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

A
  1. ionizing radiation
  2. drugs
  3. stress
66
Q

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

A

breast milk

67
Q

Common pregnancy discomforts include:

A
  1. nausea & vomiting
  2. indigestion
  3. headaches
  4. polyuria
  5. lumbar pain
  6. perspiration
  7. breast tenderness
68
Q

What is responsible for the nausea & vomiting discomforts of pregnancy?

A

-hormonal imbalances
-stress (physical & emotional)
-hyperacidity

69
Q

Pregnant women have indigestion, especially with:

A

digesting foods rich in fats. sugars, and acids

70
Q

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

A

Maintain optimal oral health

71
Q

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

A

False- avoid elective dental care during the first trimester

72
Q

T/F: Second trimmest is the best tine to perform dental treatment on a pregnant lady

73
Q

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

74
Q

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

75
Q

Lack of proper oral health care during pregnancy could:

A
  1. harm the developing fetus
  2. affect the time of delivery
76
Q

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

A

If the patient could possibly be pregnant

77
Q

The gonadal/fetal dose incurred with 2 periapical images when a lead apron is used is _____ than that for 1 day of exposure to natural background radiations in the US/

A

700 times less

78
Q

Describe when a radiograph is acceptable during pregnancy:

A

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

79
Q

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

A

Radiographs should be postponed until post-partum

80
Q

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

A

First statement true

Second statement false- NO benefit to health of developing child

81
Q

When radiographing a pregnant person,

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

A

unborn child, mother

82
Q

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

A

National council on radiation & protection measurements (NCRP)

83
Q

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

A

general population

84
Q

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

A

NCRP recommendations

85
Q

For emergency pregnant dental patients:

A
  1. necessary radiographs are part of the standard of care to treat & diagnose a condition that threatens health of the mother & unborn child
  2. lack of radiographs compromises the emergency care diagnosis & treatment (and this will directly impact the health of the unborn child)
  3. primary beam is not directed toward the child-bearing area
86
Q

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

A

May be provided as needed any time during pregnancy

87
Q

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

A

pain control & elimination of infections

88
Q

When performing emergency treatment on a pregnant patient, this may require a consult with the OB, if:

A

There is a concern about medications or the effect of treatment on the fetus

89
Q

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

90
Q

____ & ____ may precipitate a spontaneous abortion

A

Fever & sepsis

(this is why we say its better to go ahead and provide emergency care to pregnant patients in regard to pain & infection)

91
Q

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

A

supine position

92
Q

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

A

Supine hypotension syndrome

93
Q

What is supine hypotension syndrome?

A

Occurs late in third trimester, due to compression of the inferior vena cava that results in impaired venous return to the heart

94
Q

Supine hypotension syndrome manifests as:

A
  1. fall in BP
  2. bradycardia
  3. sweating
  4. nausea
95
Q

Supine hypotension syndrome is due to compression of the:

A

Inferior vena cava

96
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 have indicated that the LEFT side is best)

97
Q

Discuss taking drugs during pregnancy in a general sense:

A

All drugs should be avoided during pregnancy if possible (benefit should outweigh potential risks)

98
Q

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

99
Q

Discuss use of local anesthetics in pregnant individuals:

A

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

100
Q

Avoid ____ & ____ due to:

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

Aspirin & other NSAIDS

101
Q

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

A
  1. closure of the ductus arteriosus
  2. risk postpartum hemorrhage and delayed labor
102
Q

What is the analgesic of choice in a pregnant patient?

A

Acetaminophen

103
Q

When are opioids acceptable during pregnancy?

A

Opioids should be avoided & only use when absolutely necessary and in consolation with the physician

104
Q

what is typically preferred for the effects of opioids in a pregnant patients while avoiding opioids?

A

Codeine with aetaminophien (APAP) is usually the preferred agent

105
Q

What antibiotics are ACCEPTABLE during pregnancy? (5)

A
  1. Amoxicillin
  2. Azithromycin
  3. Clindamycin
  4. Erythromycin
  5. Metronidazole
106
Q

What antibiotics are CONTRAINDICATED during pregnancy? (2)
Why?

A
  1. Tetracycline
  2. Doxycycline

These antibiotics are teratogenic

107
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 min with at least 50% O2
108
Q

T/F: Pregnant patients should not have multiple appointments or extended appointments with NO sedation as cumulative effects are a point for concern

109
Q

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

A

first trimestser

110
Q

T/F: Benzodiazepines are okay to take during pregnancy

111
Q

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

A

consult physician

112
Q

Women of child-bearing age should not be chronically exposed to nitrous in an occupation capacity for more than _____ hours per week without scavenging equipment

113
Q

Women of child-bearing age should not be chronically exposed to nitrous in an occupation capacity for more than 3 hours per week without scavenging equipment due to the risk for:

A
  1. decreased fertility
  2. greater rates of spontaneous abortion
114
Q

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

A

Less than or equal to 1mS/yr

115
Q

What is the occupation limits of ionizing radiation?

A

1 mSv/yr (same as pregnant radiation workers)

116
Q

Average dental occupational exposure is _____ although 68% of dental workers have readings BELOW the threshold

A

0.2 mSv/yr

117
Q

T/F: Most drugs are of little pharacologic significant to lactation. Medications should be taken just before breast feeding.

A

First statement true, second statement false

118
Q

Also known as “pregnancy tumor”:

A

Pyogenic granuloma epulis gravidarum

119
Q

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

A

Pyogenic granuloma

120
Q

Gestational diabetes risks to fetus:

A
  1. excessive weight gain of fetus
  2. affects lung development
  3. C-section may be warranted
121
Q

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

A

Metformin PO

122
Q

The adrenal glands are responsible for secreting:

A
  1. cortisol
  2. aldosterone
  3. adrenal androgens
123
Q

____ come from the medial of the adrenal gland

A

catecholamines

124
Q

Where does aldosterone, androgens & cortisol come from?

A

Adrenal cortex

125
Q

Give an example of a mineralocorticoid:

A

aldosterone

126
Q

Where does aldosterone act?

A

Distal tubules of kidney

127
Q

AlDosTerone airs on the Distal Tubules of kidney to:

A
  1. Control intravascular volume
  2. Acts on RAA system
  3. Regulates sodium/water balance (affecting BP!)
128
Q

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

129
Q

Cortisol is classified as a:

A

glucocorticoid

130
Q

Cortisol antagnizes:

131
Q

What adrenal hormone is known for:

-activating lipolysis
-stimulating gluconeogenesis

132
Q

What is cortisols effect on blood sugar?

A

Increases sugar

133
Q

Catecoholamines 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
134
Q

-increased aldosterone, cortisol, androgens estrogen (isolated or in combo):

A

Hyperadrenalism

135
Q

What are some symptoms of hyperaldosteronism?

A
  1. HTN
  2. hypokalemia
  3. edema
136
Q

The most common adrenal insufficiency we see is:

A

glucocorticoid excess

137
Q

Glucocorticoid excess means there is too much:

138
Q

Cushing DISEASE is caused by:

A

pituitary or adrenal gland tumor

139
Q

Cushing SYNDROME is caused by:

A

exogenous corticosteroids

140
Q

Complications of glucocorticoid (cortisol) excess include:

A
  1. DM
  2. HTN
  3. Weight gain
  4. Moon facies
  5. Buffalo hump
  6. Hirsutisms
  7. Acne
  8. Osteoporosis
  9. Heart failure
  10. Delayed wound healing
  11. Susceptibility to infection
  12. Irregular menses
  13. Insomnia
  14. Peptic ulcer
  15. Psychiatric disorders
  16. Glaucoma
  17. Cataracts
141
Q

Describes the collection of signs & symptoms that are associated with Cushing syndrome:

A

Cushingoid

142
Q

Mneumonic CUSHING GOID

A

C: cataracts
U: ulcers
S: striae & skin thinning
H: HTN & Hirsutism
I: immunosupresion & infections
N: necrosis of femoral heads
G: glucose elevation
O: osteoporosis & obesity
I: Impaired wound healing
D: depression & mood changes

143
Q

-Prednisolone
-Triamcinolone
-Methylprednisolone

These are all:

A

Immediate-acting glucocorticoids

144
Q

-Dexamethasone
-Betamethasone

These are:

A

Long-acting glucocorticoids

145
Q

Primary adrenal insufficiency:

A

Addision disease

146
Q

Addisons disease involves destruction of the adrenal cortex leading to:

A

LOW cortisol & HIGH ACTH

147
Q

The following are cutaneous findings of _____

  1. Hyperpigmentation of skin & mucous membranes
  2. Longitudinal pigmented bands in the nails
  3. Vitiligo
  4. Decreased axially & pubic hair in women
  5. Calcification of auricular cartilage in men
A

Addison’s disease

148
Q

Low cortisol & LOW ACTH:

A

Secondary adrenal insufficiency

149
Q

Secondary adrenal insufficiency is caused by:

A

impaired/destructive pituitary disease

150
Q

Tertiary adrenal insufficiency is caused by:

A

impaired function of hypothalamus

151
Q

Most commonly a result of exogenous steroid use:

A

Tertiary adrenal insufficiency

152
Q

What may be a consequence of BOTH hyperadrenalism & adrenal insufficiency?

A

Impaired wound healing

Dental management of the Medically Complex Patient (5 decks)

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