LO 18 - Part 2 Flashcards
Hormones and supplements
List the endocrine glands and the general function of endocrine glands
Glands
1. pituitary, thyroid, parathyroids, pancreas, adrenals, gonads, and placenta
Function
1. Help maintain homeostasis
2. Feedback system control; mostly negative
3. Synthetic hormone agonists and antagonists drugs affect the endocrine system - Used in replacement therapy
Describe anterior pituitary hormones
Secrets GH, , luteinizing hormone (LH), FSH,TSH, ACTH, and prolactin
What will an increase in growth hormone (GH) cause?
- Prior to puberty: gigantism (proportionately large person)
- After puberty: acromegaly (disproportionately large body parts)
*Human growth hormone is used medically to treat children who lack it
Pharmaceutical gonadotropin-releasing hormone (GnRH) is a ____________
synthetic analogue
__________ stimulates pituitary function and is used to treat infertility
Leuprolide
___________ agonists are used to treat prostate cancer and endometriosis
GnRH
Describe posterior pituitary hormones and common mimicking drugs
- Secretes ADH and oxytocin
- vasopressin (Pitressin) is used to treat transient diabetes insipidus
- oxytocin (Pitocin, Suntocinon) is used to induce labor, control postpartum hemorrhage, and induce postpartum lactation
Describe thyroid hormones
- The thyroid gland secretes two iodine-containing thyroid hormones - triiodothyronine (T3) & tetraiodothyronine (thyroxine [T4])
- Thyroid also secretes Calcitonin - regulates calcium metabolism
- Thyroid hormones are important for energy metabolism, growth, and development
- Thyroid hormones are synthesized from iodine and tyrosine and stored as complex protein until TSH stimulates their release
Describe iodine in relation to thyroid function
- If iodine intake is deficient, normal amounts of thyroid hormones cannot be made
- TSH is secreted in excess (b/c body wants to stimulate release of hormones), and the thyroid hypertrophies (simple or nontoxic goiter)
- Marine life is the only common food that is naturally rich in iodine; iodized salt has decreased the incidence of simple goiter
Describe Hypothyroidism
- hypothyroidism in child: is called cretinism
- hypothyroidism in an adult is called myxedema
- Patients are usually drowsy, weak, and listless and exhibit an expressionless, puffy face with edematous tongue and lips
- Thyroid hypofunction is treated with exogenous thyroid hormones the most common is levothyroxine(Synthroid)
What are the 2 forms of Hyperthyroidism?
- Diffuse toxic goiter (Graves disease)
- Toxic nodular goiter (Plummer disease)
Describe Diffuse toxic goiter (Graves disease) - form of Hyperthyroidism
- autoimmune response
- characterized by a diffusely enlarged, highly vascular thyroid gland
- common in young adults
Describe Toxic nodular goiter (Plummer disease) - form of Hyperthyroidism
- Characterized by nodules that secrete excessive hormone while the rest of the glandular tissue is atrophied
- Occurs primarily in older patients
Describe thyrotoxicosis (result of Hyperthyroidism)
- Adverse effects include excess production of heat, increased sympathetic activity, increased neuromuscular activity, increased sensitivity to pain, direct inotropic effect in CVS, exophthalmos, and anxiety
- Oral manifestations include accelerated tooth eruption, marked loss of alveolar process, diffuse demineralization of jawbone, and rapidly progressive periodontitis
Describe the treatment options for Hyperthyroidism
- The two most common treatments are radioactive iodine (131) and thyroidectomy - results in hypothyroidism
- Antithyroid drugs such as propylthiouracil (PTU) and methimazole (Tapazole) are used in patients who cannot tolerate surgery or treatment with 131
What are the dental implications of Hyperthyroidism
- Thyroid storm emergency -Can be loud - verbal and physical Keep distance from individuals, there is nothing we can do. Call 911! - Can be induced through stress
- Limit Epinephrine
Describe Female Sex Hormones
- Most sex hormones occur in both sexes but in different proportions
- The two major female sex hormones are estrogens and progestins - The are secreted primarily by the ovaries but also by the testes and placenta; They are largely responsible for producing female sex characteristics, developing the reproductive system, and preparing the reproductive system for conception
- Estrogen and progesterone levels vary daily - Changes are dependent on FSH and LH
Describe estrogens
- Estrogens are largely responsible for the changes that take place during puberty
- Synthetic estrogens (Estradiol)can be used for replacement therapy and conception
- The most common side effects of estrogen therapy are nausea and vomiting - Other side effects include uterine bleeding, vaginal discharge, edema, thrombophlebitis, weight gain, and hypertension
- Estrogen therapy may also promote endometrial carcinoma in postmenopausal women - This risk may be cancelled out by administration of a progestin
What is the effect of estrogens on oral tissues?
- Gingivitis at puberty
- During pregnancy
- After menopause
*The increase in gingival inflammation may occur even with a decrease in the amount of plaque
Describe progestins
Progesterone prepares the uterus for implantation of the fertilized ovum - If implantation does not occur, progesterone secretion declines and menstruation occurs
Describe the dose forms of progestins
- Parenteral medroxyprogesterone (Depo-Provera) is administered every 3 months as a contraceptive
- Progestin-only “minipills” are used orally
- A progestational agent can be administered as an intrauterine device (IUD) or implant under the skin of the arm
Describe hormonal contraceptives
- Oral contraceptives are the most common dose forms and consist of estrogens and progestins in various combinations - 99% effective
- Seasonale: extended(3-month) cycle OC
- Vaginal ring and injectable contraceptives
List the adverse reactions of hormonal contraceptives
- significant increase in the frequency of dry sockets after extractions
- AB decrease OC efficacy
- candidiasis
What are the contraindications for oral contraceptives
thromboembolitic disorders, significant dysfunction of the liver, known or suspected carcinoma of the breast or other estrogen-dependent neoplasm, and undiagnosed genital bleeding
Other than hormonal contraceptives, what agents effect hormone systems of women?
- Clomiphene has the ability to induce ovulation in some anovulatory women
- Leuprolide is used in the management of endometriosis and to treat infertility
- Tamoxifen is indicated in the palliative treatment of breast cancer in postmenopausal women
- Danazol is used to treat endometriosis and fibrocystic disease in women
- Aromatase inhibitors reduce almost the entire amount of estrogen made in the bodies of postmenopausal women
Describe male sext hormones
- Androgens are responsible for the development of secondary male sex characteristics
- Testosterone, the main androgen, has both androgenic and anabolic effects
- Androgenic steroids are used illicitly for muscle mass gain
Describe Pancreatic Hormones
- Two primary hormones secreted by islets of Langerhans of the pancreas are insulin and glucagon
- Insulin promotes fuel storage (glucose out of blood)
- Glucagon promotes fuel mobilization (glucose into the blood)
Describe Diabetes Mellitus
- A group of metabolic disorders characterized by persistent hyperglycemia
- Type I (insulin-dependent DM [IDDM])
- Type II (non–insulin-dependent DM [NIDDM])
Describe type 1 diabetes
- usually develops in persons younger than age 30 years and results from autoimmune destruction of pancreatic beta cells
- Must be treated with injections of insulin
Describe type 2 diabetes
- usually develops in persons older than age 40 years, due to insulin resistance
- Must be treated with hypoglycemic (and insulin if necessary)
List and describe the systemic complications of diabetes
- Cardiovascular system - incidence of problems is higher in patients with diabetes
- Retinopathy - microvascular disease affects the blood supply to the retina(blindness)
- Neuropathy - leads to reduced and sometimes absent feelings, especially in the lower extremities
- Infections - gangrene(and amputations) can occur in the peripheral extremities due to depressed immunity, less effective white blood cells, microvascular changes, and neuropathy(dialysis)
- Healing - slower healing
What are the Dental Complications of Diabetes?
Xerostomia
1. pronounced susceptibility to caries
2. Dry, cracking oral mucosa with presence of mucositis, ulcers
3. More prone to infections with delayed healing
4. Inflamed painful tongue
5. candidiasis
*Also more prone to periodontal disease
What are the appointment management items to keep in mind with diabetics1.
- Dental appointments should not interfere with meals and should involve minimal stress
- Drugs that may decrease insulin release or increase insulin requirements, such as epinephrine, glucocorticoids, or opioid analgesics, should be used with caution in patients with diabetes
What 2 lab tests are useful in evaluating a patient’s glucose control are serum glucose and glycosylated hemoglobin?
- Serum glucose is a measure of the patient’s FASTING glucose control at the time that the blood is sampled 4-<7mmol
=(80 – 120mg/dl) - Glycosylated hemoglobin (HbA1C) reflects glucose control over a 2- to 3-month period should be <7
How is Hypoglycemia treated?
- Most common emergency (insulin shock if taking insulin)
- Treatment with any source of sugar: fruit juice, cake icing, glucose gel, or soluble carbohydrate
- safe dental treatment blood sugar level is 4.5
- If the patient is unconscious and lacks a swallowing reflex, treatment consists of intravenous dextrose (50%)
What drugs are used to manage diabetes?
- Insulins
- Oral antidiabetic agents(hypoglycemic)
Describe insulins
- Subcutaneous injection
- Recently, an inhaled dose form was approved for both type 1 and type 2 diabetes
- Differ in onset and duration of action - rapid acting, short acting, intermediate acting, long acting
List common rapid acting insulin
- Novolog
- Humalog
- Apidra
List common short acting insulin
- insulin regular Novolin R
- Humulin R
List common intermediate acting insulin
- Humulin N
- Novolin N
- Humulin L
- Lente
List common long acting insulin
- Levimir
- Lantus
List the common oral Antidiabetic Agents
(Hypoglycemics)
- Biguanides - metformin (Glucophage) - also used as fertility drugs ( used in Tx polycystic ovarian syndrome
- Sulfonylureas - Glyburide; Glucovance (Glyburide with metformin)
- Inhibitors of dipeptidyl peptidase 4 (DPP-4 inhibitors or gliptins) - sitagliptin (Januvia); sitagliptin and metformin (Janumet)
Describe newer diabetic medications
- SGLT-2 inhibitors: Gliflozin drugs( note: suffex flozin) - e.g. canagliflozin = Invokana
- blood sugar control
- reduce body weight
- educe systolic and diastolic blood pressure
*These drugs basically pump sugar out of the body through the urine
What is the adverse reaction of newer diabetic medications?
kidneys pay the price for these meds - kidney disease/failure is high risk
Describe treatment of gestational diabetes
- Diet control or Insulin
- Hypoglycemics not used due to Teratogenic effects
Describe Adrenocorticosteroids
- A group of agents secreted by the adrenal cortex
- Use in dentistry: used topically or systemically for treatment of oral lesions associated with inflammatory disorders
- Long-term therapy: prescribed for patients with chronic systemic diseases such as asthma or arthritis
What 2 major groups are Adrenocorticosteroids divided into?
- Glucocorticoids - affect intermediate carbohydrate metabolism (cortisol =hydrocortisone)
- Mineralocorticoids - affect water and electrolyte composition of the body
What dose forms are Glucocorticoids available in?
- Topical
- Oral
- Intramuscular
- IV
*There is a lag time in the action of steroids, and the relationship between their effects and blood level is poor
Describe the mechanism of action for Glucocorticoids
Anti-inflammatory action
1. They result in an increase in the concentration of neutrophils and decrease in lymphocytes, monocytes, eosinophils, and basophils
2. Inhibition of phospholipase A decreases production of prostaglandins and leukotrienes
3. Steroids also inhibit interleukin-2, migration inhibition factor, and macrophage inhibition factor
What are the pharm effects of Glucocorticoids?
- Effects for which they are used include anti-inflammatory action and suppression of allergic reactions
- They suppress the immune response
- Corticosteroids are palliative rather than curative
List the adverse reactions of Glucocorticoids
- Metabolic changes - moon face, buffalo hump, truncal obesity, weight gain, and muscle wasting produce Cushing syndrome appearance
- Hyperglycemia - may be aggravated
- Infections - corticosteroids decrease resistance to infection
- CNS - changes in behavior and personality, including euphoria (with increasing dose), agitation, psychoses, and depression (with decreasing dose) behavior
- peptic ulcer - stimulate an increase in production of stomach acid and pepsin
- Impaired wound healing and osteoporosis - catabolic effects resulting from impaired synthesis of collagen can impair wound healing
- Ophthalmic effects - can increase intraocular pressure, may exacerbate glaucoma
- Electrolyte and fluid balance - can produce sodium and water retention resulting in Hypertension or congestive heart failure and hypokalemia may result
What are the medical uses of Corticosteroids
- Replacement - Addison disease and Cushing syndrome
- Emergencies - Treatment of shock or adrenal crisis
- Inflammatory/allergic - Treatment of a wide variety of inflammatory and allergic conditions; Topical steroids are used for skin conditions which involve dermatoses or “irritations”
List the dental uses of Corticosteroids
- Oral lesions - Topical and systemically administration
- Aphthous stomatitis - TAC (triamcinolone acetonide)= Kenalog in Orabase
- Temporomandibular joint - Intraarticular injection can often decrease pain and improve joint movement
- Uses in oral surgery - Reduce edema, trismus, and pain
- Pulp procedures - Pulp capping, pulpotomies, and control of hypersensitive cervical dentin
List common short acting Corticosteroid Products
- hydrocortisone (Cortisol)
- prednisone (Deltasone)
List common Intermediate acting Corticosteroid Products
- TAC (triamcinolone)
- prednisolone
List common Long acting Corticosteroid Products
- dexamethasone
- betamethasone
What are the 4 dental implications of Glucocorticoids
- Adrenal crisis - adrenal suppression with prolonged use (consider steroid supplementation - refer to MD); The adrenal gland cannot respond adequately if a stressful situation arises
- Delayed healing of mucosal surfaces, more likely to have an infection, and are more friable
- Periodontal disease - steroids interfere with the body’s response to infection and can produce osteoporosis, which may reduce bony support for teeth
- Oral candidiasis may result with use of inhaled oral steroid inhalers (asthma puffers)
What is important to keep in mind about exogenous steroids?
- Exogenous steroids act in the same way as hydrocortisone; via negative feedback they inhibit the release of ACTH
- With long-term administration of steroids, ACTH release is suppressed
- Adrenal crisis may occur if exogenous steroids are abruptly withdrawn
Describe the use of Steroid Supplementation
- To prevent adrenal crisis
- Must consult MD to supplement if the following rule applies: rule of 2s - Patient on >20mg per day for 2 continuous weeks within the last 2 years
