Prednisolone Flashcards
What precautions should be taken during the tooth extraction process for a patient on prednisone?
For a patient taking prednisone long-term, the following precautions should be taken during tooth extraction:
- Consult the patient’s physician to evaluate the need for steroid supplementation before the extraction. to prevent adrenal crisis during the surgical procedure.
- Minimize anxiety and stress during the extraction process, as this can also impact the body’s stress response in these patients.
- Consider using prophylactic antibiotics to prevent infection, as prednisone can impair the immune system and wound healing.
- Monitor the patient closely for any signs of delayed healing or infection after the extraction, and provide appropriate follow-up care.
stress-dose steroids
Steroid supplementation
Who is authorized to change a patient’s steroid dose?
Physicians
Adrenal suppression or
adrenal insufficiency
a condition where the adrenal glands do not produce sufficient cortisol in response to stress due to long-term use of corticosteroids like prednisone or prednisolone.
Secondary Adrenal Insufficiency: This is because exogenous steroids suppress the hypothalamic-pituitary-adrenal (HPA) axis. (trục hạ đồi-tuyến yên-tuyến thượng thận)
“rule of 2” for Adrenal suppression
Adrenal suppression risk occurs if the patient has taken corticosteroids for more than 2 weeks within the last 2 years at doses equivalent to 20 mg hydrocortisone or 5 mg prednisolone daily.
Symptoms of Adrenal Insufficiency:
Fatigue, weakness
Nausea, vomiting
Low blood pressure
Hypoglycemia
In severe cases: Adrenal crisis (life-threatening) = collapse (Cardiovascular collapse), or shock (Electrolyte imbalances).
Long-term use of corticosteroids: Implications for Dental and Surgical Procedures:
- Stressful procedures can precipitate adrenal insufficiency
- Prednisone suppresses the immune system and inhibits collagen synthesis, which can delay soft tissue healing and osseointegration
- Long-term corticosteroid use can lead to secondary osteoporosis,
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