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16 Cards in this Set
- Front
- Back
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1. Which hormone is a hypoglycemic agent?
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Insulin
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2. What are the mechanisms of action of the various oral hypoglycemic agents and what is their effect on glycohemoglobin (HbA1c) concentrations?
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-glyburide: inhibits ATP-sensitive K channels in pancreatic β cells, causing depolarization, which caused voltage-dependent Ca channels to open, increasing intracellular Ca, stimulating insulin release
-metformin: hepatic gluconeogenesis inhibition -actos (pioglitazone): decreases insulin resistance (gene modulation) -januvia (sitagliptin): potentiates the release of insulin & suppresses the release of glucagon after a meal -effect on HbA1c: lower it |
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3. Discuss the following in relation to the patients with diabetes mellitus and dental care. a. The epinephrine and blood glucose levels.
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-epinephrine has the opposite action of insulin, though studies have shown that there is no appreciable rise in blood glucose levels during dental appointments; 0.045mg of epinephrine is equivalent to 4 METs
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3. Discuss the following in relation to the patients with diabetes mellitus and dental care. b. Antibacterial prophylaxis
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-no studies directly support antibiotic prophylaxis for uncontrolled diabetes
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3. Discuss the following in relation to the patients with diabetes mellitus and dental care. c. The use of therapeutic doses of ASA in patients taking insulin or sulfanyureas.
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-ASA impairs insulin-mediated glucose utilization & reduces insulin clearance in healthy, non-insulin dependent diabtetics, therefore can increase the risk of hypoglycemia
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3. Discuss the following in relation to the patients with diabetes mellitus and dental care. d. The use of ASA for the prevention of a thromboembolic event and managing pain.
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-opioids are good for pain management because the contribute to CV stability; ASA helps prevent thrombolytic events
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4. What are the physiological effects of glucocorticosteroids?
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-decrease inflammation, immune suppresion
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5. The presence of which medical conditions may suggest treatment with a glucocorticosteroid?
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-allergic rhinitis, asthma, inflammatory & autoimmune diseases, organ transplant, neoplastic diseses, adrenocortical insufficiency (Addison’s, Cushing’s)
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6. Discuss considerations in developing strategies for corticosteroid supplementation in association with dental care?
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-minor surgery: no augmentation necessary (confirm normal dose)
-moderate surgery: supplement w/ 50-75mg hydrocortisone for 1-2days OR 50mg IV hydrocortisone prior to induction of anesthesia & 25mg hydrocortisone q6h for 24-48hours, then resume normal routine -major surgery: supplement 100-150mg hydrocortisone for 2-3days OR 100mg IV hydrocortisone prior to induction of anesthesia & 50mg hydrocortisone q6h for 48-72hours, then resume normal routine |
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Discuss the physiological effects of thyroid hormones.
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-regulates CHO, protein & lipid metabolism; regulates O2 consumption; thermoregulation; (synergistic w/ epinephrine); synergistic w/ epinephrine
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7. Discuss considerations in the dental management of patients with thyroid dysfunction.
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-hyperthyroid: use epinephrine w/ caution, in untreated; ASA displaces TH from protein binding sites; increase CO may limit cardiac reserve during surgery; increased stress may precipitate cardiac event
-hypothyroid: no adverse effects w/ epinephrine; hyper-reactive to opioid analgesics |
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8. What are the physiological effects of estrogen?
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-promotes growth & development of female reproductive system, conserves Ca & P & encourages bone formation, overrides stimulatory effect of testosterone
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9. Give an example and discuss the physiological/pharmacological effects of estrogen receptor modulators on bone, and breast and uterinetissues.
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-Evista (raloxifene); prevent osteoclastic activity (estrogen agonist), antagonistic to estrogen in breast & endometrial tissue (prevents growth of estrogen-dependent tumors)
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10. Which hormones, when taken by a man, may suggest the medical diagnosis of prostate carcinoma?
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-estrogens (premarin-conjugated estrogen)
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11. Discuss considerations in the dental management of patients taking contraceptives.
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-there is no data supporting the claim that oral contraceptives are affected by antibiotics
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12. Bisphosphonates: mechanisms of action and osteonecrosis
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-mechanism: inhibit osteoclastic activity & reduce osteoblastic activity
-osteonecrosis: due to exposure of the bone to oral cavity during surgery on a patient who has previously taken (esp. IV) bisphosphonates |
