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22 Cards in this Set
- Front
- Back
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2 adrenal disorders and do they cause hypo/hyper secretion of cortisol?
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addison's dz: hyposecretion
cushing's dz: hypersecretion |
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physiologic actions of cortisol
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activates stress response. activates gluconeogenesis and hyperglycemia, catabolism of protein & lipids, maintains vascular permeability (blood volume), maintains vascular contractility (blood pressure)
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pharmacologic actions of cortisol (at high doses, above physiologic levels)
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anti-inflammatory, immunosuppressive
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most potent of all corticosteroids (and longest half life- 2-3 days)
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dexamethasone
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fluocinonide dose
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"Lidex". topical gel/cream 5-10x/day (5 min)
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clobestasol dose
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"temovate". topical cream. 2-3x/day (5 min)
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triamcinolone
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Aristocort or Kenalog. topical corticosteroid. 10x/day
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good way to give topical corticosteroids in dentistry
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orabase + hydrocortisone or traimcinolone
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dexamethasone dose
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as Elixir (mouthwash). 1 mg in 10 ml for 2 min. don't swallow! repeat 2-4x/day. taper off when symptoms are relieved
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side effects of dental topical corticosteroids
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susceptibility to infection (candidiasis), poor wound healing. may need antifungal agent (nystatin)
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therapeutic uses for topical corticosteroids in dentistry
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oral ulcerations. pulpal hypersensitivity. TMJ pain. allergic rxns. adrenal insufficiency/shock (cortisol replacement necessary)
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benefits & toxicity w/ inhaled corticosteroids for asthma
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decr airway inflam & hyper-reactivity. not a bronchodilator! good local control. toxicity: oropharyngeal candidiasis. potential systemic toxicity if swallowed but minimized by rapid metabolism in liver
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replacement doses for systemic oral corticosteroids (cortisol, prednisone & dexamethasone)
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20 mg/day cortisol
5 mg/day prednisone (4x more potent than cortisol) 1 mg/day dexamethasone (20x more potent) |
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anti-inflam (therapeutic) levels of prednisone
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initial 60-80 mg/ day
chronic: 20 mg/day |
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diff btwn action of corticosteroids vs NSAIDS in inflam
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corticosteroids inhibit release of AA from membrane phospholipids by working on PLA2. NSAIDS only reduce PG and can cause incr in leukotrienes
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net effect of corticosteroids on immune cells
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immunosuppresion. anti-inflam (palliative rather than curative). decr pain, decr tissue destruction. no incr in protein production so no healing (no cure)
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symptoms of iatrogenic cushing's disease
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gluconeogenesis (->diabetes)
catabolism of proteins (-> osteoporosis, muscle weakness, poor wound healing, poor tissue repair) susceptibility to infection gastric ulcers cataracts growth suppression in kids psychosis or depression |
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what happens when you take 20 mg/day prednisone for 1 month
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may require 2-6 months to restore normal after discontinuation to restore normal ACTH (pituitary)/cortisol (adrenal gland) production. symptoms: decr response to stress, hypotension/shock
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what can you do to prevent adrenal-pituitary suppression?
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alternate day therapy. by day 8 taking physiologic level dose on alternate day. then taper off 1st day dose
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tapering
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gradual reduction in dose over 2-3 months. prevents flare of inflam process. erratic dosing hazardous
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tx for severe allergic reactions such as anaphylaxis
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1st- epinephrine
2nd- benadryl 3rd- solu-cortef (hydrocortisone succinate_ |
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special problems in dental therapeutics w/ immunosuppressed patients (eg on corticosteroid drugs)
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susceptibility to infection & poor wound healing. need prompt tx of oral infections. consider prophy antibiotics. response to stress0 may need cortisol for adrenal-pituitary suppression
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