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95 Cards in this Set
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Used to treat oral lesions associated with inflammatory diseases
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Adrenocorticosteriods
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Corticosteriod Drugs:
1. 2. 3. 4. |
1. Hydrocortisone
2. Methylprednisolone (Medrol) 3. Prednisone 4. Kenalog in Orabase |
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Conditions where Corticosteriods are used:
Addison's Disease Cushing's Disease Reheumatoid Arthritis Phemphigus Vulgaris Psoriasis Systemic Lupus Erythematis Chrone's Disease Ulcerative Colitis Organ Transplant Asthma Skin Conditions IBD & Ulcerative Colitis = _____ |
Gastrointestinal
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Pharmacological Effects of Corticosteroids:
* ________ action * ________ of Allergic Reaction * ________ of Immune System |
* Antiinflammatory
* Suppression * Suppression |
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Adverse Reactions to Corticosteroids:
1. 2. 3. 4. 5. |
1. Metabolic
2. Infections 3. Behavioral 4. Peptic Ulcer 5. Impaired Wound Healing |
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Adverse Reactions to Corticosteroids:
- _______- moon face, buffalo hump, obesity, muscle wasting. - _______- Decrease resistance to infection |
Metabolic, Infections
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Adverse Reactions to Corticosteroids:
-_______- Changes in personality (euphoria, agitation, psychosis, depression) -_______- Stimulate production of stomach acid (Healing is impaired and ulcer may perforate) |
Behavorial-CNS; Peptic Ulcer
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Adverse Reactions to Corticosteroids:
-________- Alveolar bone- tooth loss-general fractures (not related to trauma) |
Impaired wound healing & osteoporosis
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Adverse reactions to Adrenocorticosteriods:
1. 2. 3. |
1. Gastrointestinal
2. Blood Pressure 3 Periodontal Disease |
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Adverse reactions to Adrenocorticosteriods:
-_________- Adrenocorticosteriods stimulate acid secretion -_________- Exacerbates hypertension -_________- By producing osteoporosis and lowering healing |
Gastrointestinal, Blood Pressure, Periodontal Disease
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Adrenal Crisis of Corticosteroids:
With prolonged use, adrenal suppression can occur. During a stressful situation, the adrenal gland can not secrete Corticosteroids. Sign of Adrenal Crisis: _________,_________,_________, _________ |
Weakness, Syncope, Cardiovascular Collapse, Death
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Dental Effects of Adrenocorticosteriod Use:
-Mucosal surfaces heal more slowly -Prone to infection -Gingival tissue is friable -If using a steroid inhaler for Asthma, _______ may develop. |
Candidiasis
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Dental Use of Adrenocorticosteriods:
1. 2. 3. 4. 5. |
1. Oral Lesions
2. Aphthous Ulcers 3. TMJ 4. Oral Surgery 5. Pulp Capping, Pulpotomy |
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Dental Use of Adrenocorticosteriods:
_____- to treat non-infectious inflammatory disease (Pemphigus, Desquamative Gingivitis, Lichen Planus, Canker sores, Pemphigoid) ________- Kenalog in Orabase |
Oral Lesions; Aphthous Ulcers
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Dental Use of Adrenocorticosteriods:
______- Injection ______- reduce postoperative edema, pain ______- Deciduous teeth, decay pulp |
TMJ; Oral surgery; Pulp capping-Pulpotomy
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Rule of Twos: Adrenocorticosteriods:
-Conservative Approach * if the patient has: Taken _____mg of Cortisone For ____ weeks Within ____ years For stressful dental procedures, double the dose of Cortisone |
20mg; 2; 2
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Antineoplastic Cancer Drug Chemotherapy: Chemotherapy Drugs Not only for Cancer Treatment:
-Psoriasis -Inflammation -Rheumatoid Arthritis - Systemic Lupus -Pemphigus Vulgaris -Transplant -_________ Conditions |
Autoimmune
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What Makes A Cell Cancerous?:
Normal cells have a ______ that makes them stop growing. When a cell becomes cancerous, the _____ does not work, they continue to grow. |
Trigger, Trigger
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Antineoplastic Cancer Drugs: Who is at risk?:
______ & ______ have a tendency to produce cancerous changes. Patients with a history of ______ cancer have a greater incidence of liver cancer. _______ ________ |
Papilloma & Herpesviruses; Liver; Environmental Exposure
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Antineoplastic: Mechanism of Action of Chemotherapy:
_____ _____ _____ of the rapidly growing malignant cell. _____ _____ _____ the rapid growing cell. _____ _____ ______ ______ of rapidly growing cells. These cancer agents are often used in combination with radiation treatment |
Suppress the growth, Attempt to destroy, Attempt to prevent spread
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Cancers moderately sensitive to chemotherapy:
-Head & Neck Squamous Cell -Neuroblastoma -Bladder - - - -Chornic Lymphocytic leukemia -Kaposi's Sarcoma |
Cervical; Ovarian, Prostate
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Not Very Sensitive to Chemotherapy:
1. 2. 3. 4. 5. |
1. Liver
2. Lung 3. Melanoma 4. Pancreatic 5. Renal |
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Adverse effect of chemotherapy:
The Antineoplastic drug is not selective between tumor tissue and normal tissue.. Cells of the gastrointestinal tract, bone marrow and hair follicles are fast growing cells. Early side effects of chemotherapy are associated with these cells ( ______, ______, _____, ______ ) |
Nausea, Vomiting, Hair Loss, Bone Marrow Suppression
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Antineoplastic Adverse Drug Effects:
1. 2. 3. 4. 5. 6. 7. 8. 9 |
1. Bone Marrow Suppression
2. Gastrointestinal 3. Dermatological 4. Alopecia 5. Hepatotoxicity 6. Neurologic 7. Nephrotoxicity 8. Immunosuppression 9. Germ Cells |
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Antineoplastic Adverse Drug Effects:
Liver-________ Peripheral Neuropathy-________ Kidney-_________ |
Hepatotoxicity; Neurologic; Nephrotocicity
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Antineoplastic Adverse Drug Effects:
Susceptible to infection- ______ Inhibition of spermatogenesis- ________ |
Immunosuppression; Germ Cells
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Antineoplastic Adverse Drug Effects:
_____ ______ ______- Leukopenia, agranulocytosis, thrombocytopenia, anemia. _______- Nausea, Stomatitis, Oral Ulcerations, Vomiting, hemorrhagic diarrhea. _______- Erythema, maculopapular erruptions, exfolative dermatitis, Stevens-Johnson Syndrome. _______- Hair Loss |
Bone Marrow Suppression; Gastrointestinal; Dermatological; Alopecia
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Antineoplastic Adverse Oral Effects:
Discomfort Sensitivity of teeth and gums Mucosal pain Mucosal ulceration Gingival hemorrhage Dryness Impaired taste Infection of oral mucosa _____ on hard palate Caries Do not use mouthwash containing ______. |
Petechiae; Alcohol
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Antineoplastic: Bisphosphonates Prescription Calcium:
IV Bisphosphonates have been associate with _____ _____. pamidronate (Aredia) clodronate (Bonefos) zolendronix acid (Zometa) Oral Bisphosphonates use of 3 years or longer, is now being linked to ______ ______ and bone break down. tiludronate (Skelid) alendronate (Fosamax) risedronate (Actonel) etidronate (Didronel) ibandronate (Boniva) |
Jaw Necrosis; Periodontal Disease
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Antineoplastic: Mechanism of Action of Bisphosphonates:
Bisphosphonates bind to ______ in bone mineral. Bone " _____" is suppressed and the bone is unable to remodel If aggressive dental treatment is performed: extraction, denture sores, implants; possibly curettage. The bone cannot heal= a hole |
calcium; turnover
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Antineoplastic: Management of patients taking oral Bisphosphonates:
Ask what Bisphosphonate the patient is taking- make sure it is _________, OTC calcium is not a problem. How long have they taken the oral Bisphosphonate? If the patient has been taking bisphosphonates 3 years or longer, a ______ ______ must be performed to evaluate bone turnover. No aggressive procedure should be performed unless the turnover is occurring. Monitor tissue and pocketing for signs of ______ ______. |
Prescription; Blood Test; Periodontal Breakdown.
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Antineoplastic: Management of patients taking IV Bisphosphonate:
1. Ask the patient the name of the bisphosphonate? 2. What cancer is being treated? 3. No aggressive treatment may be initiated by the general dental office. 4. Maintain _____ ______ ______ 5. Start treatment within _____ Months. Osteonecrosis present: Antibiotic, Chlorhexidine |
Good Oral Hygiene; 3
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Antineoplastic: Bisphosphonate tablets: Fosamax, Boniva:
After _____ years use of Bisphosphonate tablets, the patient may be susceptible to _______, _____ ______, _______ _______. |
Osteonecrosis, bone loss, periodontal disease.
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Antineoplastic: Oral Care for Patients before Chemotherapy:
1. _______ and/or _______ infection 2. _______ periodontal disease 3. Provide oral hygiene _______ |
Eliminate and/or manage; Control; Instruction
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Antineoplastic: Oral Care For Patients during Chemotherapy:
1. Schedule appointment just before next ________. 2. Consult with the oncologist before any procedure. 3. Document ______ Count > 1000 mm 4. Give endocarditis antibiotic prophylaxis 5. Good Oral Hygiene |
Chemotherapy; Neurtophil
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Antineoplastic: Management of Dental Patient Taking Antineoplastic Drugs:
1. Maximize oral hygiene before chemotherapy 2. Hygiene instructions to match patients symptoms 3. What for symptoms of infection 4. Check the neutrophil count before treatment > 1000 mm 5. Check _______ for adequate clotting 6. Rinse with soda/saline or chlorhexidine. |
Thrombocytes
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Respiratory Drugs:
Asthma: Precipitated by: allergens, pollution, exercise, stress, upper respiratory infection. Signs: Shortness of breath and wheezing Characteristics: ________ airway obstruction ______: inflammation resulting in increased secretions in the lungs. Swelling in the bronchiloles |
Reversible, Later
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Respiratory Drugs: Chronic Pulmonary Disease:
Characteristics: _____ airway obstruction Chronic Bronchitis: Chronic Inflammation of the airways -Excessive sputum Emphysema: ______ destruction with airspace enlargement and collapse. |
Irreversible; Alveolar
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Respiratory Drugs: Chronic Obstructive Pulmonary Disease:
Characteristics of Medication: 1. 2. 3. 4. 5. |
1. Anticholinergics
2. Beta-Adrenergic agonists 3. Antihistamines 4. Expectorants 5. Antitussives |
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Respiratory Drugs: Chronic Obstructive Pulmonary Disease:
1. Anticholinergics- ________ 2. Beta-Adrenergic agonists- _______ 3. Antihistamines- ________ 4. Expectorants- ______ 5. Antitussives- _________ |
Bronchodilation; Bronchodilation; Reduce secretion; Thin Sputum; Control Cough
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Respiratory Drugs: Review of Parasympathetic Autonomics:
" _______" Cholinergics Drugs- ______, ________ Heart- Slow Down Vessels -Vasodilate Respiratory- may precipitate bronchospasms or asthmatic attack. Dental- Used in treatment of ________. |
Vegetative; Pilocarpine, Physotigmine; Xerostomia
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Respiratory Drugs: Review of Parasympathetics:
Anticholinergics: Drugs: _______- produce dry mouth _______- Motion Sickness _______- Psychoses (Produce Parkinson-like side effects) _______- reduce the flow and volume of secretion _______ _______- relax smooth muscle in the respiratory and gastrointestinal tract. -Bronchodilation |
Atropine, Scopolamine, Phenothiazines; Glands; Smooth muscle
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Respiratory Drugs: Review of Sympathetics:
" ______ or ______" Neurotransmitter: Norepinephrine Epinephrine (from Medulla) Beta 1 Receptors- _________ Beta 2 Receptors- _________- Vasodilation Adrenergics- Used in Anaphylaxis, Asthma, added to local anesthetic |
"Fright or Flight"; Heart; Lungs
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Respiratory Drugs: Review of Sympathetics:
"Amphetamine like" effects: CNS excitation & alertness Heart- Generally _____ force and strength of contraction Vessels- ______ blood vessels Blood Pressure-_______ Salivary Glands- _______ & _______ stimulation Respiratory-________ |
Increase; Constrict; Increase; Submaxillary & Sublingual; Bronchodilation
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Drugs used to treat Respiratory Disease:
1. Anticholinergics Drugs: _______ (old fashioned) Ipratropium- Atrovent |
Atropine
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Drugs used to treat Respiratory Disease:
2. Sympathetics (Adrenergic Agonists) They produce _________ by stimulation of the B-2 Receptors -Epinephrine (alpha & Beta- Agonist) -Isoproternol (nonspecific Beta-Agonist) |
Bronchodilation
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Respiratory Drugs: Inhalers-Sympathomimetics:
-Delivers medication directly into the bronchioles -Accurately measured -Onset of action is rapid and predictable Epinephrine- (alpha & beta agonist) Primatene Albuterol (Beta- 2 Agonist) _______ |
Proventil
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Respiratory Drugs: Inhalers- Aerosolized Corticosterioid:
Especially good for reducing inflammation, secretions and swelling within the lungs after an asthmatic attack. Drug: ______ ________ can result from chronic use. Advise the patient to rinse their mouth and gargle with water after use. |
Flovent; Candidiasis
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Patients prone to developing respiratory failure, if given Oxygen or Nitrous Oxide or CNS depressants May manifest _____ ______ ______.
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Acute Respiratory Failure
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Respiratory Drugs:
______ should be avoided in patients with Asthma Erythromycin may alter the metabolism of theophylline (xanthine) |
Aspirin
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Management of the Dental Patient with Asthma:
Avoid Aspirin, NASAIDS, strong Opiods- respiratory depression, release of histamine. (acetaminophen and weak opioids okay) Watch sulfiting agent in local anesthesia with vasoconstrictor = _________ Avoid erythromycin with theophylline Have patients inhaler available Watch for oral candidiasis- inhaled steroid, rinse mouth ______ Stress Use N2O With Caution |
Bronchoconstriction; Reduce
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Respiratory Drugs: Decongestants:
Nasal Decongestants: Beta-Adrenergic Agonists- Constrict blood vessels of the nasal mucous membrane. Entex LA Tavist-D Pseudophedrine- Sudafed They should not be used for more than a few days as they may result in rebound _______ & ________ |
Swelling & Congestion
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Respiratory Drugs: Expectorants:
Promote the removal of exudate or mucous from the respiratory passages. Guaifenesin-Contained in _____ products such as Robitussin |
OTC
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Respiratory Drugs: Antitussives:
______ are the most common Antitussive. Used for the relief of non productive cough. Codeine-containing products cause release of histamines. Dextromethorphan-Robitussin Suppresses the cough reflex but does not cause release of ________ |
Opiods; Histamines
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Respiratory Drugs: Xanthaines:
Drug: ________ Used as a bronchodilator Used to treat _______ ______ Used to treat brochospasms associated with chronic broncitis and emphysema Side effects: CNS stimulation, Increased gastric secretion Erythromycin may increase the serum levels =_______ |
Theophylline; chronic asthma; Toxicity
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Gastrointestinal Drugs: Ulcers
Occur in the _______ or ______ _______ Related to the Organism _____ _______ Not related to stomach acid Treated with antibiotics and H2-Blockers |
Stomach or Small Intestine; Helicobacter pylori
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Gastrointestinal Drugs: Gastroesophageal Reflux (GERD) "Heartburn"
Stomach contents and acid flow backward through the cardiac sphincter, up into the esophagus. Irritation, inflammation and erosion of the esophagus can occur. The pain may be severe and located in the _____ of the ______ |
Middle of the chest
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Gastroesophageal Reflux:
Avoid eating for _____ house before bedtime. Eat ____ meals frequently Raise the head of the bed. Treatment: Decrease Stomach Acid Constrict Cardiac Sphincter |
4; Small
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Drugs used to treat Gastrointestinal Diseases:
Histamine 2- Blocking Agents: Block gastric acid secretion by inhibiting histamine. Inhibit gastric acid secretion stimulated by food or caffeine. Drugs: Climetidline (Tagamet) Famotidne (Pepcid) Omeprazole (Prilosec) Lansoprazole (Prevacid) Use: Treatment of ________ Management of the symptoms of _______ Gastroesophageal reflux. |
Ulcers, Ulcers
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Gastrointestinal Drugs: Treatment of Gastrointestinal Diseases: Histamine 2-Blockers:
Smoking ______ acid production and reduces the effect of H2-Blockers |
Increases
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Gastrointestinal Drugs: Drugs used to treat Gastrointestinal Diseases:
Antacids (Sodium Bicarbonate) Neutralize hydrochloric acid in the stomach Used to treat: _______ _______ Symptoms of _______ Disadvantages: Alkalosis can occur Contains sodium= contraindicated with cardiovascular patients |
Acute gastritis; Ulcers
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Gastrointestinal Drugs: Drugs used to treat Gastrointestinal Diseases:
Antidiarrheals: They are either ______ or ______-like in action Drugs: Diphenoxylate with atropine (lomotil) Decreases peristalsis by acting on the smooth muscle of the gastrointestinal tract |
adsorbents or opioid-like
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Gastrointestinal Drugs: Drugs used to treat Gastrointestinal Diseases:
Emetics: Used to treat persons who have ingested an overdose of drugs that could be harmful. Antiemetics: Used to treat ______ (Motion sickness, pregnancy, drugs, infections, radiation therapy) Drugs: Phenothiazines (Compazine) Anticholinergics-Dramamine= Motion Sickness -Have antihistamine effect=_______ |
Vomiting; Sedation
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Gastrointestinal Drugs: Drugs used to treat Gastrointestinal Diseases:
Chronic Inflammatory Bowel Diseases: ______ ______- extends through all layers of the intestinal wall ______ _______- in the mucosa |
Chrone's Disease; Ulcerative Colitis
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Hormones: Thyroid Hormones:
Thyroid Hormones are synthesized from iodine & tyrosine. They are stored until _____ stimulates their release. The thyroid acts upon every tissue and organ in the body. These hormones are important for ____, _____, _____ , _______ |
TSH; Energy, Metabolism, Growth, Development
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Hormones: Iodine:
Must be present to create _____ _______ Marine life is the only common food that is naturally rich in iodine. Our salt is iodized Many countries do not have a source of iodine= _______ |
Thyroid Hormones; goiter
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Hormones: Hypothyroidism:
________- hypofunction of the thyroid in children. _________- hypofunction in adults. |
Cretinism; Myxedema/ Hyperthyroidism
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Hormones: Hypothyroidism:
Characteristics: Mental & Physical retardation Drowsy, weak, listless, expressionless, puffy face Edematous tongue and lips Delayed tooth eruption, malocclusion Tendency to develop ______ _____ Teeth are poorly shaped and carious Gingiva is inflamed or pale and enlarged |
Periodontal disease
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Hormones: Hypothyroidism:
Difficulty withstanding ______ Abnormally sensitive to CNS depressants (Opioids & Sedatives) Difficult to motivate to good oral hygiene Hypothyroid pregnant women tent to produce offspring with _____ teeth |
Stress; large
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Hormones: Hyperthyroidism: Types of Diseases:
1. 2 3. |
1. Graves Disease
2. Plummer's Disease 3. Hashimoto's Disease |
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Hormones: Hyperthyroidism: Types of Diseases:
Diffuse Toxic Goiter-_____ _____ Toxic Nodular Goiter-______ _____ Chronic inflammation of the thyroid associated with an autoimmune response- _______ _______ |
Grave's Disease, Plummer's Disease, Hashimoto's Disease
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Hormones: Hyperthyroidism:
Characteristics: Excessive heat Increased sympathetic activity Increased nueromuscular activity Increased sensitivity to pain- decreased tolerance to CNS depressants Exophthalmos( _____ _____) Anxiety Accelerated tooth eruption Marked loss of alveolar process Diffuse demineralization of the mandible Rapidly progression periodontal destrction |
Protruding Eyes
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Hormones: Hyperthyroidism:
They may require higher than usual doses of sedative, analgesics, and local anesthetic. At the same time, anesthetic with epinephrine must be used in small doses or not at all due to " ______ ______" |
Thyroid Storm
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Hormones: Hyperthyroidism:
No treatment should be begun for any patient with a visible goiter, exophghalmos or a history of taking anti thyroid drugs until approval is obtained from the patient's ______ |
MD
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Hormones: Hyperthyroidism:
Use the cardiac dose of epinephrine if epinephrine is needed. Monitor Carefully Keep stress to a minimum Consider _________ __________ |
Preoperative Sedation
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Hormones: Treatment Drugs:
Hypothyroidsim: 1. 2. Hyperthyroid: 1. 2. 3. 4. Propranolol is often given with these drugs. |
1.Iodide
2.Levothyroxine (Synthroid) 1. Radioactive Iodine (Iodine-131) 2. Partial thyroidectomy 3. PTU 4. Tapazole |
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Hormones: Antithyroid Drug: PTU (Propylthiouracil) Side Effects:
-Fever -Skin Rash -Agranulocytosis leading to: poor wound healing oral ulcers necrotic lesions oral infections -Paraesthesia of facial areas Loss of ______ |
Taste
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Pancreatic Hormones:
________ |
Diabetes
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Pancreatic Hormones:
______-promotes fuel storage-Glucose taken out of the blood _______- produces fuel mobilization-Glucose put into the blood |
Insulin; Glucagon
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Hormones: Diabetes Mellitus:
Manifested by abnormal carbohydrate metabolism Resulting in ________ Type ______- Juvenile-Onset Type ______- Maturity Onset |
Hyperglycemia, I, II
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Hormones: Type 1 Diabetes:
Less than _____ years old Complete lack of insulin Must be treated with insulin injections |
30
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Hormones: Type II Diabetes:
Develops in persons older than _____ years of age. The insulin secreted does not reduce the glucose levels in the blood to normal levels. Slower onset, less severe symptoms Treated 1st with ______ & _____, then orally and then lastly with injections |
40; Exercise & Diet
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Hormones: Dental Complications of Diabetes:
Xerostomia- Related to fluid loss due to increased urination ______- in tongue and other oral structures due to neuropathy Periodontal- Mild gingivitis to painful periodontitis Widened PDL Multiple Abscesses Exudate from pockets Increased mobility |
Pain
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Hormones: Dental Complications of Diabetes:
Dental appointments should not interfere with meals and should involve minimal ______. Oral surgery should be performed ____- ______ hours after eating and taking diabetic medication After surgery, food should be consumed to prevent _______ |
Stress, 1.5-2, hypoglycemia
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Hormones: Complications of Diabetes
-_____ wound healing -tendency to develop infections -cardiovascular problems -______ -Neuropathy in the extremities -Depressed immunity -Slow Healing |
Delayed, Blindness
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Hormones: Questions to ask your dental patient with Diabetes:
1. When did you last test your blood sugar? 2. What numbers have you been getting for you ______ _____? 3. When did you last test? |
Blood sugar
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Diabetic Testing:
Fasting Plasma Glucose: Normal= Less than ______ Goal = _____-______ Take Action: Less than _____, Greater than ______. |
115, 80-120, 80, 140
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Diabetic Testing:
Glycosylated hemoglobin HbA1c: Normal :Less Than _____ Goal: Greater Than _____ Taken Action: Greater Than ____ |
6,7,8
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Hormones: Treatment of Hypoglycemic Emergency:
If conscious: Administer _____ _____, _____ ______, ______ _____ If Unconscious: ____ _____ |
Fruit Juice, Cake Icing, Glucose gel; IV Dextrose
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Drugs used to treat Diabetes:
________- Injected subcutaneously Adverse RXN- Hypoglycemia Hypoglycemia reaction can be caused by: Overdose of Insulin Failure to eat Increased exercise or stress |
Insulin
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Symptoms of Hypoglycemia:
-Headache -Blurred Vision -Mental Confusion -Incoherent Speech -______ -Convulsion -______ |
Coma, Death
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Hormones: Oral Antidiabetic Drugs:
_______: Used for treatment of patients who cannot be treated with exercise and diet or patients unwilling to take Insulin. Produce an increase in insulin secretion Chlorpropamide (Diabinese) Tolbutamide (Orinase) |
Sulfonylureas
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Oral Antidiabetic Drugs: (To reduce blood sugar):
________: Chlorpropamide (Diabinese) Tolbutamide (Orinase) Other: Metformin (Glucophage) |
Sulfonylureas
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Antidiabetic Drug Used to Increase Blood Sugar:
_______: Administered parenterally It is an antagonist to Insulin |
Glucagon
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Management of the Dental Patient taking Insulin or Oral Hypoglycemics:
1. ________- question patient regarding last meal ingested. 2._____ _____ _____- monitor and give antibiotics if needed 3. _____ ______- follow up if surgical procedure was done. 4. _____ _____- large doses of salicylates may produce hypoglycemia 5. Appoint patient in the morning after breakfast and diabetic medication taken. 6. Provide quick glucose source 7. Check for oral complications 8. Ask patient what the results of their blood glucose monitoring has been. |
Hypoglycemia, Infection more likely, Healing prolonged, Drug interactions
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