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list the hormones secreted by the anterior portion of the pituitary gland and the organs they supply (6)
- luteinizing hormone (LH)-ovary
- follicle-stimulating hormone (FSH)-testes
- thyroid stimulating hormone-thyroid
- adrenocorticotropic hormone (ACTH)-adrenals
- growth hormone (GH)-bones and muscles
how are anterior pituitary drugs administered and why?
- they are destroyed by the GI tract
what ist he action of vasopressin?
- regulates reabsorption of water by the kidneys
- major physiologic action ois antidiuresis
what is the synthetic drug for vasopressin?
desmopressin acetate (Octostim, DDAVP)
what is the deficiency state of vasopressin known as?
how is the desmopressin acetate administered?
list the hormones secreted by the adrenal cortex
glucocorticoids and mineralocorticoids
what is the most commonly prescibed glucocorticoid?
what are three mechanisms of actions of glucocorticosteriods?
- decrease inflammation
- suppress immune system
- adverse effects (delayed wound healing and infection)
what are examples of steriods and their medical or oral purpose? 7
- prednisone-spinal cord injury
- corticosteriods-lymphocytic leukemia chemotherapy
- triamcinolone, clobetasol, fluocinonide-autoimmune oral conditions
are supplemental steroids needed for dental hygiene procedures when the pt takes supraphysiologic doeses of a steriod
compare the potency of prednisone and dexamethasone with cortisol; list their usual doeses per day
- prednisone is four times the anti inflammatory of cortisol, given at 5 mg/day
- dexamethasone is 25 times the anti inflammatory of cortisol, given at .75 mg/day
list topical cortiocosteriods used in dentistry and describe the application instructions (3)
- triamcinolone (kenalog)
- clobetasol (temovate)
- fluocinonide (lidex)
- applied three to four times a day after measl and at bedtime small amounts on lesion using cotton tipped applicator
why is orabase added to triamcinlone paste?
to keep the active ingredient localized to the area of concern
which steroid doseforms are most likely to produce ADEs?
Oral doseforms (tablets)
describe the oral health recommendation when steriod sprays are used? 3
- monitor oral tissues for yeast infection
- report findings to dentist
- rinse mouth after spray to reducecandidiasis
describe clinical considerations for the pt who takes a glucocorticosteroid? 7 (table 14-1)
- Chronic high dosing-extraoral exam
- masked infection-comprehensive periodontal assessment
- opportunistic infection-intraoral exam for candidiasis
- hypertension-monitor blood pressure
- miscelaneous-assess vision capabilities, acetaminophen for postop anlgesia, if oral steriod spray is used recommedn rinsing after use
list the actions of estrogen in the body 4
- inhibt the release of gonadotriopin releasing hormone
- reduce release of FSH and LH-permits the use of estrogen as contraception
- reduces thinning of mucosal tissues of vaginal area
- prevents vasomotor symptoms (hot flash)
list 6 ADEs associated with estrogen use and their relationship to smoking tobacco
- candidiasis, peripheral edema, hypertension, thromboembolism, stroke and myocardial infarction
- smoking tobacco increases the risk for formation of intravscular blood clots, leading to an increased risk for thromboembolism, stroke and MI
describe clinical considerations for teh dental hygiene treatment when estrogen products are reported by the pt
- monitor blood pressure (hypertension)
- smoking cessation program for females
- antibacterial agents-inform women of possible interactions and potnetial risk (consider alternative contraception during periods of antibaterial chemotherapy)
when ADEs are noted in a hypothyroid individual what is the most likely cause?
hormone therapy at excessive doeses is generally responsible
identify the risk factors of an interaction between vasoconstrictors and thyroid hormones
administer local anesthetics with vasoconstricor with caution using aspriating techniauew and low concentration of vasoconstricot-2 cartridges 1:100,000 or 4 cartridges 1:200,000
identify drugs used to manage symptoms of hyperthyroidism. 3
- methimazole (tapazole)
- iodine or iodide
what factors increase the risk of thyroid storm?
excessive doses of thyroid hormones or hyperthyroidism is uncontrolled
what are the signs and symptoms of thyroid storm? 3
- elevated temperature
- high blood pressure
identify potential drug interactions in the hyperthyroid individual
- combination analgesics containing acetylsalicylic acid (ASA) are contraindicated
- careful administration of small doses of vasoconstrictors with controlled hyperthyroidism
discuss clinical considerations when treating a pt with thyroid disease
develop and implement timely preventive and therapeutic strategies compatible with pts physical and emotional ability to undergo and respond to dental care
identify the ADE associated with BIS medications
osteonecrosis of the jaw (ONJ)
what is the role of the DH in providing oral health information when a BIS is reported o will be used in the future
- BEFORE-discuss the ADA pt information sheet, describe signs and symptoms of ONJ, perform oral exam to identify disease or inflammation, remove dental/periodontal disease, place on 3 to 6 month recall, evaluate fit of removable or fixed appliances and third molars, instruct in biofilm removal to prevent periodontal inflammation
- BIS reported-all of the above, many dentists and surgeons will not remove teeth, endo therapy may be the safest procedure if pulpal inflammation is found
identify goals of therapy in the management of DM
reduce fasting blood glucose to levels <120mg/dL and Hb A1c levles to <6%
describe the signs of hypoglycemia
weakness, dizziness, hunger, sweating, tachycardia, tremor, headaches, visual disturbances, impaired consciousness and loss of concentration
what is th emost common medical emergency in diabetes?