Endocrine I and II
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5 dental impacts of oral contraceptives
- 1. oral mucosa is more resistant to trauma
- 2. increased risk of dry socket during active pill (3 weeks)
- 3. patients on OC are more likely to develop gingivitis
- 4. antibiotic premed single dose will NOT interact with OCs
- 5. greater than 48 hours of dental antibiotics may decrease the effectiveness of OC (i.e. a continuous dose)
How many hours must a patient be on dental antibiotics before the effectiveness of their OC may become decreased?
What are the different categories of diabetic drugs?
- 1. Sulfonylureas
- 2. Alpha-Glucosidase Inhibitors
- 3. Thiazolidinediones (TZDs)
- 4. Metformin (Glucophage, G)
Which categories of anti-diabetic drugs may cause acute hypoglycemia?
Sulfonylureas and Meglitinides
What are 3 sulfonylureas?
- 1. glyburide
- 2. glipizide
- 3. glimepride
Which category of antidiabetic medications is the mainstay for anti-diabetic therapy?
What are 2 Alpha-Glucosidase inhibitors?
What are 2 Thiazolidinediones?
- 1. Pioglitazone
- 2. Rosiglitazone
What are 2 examples of Meglitinides?
- 1. Nateglinide
- 2. Repaglinide
What is the mechanism of action for sulfonylureas?
increase insulin secretion
What is the mechanism of action of Alpha-Glucosidase Inhibitors?
they decrease carbohydrate absorption from the gut
What is the mechanism of action of TZDs?
they are insulin sensitizers
What is the mechanism of action for Metformin?
increase uptake of glucose and decrease gluconeogenesis
What is the mechanism of action for Meglitinides?
they stimulate insulin secretion
Who are the special risk patients to adverse effects of steroids?
- 1. HTN and CV disease
- 2. Peptic ulcer, gastritis or esophagitis
- 3. Osteoporosis
- 4. Diabetes Mellitus
- 5. Tuberculosis or other infections
- 6. Psychological difficulties
- 7. Glaucoma
- 8. Pregnancy
- 9. Young patients
What are the adverse side effects of corticosteroids?
- 1. altered host response leading to infections, delayed wound healing, oral candidiasis
- 2. decreased stress tolerance
- 3. drug-drug interactions
- 4. osteoporosis in alveolar bone
What are the risk factors for osteonecrosis?
- 1. dental extraction
- 2. dental infection or other trauma
- 3. drug therapy (corticosteroids, cancer chemo, IV bisphosphonates, and potentially intermittent injections for osteoporosis therapy and CTX)
What drug therapies increase the risk of osteonecrosis?
- 1. corticosteroids
- 2. cancer chemotherapy
- 3. IV bisphosphonates
- 4. Intermittent injections for osteoporosis --> risk uncertain still
- 5. CTX --> risk uncertain still
What bisphosphonates put patients at higher risk for osteonecrosis of the jaw?
- 1. Pamidronate
- 2. Zoledronate
- **(Ibandronate also comes in injectable)
What is the normal fasting blood glucose level and 2hr post-prandial level?
- Fasting: <110mg/dl
- 2hr Post-Prandial: <140
What is the fasting blood glucose and 2hr post-prandial levels in a patient with impaired glucose metabolism?
- Fasting: 110-125 mg/dl
- 2hr Post-Prandial: 140-199 mg/dl
What is the fasting blood glucose and 2hr post-prandial levels in a patient with Diabetes Mellitus?
- Fasting: > or = 126 mg/dl
- 2hr post-prandial: > or = 200 mg/dl
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