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Types of corticosteroids:
When the body is stressed what happens?
- Release cytokines esp IL-1
- causes increase in cortisol level
- This mobilises bodys glycogen and fat stores
FX of glucocorticoids x4:
- HPA axis feedback
- Anti-inflamm FX
- Metabolic FX
- Immunosuppressive FX
Name 6 uses of steroids in dentistry:
- 1.Ledermix, pulpal inflamm
- 2.Oral ulceration
- 3.Oral mucosal lesions eg.lichen planus
- 4.Vesicullo bullous disorders
- 5.Bells Palsy
- 6.Temporal arteritis
Steroids have differing levels of potency. Classify hydrocortisone and betamethasone:
- Hydrocortisone mild
- Betamethasone strongest, most potent
What is a Corlan tablet?
- Hydrocorticosone hemisuccinate 2.5mg
- 1 tablet sucked 4 times/day.
- Pts often done like putting the tablet next to the ulcer, painful.
What is adcortyl A?
- Triamcinalone acetonide in orabase
What is betnasol mouthwash?
- 500 MICROgrams betamethasone tablet dissolved in 5ml water
- Rinse and hold next to ulcer 2mins
What is Becotide?
- Beclomethasone metered inhaler
- Spray onto site 4 times a day.
- 50/100/200 MICROgrams
Clobetasol 0.05% cream
Systemic options for ulcers?
- Prednisolone 20-40g daily for 5 days.
- Reduce by 5mg every 2days.
- Azathioprine 150mg daily
- Others: colchicine, thalidomide, dapsone
Any other METHODS to treat ulcers?
- Intralesional injection
- With 10mg/ml Triamcinalone acetonide
Danger of Dapsone?
Decrease in red blood cell count
Principles of systemic steroids?
- Lowest dose as possible
- Shortest length of time
- Take in morning
- Caution withdrawing -Hypoadrenalism
Who gets steroid cover?
- More than 10mg Prednis daily, including if within the past 3 months
- Double the dose 1hr before surgery and for 24hrs postop.
Who carries a steroid card?
Steroids >3 weeks
Adrenal crisis symptoms:
- N + V
- Abdo pain
- Low glucose
- Increase K
- Low Na
Why get adrenal crisis?
Adrenal suppression from long term supplements. Therefore decreased response to stress.
Side FX streroids?
- Weight gain
- Susceptibility to infection
- Precipitation/aggravate diabetes
- Peptic ulceration
Monitor what for a pt on steroids?
- BP, electrolytes
- Liver function
- Random cortisol
Name 5 immunomodulatory drugs?
Pts on Azathioprine need monitoring because?
- Causes bone marrow suppression
- therefore take LFTs and FBC
- Long term may predispose to neoplasms
Antiviral drugs give 2 examples:
- Topical 5% cream FIVE times daily for 5-10 days
- Systemic 200mg FIVE times a day PO or 400mg if immunocomp for 5 days
1% every 2 hours
Topical Antifungal names and doses
- Nystatin pastilles 100,000 units QDS
- Miconazole gel QDS
What does miconazole interact with?
Micon is absorbed by gut.
- Decrease METABOLISM of:
- Warfarin, Phenytoin and Cyclosporin
Therefore increased bleeding
Fluconazole dose and duration?
50-100mg for 7-14days
100mg for 15days