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list the hormones secreted by the anterior portion of the pituitary gland and the organs they supply (6)
- prolactin-breast
- luteinizing hormone (LH)-ovary
- follicle-stimulating hormone (FSH)-testes
- thyroid stimulating hormone-thyroid
- adrenocorticotropic hormone (ACTH)-adrenals
- growth hormone (GH)-bones and muscles
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how are anterior pituitary drugs administered and why?
- Injection
- they are destroyed by the GI tract
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what ist he action of vasopressin?
- regulates reabsorption of water by the kidneys
- major physiologic action ois antidiuresis
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what is the synthetic drug for vasopressin?
desmopressin acetate (Octostim, DDAVP)
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what is the deficiency state of vasopressin known as?
diabetes insipidus
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how is the desmopressin acetate administered?
nasal solution
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list the hormones secreted by the adrenal cortex
glucocorticoids and mineralocorticoids
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what is the most commonly prescibed glucocorticoid?
cortisol
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what are three mechanisms of actions of glucocorticosteriods?
- decrease inflammation
- suppress immune system
- adverse effects (delayed wound healing and infection)
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what are examples of steriods and their medical or oral purpose? 7
- prednisone-spinal cord injury
- corticosteriods-lymphocytic leukemia chemotherapy
- hydrocortisone-antiinflammatory
- deamethasone-antiinflammatory
- triamcinolone, clobetasol, fluocinonide-autoimmune oral conditions
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are supplemental steroids needed for dental hygiene procedures when the pt takes supraphysiologic doeses of a steriod
no
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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
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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
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why is orabase added to triamcinlone paste?
to keep the active ingredient localized to the area of concern
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which steroid doseforms are most likely to produce ADEs?
Oral doseforms (tablets)
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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
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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
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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)
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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
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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)
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when ADEs are noted in a hypothyroid individual what is the most likely cause?
hormone therapy at excessive doeses is generally responsible
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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
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identify drugs used to manage symptoms of hyperthyroidism. 3
- methimazole (tapazole)
- propylthiouracil
- carbimazole
- iodine or iodide
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what factors increase the risk of thyroid storm?
excessive doses of thyroid hormones or hyperthyroidism is uncontrolled
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what are the signs and symptoms of thyroid storm? 3
- elevated temperature
- tachycardia
- high blood pressure
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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
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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
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identify the ADE associated with BIS medications
osteonecrosis of the jaw (ONJ)
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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
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identify goals of therapy in the management of DM
reduce fasting blood glucose to levels <120mg/dL and Hb A1c levles to <6%
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describe the signs of hypoglycemia
weakness, dizziness, hunger, sweating, tachycardia, tremor, headaches, visual disturbances, impaired consciousness and loss of concentration
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what is th emost common medical emergency in diabetes?
hypoglycemia
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