Adrenocorticosteroids

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Chapter 19
Adrenocorticosteroids
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Adrenocorticosteroids
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Adrenocorticosteroids are naturally occurring
compounds that are released by the adrenal
gland.
Stress, anxiety, and the time of day cause the
hypothalamus to release corticotropin-releasing
hormone which acts on the pituitary gland.
The pituitary gland secretes adrenocorticotropic
hormone which stimulates the adrenal cortex to
release hydrocortisone.
Once sufficient levels of hydrocortisone have
been reached, hydrocortisone causes the pituitary
gland and hypothalamus to inhibit the release of
their respective hormones.
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Classification
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Glucocorticosteroids
 These steroids affect intermediate
carbohydrate metabolism.
Mineralocorticosteroids
 These
steroids affect the water and
electrolyte composition of the body.
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3
Pharmacologic Effects
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
Exogenous steroids (drugs) produce many
different effects on the body.
Glucocorticosteroid effects are as follows:

Broad
• Carbohydrate metabolism
• Antiinflammatory
• Antiallergenic
• Enzyme action
• Membrane function
• Nucleic acid synthesis
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4
Pharmacologic Effects

Glucocorticosteroids
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Specific
• Catabolic (breaking down muscle mass)
• Increased gluconeogenesis
• Decreased glucose use
• Inhibit protein synthesis
• Increase protein catabolism
• Decrease growth
• Decrease bone density
• Decrease resistance to infection
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5
Pharmacologic Effects
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Mineralocorticosteroid Effects
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
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Increase in sodium retention
Increase in potassium loss
Edema and hypertension
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6
Adverse Reactions

Metabolic changes include moon face,
buffalo hump, truncal obesity, weight gain,
and muscle wasting.


Corticosteroids decrease resistance to
infection. They also delay healing and mask
the symptoms of infection.
Corticosteroids stimulate the increase in the
production of stomach acid and pepsin. As a
result, they can cause ulcers.
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7
Adverse Reactions

Corticosteroids can cause premature
closure of the growth plates and can delay
or stop growth in children.
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

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They can also cause osteoporosis.
Corticosteroids increase intraocular pressure and can
exacerbate glaucoma.
Some glucocorticosteroids can cause sodium and water
retention and can cause hypertension.
Adrenal suppression can occur with long-term use and
cause adrenal crisis. Adrenal crisis is characterized by
weakness, syncope, cardiovascular collapse and death.
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8
Medical Uses
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9
Dental Uses
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Systemic steroids are often effective in the
treatment of oral lesions due to
noninfectious inflammatory disease.
Topical steroids are used to treat aphthous
stomatitis.
Temporomandibular joint responds to
systemic steroids.
Systemic steroids are used during oral
surgery to reduce postoperative edema,
trismus, and pain.
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10
Dental Concerns
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Gastrointestinal Adverse Effects
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Dental patients should avoid aspirin and
NSAIDs because of the increased risk for GI
distress and ulcer. Acetaminophen is an
acceptable pain reliever.
Blood Pressure

Check the patient’s blood pressure since
steroids have the ability to raise blood
pressure. Epinephrine use may need to be
avoided if the patient’s blood pressure is
elevated.
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11
Dental Concerns
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Behavioral Changes
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Steroids can cause behavioral changes to
include psychosis, euphoria, and depression.
Appointments may need to be rescheduled if
the patient becomes aggressive or psychotic.
Osteoporosis

Osteoporosis may occur in the patient’s jaw
with long-term steroid use. Dental radiographs
may be helpful in identifying patients with
osteoporosis.
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12
Dental Concerns

Infection
 Steroids can mask the symptoms of
infection. Patients taking long-term oral
steroids may be needed to be seen
more frequently to assess for signs of
infection.
 Patients may require antibiotics after a
procedure because of their higher risk
for infection and because of delayed
wound healing.
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Dental Concerns
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Antibiotic Prophylaxis
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Because steroids can delay wound healing,
patients receiving long-term oral steroids may
require antibiotic prophylaxis prior to dental
appointments.
Adrenal Crisis

Patients taking long-term oral steroids may
require steroid supplementation prior to an oral
surgical procedure because of the body’s
inability to increase steroid production on its
own.
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14
Management of Dental
Patients Taking Steroids
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