Dental Medicine Test 3 Review

Two parts of the Adrenal Gland

Cortex and Medulla

What does the Adrenal Medulla do?

stimulated the sympathetic nervous system
secretes norepinephrine and epinephrine

What does the Adrenal Cortex do?

Produces and secretes steroid hormones:
Corticosteroids (glucocorticoids, mineralocorticoids)
Gonadocorticoids

two types of corticosteroids

Glucocorticoids (cortisol, metabolism, infl. process, cardiovasular, immune system, stress**) and Mineralcorticoids (aldosterone, maintain Na+/K+)

Increased release of cortisol can be reduced by

morphine, benzodiasepines (valium
), local anesthetic
, N2O

what do mineralocorticoids do?

Aldosterone*
Essential for sodium/potassium balance
responsible for fluid/water maintenance in blood

Addisons Disease cause

Chronic Adrenal insufficiency
decreased glucocorticoids ( cortisol*)
decreased mineralcorticoids (aldosterone*)

Addisons Disease symptoms

spots in the mouth (abnormal pigmentation)*
decreases glucose fat
, protein metabolism
inability to tolerate stress -> adrenal crisis*
Inability to conserve sodium and eliminate potassium*

Secondary adrenocortical insufficiency

more common
from exogenous corticosteroids*
When MD prescribes excess cortisol for autoimmune.

Cushing's Syndrome

Hyperadrenalism*
weight gain*
Round or moon shaped face*
Buffalo hump*
hypertension
bone fractures
mental depression

patients who take corticosteroids should...

not have any additional supplementation
MD consult

patients with hyperadrenalism have...

increased possibility of hyper tension ( due to increased Aldosterone*)
increased likelihood of osteoporosis (due to increased Corticosteroids*)
decreased connective tissue growth
inhibits osteoblasts and chondrocytes
compromises muscles integrity

Define Diabetes Mellitus

disorder of Pancreas/cells (decrease or lack of insulin)
Metabolic and vascular components*
Blood glucose levels overwhelm the kidneys

hyperglycemia

excess glucose in the blood* (increase vascular thickness, loss of elasticity)
neuropathy*
retinopathy*

the most important stimulant of insulin secretion is...

glucose*

Type 1 Diabetes

insulin dependent or juvenile *
autoimmune
genetic
environmental
absolute insulin deficiency*
Before age 25*
Idopathic

Type 2 Diabetes

Adult, non-insulin dependent
gradual onset
middle age
obesity
resistance to insulin (receptor sites)
tx: diet, exercise, oral hypoglycemics (diabinese-Orinese, Tolinese) *

Gestational Diabetes

Temporary disorder of glucose metabolism
Occurs only during pregnancy*

Body increased production of glucose from...

glycogen, fat and protein

Glucose accumulates where

tissue fluids and blood

Ketoacidosis

type of hyperglycemia
formation of ketone bodies
sweet smell
If fat metabolism continues the body develops metabolic acidosis*
Glucose, Fats, Proteins *

Diabetic Acidosis

Acidosis inhibits migration of cells to injured areas and decreases phagocytic activity
increased susceptibility to infection

Gangrene

complication of diabetes
loss of blood supply/no oxygen in fingers/toes
does not cause sepsis
untreated: may lead to sepsis

Cataract

complication of diabetes
clouding of lens

symptoms of diabetes

polydipsia ( thirst)
polyuria (urination )
polyphagia ( appetite )
weight loss
loss of strength

Function of the thyroid

basic metabolic rate
influences growth and maturation of tissues*
cell respiration
energy expenditure
essential for metabolism of carbohydrates, fats, proteins.

Thyroxine

Hormone secreted by thyroid
T4 Levothyroxine
converted to active form - T3 at target sites

Triiodothyronine

Hormone secreted by thyroid
T3

Calcitonin

Hormone secreted by thyroid

Thyroid hormones...

affect the metabolic process throughout the body (how fast you metabolize carbohydrates)

Graves Disease

most common cause of hyperthyroidism in children and adolescents
autoimmune disease
overactive thyroid
Exophythalmos** ( eye muscles swell)

Hyperthyroidism

condition due to excessive production of thyroid hormone

Thyrotoxicosis

occurs due to excessive thyroid hormone of any cause, including hyperthyroidism

Signs and Symptoms of Hyperthyroidism

increased cardiovascular
increased gastro
increased CNS
thin hair
etc

Signs and Symptoms of Hypothyroidism

decreased gastro
slower CNS
arthritis
dry hair
etc

Uncontrolled hyperthyroidism

requires a medical consult before tx *
adverse affects with epi*

controlled hyperthyroidism

conservative amounts of epinephrine*

Hypothyroidism

a condition of decreased activity of the thyroid gland
fails to secrete T4 and T3

Hashimoto's Disease

primary hypothyroidism
most common type of hypothyroidism
autoimmune disease
atrophy of the thyroid gland
diffuse goiter

neonatal cretinism

type of hypothyroidism
dwarfism
broad flat nose
wide set eyes
delayed eruption of teeth
malocclusion

Myxedema

type of hypothyroidism
accumulation of intracellular and extracellular fluid
body retains water
high BP
bradycardia
low body temp
weakness
weight gain

tx alterations for hypothyroidism

mild symptoms: no changes
avoid CNS depressant drugs, sedatives, narcotics

Drugs affecting the endocrine system include

synthetic hormone agonist/antagonists
drugs that affect the synthesis and secretion of hormones
The most important application of these drugs of Replacement Therapy*

Initial treatment for hyperthyroid

Beta Blockers*
do not reduce thyroid levels
decrease rapid heartbeat/nervousness
prevent palpations

Radioactive iodine (RAI)

hyperthyroid drug
destroys part of gland *
will become hypothyroid and need synthroid

Methimazone (tapazole)

hyperthyroid drug
more potent
fewer side effects
interfere with iodine uptake

Synthroid ( levothyroxine, levothyroid)

hypothyroid drug
A synthetic T4
drug of choice
daily dosing

Cytomel (L-triiodothyronine)

hypothyroid drug
synthetic T3
daily multiple dosing- difficult to monitor

Thyrolar (Iiotrix)

hypothyroid drug
synthetic T3/T4
controversial
expensive

thyroid hormone ( armour thyroid )

hypothyroid drug
contains iodine
difficult to monitor
Unpredictable

Victoza

injectible drug
improve blood glucose in Type 2 diabetes
used with diet/exercise

oral hypoglycemics...

stimulate the beta cells of the pancreas to release insulin
effective only when pancrease has some functional beta cells ( type II only*)
used with diet/weight control/exercise

Sulfonylureas

oral hypoglycemic drug
first oral agent
stimulate exiting B cells*
increase sensitivity of insulin receptors*
increase glucose transport in the tissues*

first generation oral hypoglycemic drugs

Diabinese* Prototype
Tolinase
Orinase*
decreased use with development of 2nd generation

second generation oral hypoglycemic drugs

more potent (smaller doses)
can be given daily
Glucotrol extended release*
Micronase
Amaryl extended release*
lower risk of hypoglycemia and wight gain

Prandin (repaglinide)

oral hypoglycemic
newer class
is a glinide
low risk of hypoglycemia and weight gain

Subcutaneous Antidiabetics

rapid: Novolog
Short-acting: Humulin-R
Intermediate acting: Humulin-N
Long-acting: Lantus

Adrenocortical Hormones

All are agents secreted by adrenal cortex

Hyposecretion of glucocorticoids and aldosterone by the adrenal cortex

Addison's*

Excessive corticosteroid secretion by the adrenal glands or by corticosteroid therapy

Cushing's*

what do glucocorticoids do?

potent anti-inflammatory
suppress immune system
are pallative rather than curative *

Corticoid (hydrocortisone)

type of corticosteroid drug
topical appilcation
skin inflammation

Decadron

type of corticosteroid drug
immunosupression- IV, IM

Deltasone

type of corticosteroid drug
oral form only
neoplasia

Kenalog

type of corticosteroid drug
IM, SC, Intradermal, Aerosol

oral side effects of steroids

mucosal heals slower
more susceptible to infection

side effects of inhalers

possible candidiasis
xerostomia

define seizure

disorders characterized by chronic recurrent, paroxysmal changes in neurologic function
altered consciousness
involuntary movements

T/F all seizures imply epilepsy?

false

Grand Mal

tonic/clonic
Aura
sudden epileptic cry**
more than 5 min -> emergency

tonic part of grand mal

generalized muscle rigidity
mydriasis
eye roll up or to the side
loss of conciousness

clonic part of grand mal

uncoordinated movements
rhythmic contractions of limbs
forced musculature closure of mouth

status epilepticus

repeated seizures in a short period of time without recovery

T/F does Valium inhibit/stop a seizure?

true

Dilantin

anticonvulsant drug
blocks sodium channels
gingival hyperplasia

anticonvulsant drugs

first line agents used
can cause an allergic response
Steven-Johnson Syndrome
toxic

T/F aspirin does not interfere with Coumadin drug for a stroke

false

Parkinsons

Chronic neurodegenerative disease of CNS
Degenerative disease of the basal ganglia involving the Dopamine* -secreting pathway

Signs and Symptoms of Parkinsons

muscle rigidity
facial impassiveness
tremors (extremities at rest, Cogwheel-type rigidity*)
stooped posture
pain
bowel/bladder dysfunction

treatment for Parkinsons

no treatment/cure
therapy with increasing dopamine levels in the CNS

L-dopa

most common prescribed med for parkinsons

Requip

drug for parkinsons
relives stiffness, tremors, muscle spasm, restless leg syndrome

Azilect

drug for parkinsons
MAO-B-Inhibitor
reduce the breakdown of dopamine which increased the level

Alzheimer's/Dementia

degeneration of cholinergic neurons that utilize neurotransmitters Ach and glutamate
impaired learning and memory

MS (multiple sclerosis)

chronic and continuous demyelination of the corticospinal and tract neurons
dry or burning mouth

ALS (Lou-Gehrig's)

chronic, progressive, fatal disease
50% die within 18 mo.
Difficult to Diagnose

Rilutek

Drug for ALS
reduce damage to motor neurons by decreasing release of glutamate