Adrenocorticosteriods

=Adrenocorticosteriods =

Adrenal insufficiency(acute or chronic, primary or caused by anterior pituitary insufficiency Cerebral edema and icreased intracranial pressure(brain tumors, meningitis, trauma, cererovascular accidents) Collagen vascular diseases Lupus erythematosus ** Pulmonary disorders Asthma Chronic bronchitis(acute episodes) Aspiration pneumonia Rheumatic diseases Rheumatic diseases and joint ailments Rheumatic arthritis **
 * What are Corticisteroids used for?
 * Polymyositis **
 * Polyarteritis nodosa **
 * Chronic granulomatous disorders **
 * Temporal ( giant cell) arteritis **
 * Mixed connective tissue disease syndrome **
 * Dermatologoc disturbances **
 * <span style="font-family: 'Comic Sans MS', cursive;">Psoriasis **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Dermatitis (atopic, allergic, irritant) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Pemphigus **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Lichen planus **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Gastrointestinal diseases **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Ulcerative colitis **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Crohns disease **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Celiac disease **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Hematologic disease **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Malignancies (acute and chronic lymphocyte leukemia, lymphoma,multiple myeloma) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Hemolytic anemia (autoimmune or drug induced) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Idiopathic thrombocytopenic purpura **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Hepatic diseases **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Chronic active hepatitis **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Alcoholic hepatitis (severe forms with hepatic encephalopathy **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Hypercalcemia ( sarcoid, malignancies,vitamin D intoxication) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Multiple sclerosis (acute episodes) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Nephrotic syndrome **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Ocular diseases with inflammatory or allergic components
 * <span style="font-family: 'Comic Sans MS', cursive;">Rheumatic carditis **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Osteoarthritis (intraarticular administation) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Bursitis (intracapsular administration) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Shock **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Solid tumors (breast) **<span style="font-family: 'Comic Sans MS', cursive;">
 * <span style="font-family: 'Comic Sans MS', cursive;">Tissue grafts and organ transplants **

Natural adrenocortical hormones: <span style="font-family: 'Comic Sans MS', cursive;">**__ Administration routes for Adrenocorticosteroids: __**
 * **<span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">steroid molecules synthesized in released by the adrenal cortex **
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**Clinical Uses:**
 * 1) <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**diagnosis of adrenal function**
 * 2) <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**treatment of adrenal function disorders**
 * 3) <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**treatment of inflammatory/immunological disorders (at higher doses)**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**Control over adrenocorticosteroid secretion:**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**pituitary corticotropin (ACTH) release**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**Angiotensin modulation of aldosterone secretion**
 * 
 * 
 * 
 * 
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**Corticosteroids with:**
 * 1) <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**androgenic activity**
 * 2) <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**estrogenic activity**
 * 
 * 
 * 
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**quantitatively -- DHEA**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**DHEA and androstenedione }very weak androgens**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**small amount of testosterone, secreted by the adrenals, maybe more important**
 * 
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**adrenal androgens: testosterone and androstenedione may be converted to estrone by non-endocrine tissue:**
 * <span style="text-align: left; display: block; font-family: 'Comic Sans MS', cursive;">**Major endogenous estrogen source in women after menopause**

__** <span style="font-family: 'Comic Sans MS', cursive;">Adrenocorticosteroids for the uses of Dentistry include: **__
 * 1) <span style="font-family: 'Comic Sans MS', cursive;">IM
 * 2) <span style="font-family: 'Comic Sans MS', cursive;">IV
 * 3) <span style="font-family: 'Comic Sans MS', cursive;">Oral
 * 4) <span style="font-family: 'Comic Sans MS', cursive;">Topical
 * <span style="font-family: 'Comic Sans MS', cursive;">Treatment for oral inflammatory lesions, such as Apthous stomatitis
 * <span style="font-family: 'Comic Sans MS', cursive;">Apthous stomatitis
 * <span style="font-family: 'Comic Sans MS', cursive;">Temporomandibular disorders
 * <span style="font-family: 'Comic Sans MS', cursive;">Oral surgery or endodontic procedures
 * <span style="font-family: 'Comic Sans MS', cursive;">Control adrenal insufficiency

__**<span style="font-family: 'Comic Sans MS', cursive; font-size: 130%;">Implications in Dentistry include: **__<span style="font-family: 'Comic Sans MS', cursive;">


 * <span style="font-family: 'Comic Sans MS', cursive;">Delayed wound healing
 * <span style="font-family: 'Comic Sans MS', cursive;">Susceptibility to periodontal disease- bone loss
 * <span style="font-family: 'Comic Sans MS', cursive;">Increased risks for infections
 * <span style="font-family: 'Comic Sans MS', cursive;">May affect density of alveolar bone
 * <span style="font-family: 'Comic Sans MS', cursive;">Oral fungal infections
 * <span style="font-family: 'Comic Sans MS', cursive;">Adrenal crisis may occur with severe stress
 * <span style="font-family: 'Comic Sans MS', cursive;">Medical consultation in regards to glucocorticosteroid therapy- Rules of Two
 * <span style="font-family: 'Comic Sans MS', cursive;">Patient may require premedication prior to dental treatment

Adrenocorticosteroids Agents secreted by the adrenal cortex <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n They are used topically or systemically for the treatment of oral lesions associated with inflammatory diseases <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n They are often prescribed for patients with chronic systemic diseases such as asthma or arthritis and long-term therapy can cause adverse reactions on patients’ dental treaments Mechanism of release <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Stress → hypothalamus → CRF pituitary → ACTH adrenal cortex → hydrocortisone → pituitary → hypothalamus inhibits release of CRF and ACTH = **negative feedback** <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Long-term therapy → ↓ ACTH → atrophy of adrenal cortex <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n For these patients, if exogenous steroid is abruptly stopped, steroid deficiency and adrenal crisis can result Classification <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Glucocorticoids <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Affect immediate carbohydrate metabolism <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Major one = cortisol <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Stress increases its release <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Mineralocorticoids <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Affect the water and electrolyte composition of the body Definitions <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Addison’s disease <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Adrenocorticosteroids /corticosteroids/steroids <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Adrenocoticotropic hormone (ACTH) <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Cushing’s syndrome <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Glucocorticoids <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Mineralocorticoids
 * __IMPORTANCE IN DENTISTRY__**

Routes of administration <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Topical <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Oral <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Intramuscular <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Intravenous

Mechanism of action <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Binding to a receptor and forming a steroid-receptor complex → alterations in gene expression <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Other effects mediated by catecholamines → vasodilation or bronchodilation <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Antiinflammatory action results from their effects on the number, distribution, and function of PMNs and their inhibition of phospholipase A <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n These effects serve therapeutic uses but also produce many severe adverse effects Pharmacologic effects – palliative not curative <span style="font-family: Wingdings; font-size: 6pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Glucocorticoid effects <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Broad <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Carbohydrate metabolism <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Antiinflammatory <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Anti-allergenic <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Enzyme action <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Membrane function <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Nucleic acid synthesis <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Specific <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Catabolic <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Increase glucogenesis <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Decrease glucose use <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Inhibit protein synthesis <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Increase protein catabolism <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Decrease growth <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Decrease bone density <span style="font-family: Wingdings; font-size: 5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Decrease resistance to infection

<span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Mineralcorticoid effects <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Increase sodium <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Increase potassium loss <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Edema and hypertension Adverse reactions <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Metabolic changes <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Moon face, buffalo hump, truncal obesity, increase weight, muscle wasting → Cushing’s syndrome appearance <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Aggravated or initiated hyperglycemia <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Infections <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Decrease resistance <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Mask symptoms <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n CNS effects <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Euphoria <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Agitation <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Psychoses <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q depression

<span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Peptic ulcer <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Stimulate production of stomach acid and pepsin <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Exacerbate peptic ulcers <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Impair healing <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Impaired wound healing and osteoporosis <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Can impair growth in children <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Could affect alveolar bone <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Can lead to fractures <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Other <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Opthalmic effects <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Increased ocular pressure <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q cataracts

<span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Electrolyte and fluid balance <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Can produce sodium and water retention <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Exacerbate hypertension or CHF <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Hyperkalemia may also occur <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Adrenal crisis <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Adrenal suppression with long term use <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q If stressful situation occurs – weakness, syncope, cardiovascular collapse, death <span style="font-family: Wingdings; font-size: 8.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Dental effects <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Oral mucosa heals more slowly <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q More likely to have infection <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q More friable <span style="font-family: Wingdings; font-size: 6.5pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q With steroid inhalers, candidiasis may occur Uses <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Medical <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Box 19-1 <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Addison’s disease <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Cushing’s disease <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Infammatory /allergic diseases <span style="font-family: Wingdings; font-size: 7pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Prednisone is most commonly used <span style="font-family: Wingdings; font-size: 7pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Potency = triamcinolone is least, bethamethasone is most Uses <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Dental <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Oral lesions <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Aphthous stomatitis <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q TMD <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Oral surgery <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Pulp procedures

<span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n Adverse reactions in patients taking them <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q GI <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q BP <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Glaucoma <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Behavioral changes <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Osteoporosis <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Infection <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Delayed would healing <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Adrenal crisis <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Periodontal disease Steroid supplementation <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n For patients who use chronic steroids and are about to undergo a very stressful dental procedure <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q Rule of twos – not reccommended <span style="font-family: Wingdings; font-size: 8pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">q One-time increase Topical use <span style="font-family: Wingdings; font-size: 10pt; mso-bidi-font-family: Wingdings; msofareastfontfamily: Wingdings; msobidifontfamily: Wingdings; mso-fareast-font-family: Wingdings; msolist: Ignore; mso-bidi-font-size: 12.0pt; msobidifontsize: 12.0pt;">n In dentistry, used to manage oral inflammatory conditions
 * __Dental implications__**

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