Adrenocorticosteriods

Adrenocorticosteriods  Candice and Ashley will work together on this page (This is week #13 reading. Deadline to complete page is May 30th) The adrenal gland is the source of many hormones that are essential to metabolic control, regulation of water, electrolight balance and the way the body responds to stress. The medullary portion of the gland secretes epinephrine and norepinephrine on sympathetic stimulation. The adrenal cortex produces numerous substances that are derived from cholesterol known as corticosteroids. Certain corticosteriods and their synthetic analogues are used in medacine for replacement in adrenal insuffciency. PHARMACOLOGIC ACTIONS: Using cholesterol as a substrate the adrenal cortex synthesizes and secretes two kinds of steriod hormone 1). the 19-carbon androgens 2). the 21-carboncorticosteriods The production of all corticosteriods (except aldosterone) are directly regulated by the blood concentration of ACTH (adrenocorticotropic hormone) which is secreated by the ant. pituitary (adenohypophysis). Corticosteriods have several roles in our bodies such as carbohydrate,protien, lipid, and purine metabolisim;electrolyte and water balance, functions of cardiovascular, nervous, and immune-inflammatory systems also the functions of the kidneys, skeletal muscle, bone, and other organs and tissues. Corticosteroids also regulate gene expression.
 * Adrenocorticosteriods are used for the treatment of acute inflammatory pain, headache, and some neuropathic pain.
 * Steroids are used in topical, oral and injectable forms.
 * Corticosteriods are more effective in treatment of cluster headaches and useful to treat intractable migraine that has not responded to to other forms of therapy.

ABSORBTION, FATE & SECRETION: All natural and synthetic corticosteriods (except desoxy-corticosterone) are well absorbed from the GI tract, other sites include skin, mucous membranes & eye. THERAPUTIC USES: Glucocorticoids are used in two ways 1). replacement therapy 2). empiric basis in many conditions ( empiric refers to the initiation of treatment prior to determination of a firm diagnosis) conditions such as chronic inflammatory and immune phenomena and are also associated with tissue destruction and functional impairment. The long term use of corticosteroids to treat inflammation should be used with caution due to there lack of specificity they can cause harm. THERAPUTIC USES IN DENTISTRY: Glucocorticoids have a limied use in dentistry in medicine thay are used to reduce the signs and symptoms of unwanted inflammatory reactions. These uses fall into these genral catagories: oral ulcerations, pulpal hypersensitivity, temporomandibular joint pain, postoperative sequelae, and anaphylaxis and other allergic reactions __ADVERSE EFFECTS__ A single large dose or a short course of moderate doses ofhydrocortisone causes few adverse effects. If more than 20-30 mg ofhydrocortisone is taken daily for more than a week, some manifestations of ofglucocorticosteroid toxicity are likely to appear. Hyperglycemia A diabetic –like state stems from the anti-insulin action ofglucocorticosteroids. Myopathy Large doses of glucocorticosteroids cause muscle wasting,mainly seen in the limbs. Reduction ofmuscle mass in the extremities can occur. Osteoporosis and Osteonecrosis Osteoporosis is a common sequela of long-termglucocorticosterois use. Glucocorticosteroids reduce the absorption of Ca++. Aseptic osteonecrosis may involve largejoints (especially in the head and femur). Suppression of Growth In children and adolescents by inhibiting skeletal growthand maturation. Negative Nitrogen Balance A Net nitrogen loss results from the imbalance betweenprotein synthesis and degredation. Peptic Ulcer Increased chance in patients taking glucocorticosteroidsespecially individuals with RA. Ocular Effects Increased intraocular pressure, which can produceirreversible damage and posterior subcapsular cataracts can occur. Patients withdiabetes are particularly susceptible. CNS Effects Reactions are reversible and range in severity from mild(euphoria, insomnia, or nervousness) to pronounced (manic-depressive or schizophrenicpsychosis). Edema and Hypokalemia Water retention and hypokalmia can be avoided by dietary Na+restriction. Altered Distribution of Body Fat Round moon face, buffalo hump (fat at neck and back), increasedabdominal fat. Extremely obese trunkcompared to thin limbs. Increased Susceptibility to Infection Body’s reaction to infections is depressed. Individuals become immunocompromised. Suppression of Pituitary-Adrenal Function Prolonged administration of glucocorticosteroids results in suppressionof ACTH à depressed adrenal corticosteroid production. Reduction and cessation of glucocorticosteroid therapy must be done slowly. Various physiological stressors elicit a rapid increase in circulating concentrations of hydrocortisone and other glucocorticsteroids. This can lead to acute adrenal insufficiency or adrenal crisis. Onset is signaled by severe nausea, vomiting,diarrhea, leading to dehydration, chills and fever, Sudden penetrating pain inthe lower back,, abdomen, and legs, extreme lethargy, hypoglycemia, hypotensionand tachycardia. Miscellaneous effects Acne, thinning of the skin, hirutism, weight gain,intestinal perforation, pancreatitis, hyperlipidemia, hypertension,hepatomegaly, and poor wound healing. __IMPLICATIONS FOR DENTISTRY__ Patients have decreased resistance to infection and poorwound healing. Patients should bescheduled in the morning when circulating cortisol is at its highest. Measures to reduce anxiety. Consultation withpatient’s physician is essential to optimal management for a patient onlong-term glucocorticosteroid use.