Steroids ppt
- 1. DIVISION OF ORAL ANDDIVISION OF ORAL AND MAXILLOFACIAL SURGERYMAXILLOFACIAL SURGERY STEROIDSSTEROIDS Dr V.RAMKUMAR CONSULTANT DENTAL & FACIOMAXILLARY SURGEON REG NO .4118 -TAMILNADU -INDIA- (ASIA)
- 2. Corticosteroids and theirCorticosteroids and their biologically synthetic analogsbiologically synthetic analogs possess glucocorticoid andpossess glucocorticoid and mineralocorticoid action.mineralocorticoid action.
- 3. Adrenocortical SteroidsAdrenocortical Steroids The adrenal cortex synthesizes two classes ofThe adrenal cortex synthesizes two classes of steroids-steroids- • The glucocorticoidsThe glucocorticoids ex; hydrocortisoneex; hydrocortisone • The mineralocorticoidThe mineralocorticoid ex; aldosteroneex; aldosterone
- 4. GLUCOCORTICOIDSGLUCOCORTICOIDS Short acting Compound Equiv. dose (anti- inflammatory 1. Hydrocortisone (cortisol) 2. Cortisone 20mg 25mg 3. Prednisolone 4. Methylprednisolone 5. Triamcinolone 5mg 4mg Intermediate acting 4mg 6. Paramethasone 7. Dexamethasone 8. Betamethasone 2mg 0.75mg Long acting 0.75 mg
- 5. MINERALO CORTICOIDSMINERALO CORTICOIDS 9. Desoxycorticosterone acetate (DOCA) 10. Fludrocortisone 11. Aldosterone 2.5 mg (sublingual) 0.2 mg Not used clinically
- 7. Adernocortical SteriodsAdernocortical Steriods Adernal cortex (Synthesizes two classes of steroids) Androgen (19 carbon atoms) Corticosteriods (21 carbon atoms) Mineralocorticoids (Electrolyte balance regulating) Glucocorticoids (Carbohydrate metabolism regulating) Hydrocortisone (cortisol) Aldosterone
- 8. Pharmacological actionsPharmacological actions Increases gluconeogenesisIncreases gluconeogenesis Increases the peripheralIncreases the peripheral utilization of glucose.utilization of glucose.
- 9. Protein metabolismProtein metabolism Decreases the conversion of ofDecreases the conversion of of amino acids to proteinsamino acids to proteins Increases muscle wastingIncreases muscle wasting Increase in loss of bone matrixIncrease in loss of bone matrix
- 10. Anti inflammatory and allergyAnti inflammatory and allergy responseresponse Steroids decreases the production ofSteroids decreases the production of inflammatory cells.inflammatory cells. Steroids interact with antigen antibodySteroids interact with antigen antibody complex and reduces the allergycomplex and reduces the allergy response.response.
- 11. Mineral metabolismMineral metabolism Steroids causes sodium and waterSteroids causes sodium and water retention and produces oedemaretention and produces oedema Fat metabolism . It produces moonFat metabolism . It produces moon face in the head and neck region.face in the head and neck region. Mood changes . It causes euphoria.Mood changes . It causes euphoria.
- 12. Anti vitamin D actionAnti vitamin D action Absorption of calcium from the gut isAbsorption of calcium from the gut is impaired due to steriod action.impaired due to steriod action.
- 13. Routes of administrationRoutes of administration TopicalTopical OralOral IntramuscularIntramuscular Intra venousIntra venous
- 14. Therapeutic uses in oral andTherapeutic uses in oral and maxillofacial surgerymaxillofacial surgery Minor surgical proceduresMinor surgical procedures TraumaTrauma TumorsTumors Orthognathic surgical proceduresOrthognathic surgical procedures Neuro surgical proceduresNeuro surgical procedures
- 15. Therapeutic Uses in Non-Therapeutic Uses in Non- endocrine Diseaseendocrine Disease Rheumatic Disorders( phempigus)Rheumatic Disorders( phempigus) Renal diseasesRenal diseases Allergic DiseaseAllergic Disease Antiemetic ActionAntiemetic Action In AsthmaIn Asthma Immunosuppressive ActionImmunosuppressive Action Ocular DiseaseOcular Disease Skin DiseaseSkin Disease
- 16. Contd…Contd… GIT DiseaseGIT Disease Hepatic DiseaseHepatic Disease MalignanciesMalignancies Cerebral EdemaCerebral Edema Apthous stomatitisApthous stomatitis Lichen planusLichen planus
- 17. MISCELLANEOUS DISEASEMISCELLANEOUS DISEASE AND CONDITIONSAND CONDITIONS • SarcoidosisSarcoidosis • ThrombocytopeniaThrombocytopenia • Autoimmune Destruction of ErythrocytesAutoimmune Destruction of Erythrocytes • Organ TransplantationOrgan Transplantation • Spinal Cord InjurySpinal Cord Injury
- 18. Therapeutic preparation and dosageTherapeutic preparation and dosage Topical applicationTopical application Corlan pellet(hydrocortisoneCorlan pellet(hydrocortisone hemisuccinate.2.5mg)hemisuccinate.2.5mg) Triamcinolonepaste(vehicle consist ofTriamcinolonepaste(vehicle consist of gelatin methyl cellulose pectin)gelatin methyl cellulose pectin)
- 19. TriamcinoloneTriamcinolone It is availabe as injectable and waterIt is availabe as injectable and water formform Tablets 8-20 mgTablets 8-20 mg Injection 10mg vialInjection 10mg vial
- 20. DexamethasoneDexamethasone Available in oral and injection formsAvailable in oral and injection forms Oral dose .2-10mgOral dose .2-10mg Iv 4-20 mgIv 4-20 mg BethamethasoneBethamethasone available as local drops skin creamsavailable as local drops skin creams ointment and lotionsointment and lotions Iv 4-20 mg.6-8hrly.Iv 4-20 mg.6-8hrly.
- 21. Rule of twoRule of two Pt receiving steroids for two yearsPt receiving steroids for two years twice a week the dose to be doubledtwice a week the dose to be doubled
- 22. Major complicationsMajor complications Suppression of hypothalmohypophysealSuppression of hypothalmohypophyseal axis.axis. Git disturbances.dyspepsiaGit disturbances.dyspepsia haemorrhage perforationhaemorrhage perforation Infection(tb, fungal,candidiasis)Infection(tb, fungal,candidiasis) Iatrogenic cushing syndrome(skinIatrogenic cushing syndrome(skin becomes pale and thin)becomes pale and thin) Skeletal osteoporosisSkeletal osteoporosis Metabolic odemaMetabolic odema
- 23. Mental disturbanceMental disturbance Increased intra ocular pressureIncreased intra ocular pressure
- 24. Minor complicationMinor complication AcneAcne StriaeStriae Weight gainWeight gain Increased apetiteIncreased apetite
- 25. Dental Management GuidlinesDental Management Guidlines Define the risk of adrenal insufficiency throughDefine the risk of adrenal insufficiency through history and clinical examination.history and clinical examination. Insure that patient have taken sufficient doses.Insure that patient have taken sufficient doses. Schedule surgery in the morning.Schedule surgery in the morning. Stress reduction.Stress reduction. Use of nitrous oxide-oxygen or IV or oralUse of nitrous oxide-oxygen or IV or oral benzodiazepine sedation is helpful.benzodiazepine sedation is helpful.
- 26. Contd.Contd. Avoid the use of barbiturates.Avoid the use of barbiturates. Avoid GA for out patient procedure.Avoid GA for out patient procedure. Discontinue drug therapy that decreasesDiscontinue drug therapy that decreases cortisol levels at least 24 hours before surgery.cortisol levels at least 24 hours before surgery. Adequate pain control.Adequate pain control. Methods to reduce blood loss should be used.Methods to reduce blood loss should be used. BP below 100/60 mm should receive fluidBP below 100/60 mm should receive fluid replacement.replacement. Take care of hypoglycemia and hypovolemia.Take care of hypoglycemia and hypovolemia.
- 27. MANAGEMENT OFMANAGEMENT OF ADRENAL INSUFFICIENCYADRENAL INSUFFICIENCY
- 28. Conscious patientConscious patient Terminate dental treatmentTerminate dental treatment If asymptomatic, supine with feet elevated, IfIf asymptomatic, supine with feet elevated, If symptomaticsymptomatic A-B-C provide BLS, as neededA-B-C provide BLS, as needed
- 29. D- definitive care, monitor vital signs, medicalD- definitive care, monitor vital signs, medical assistance, obtain emergency kit and O2assistance, obtain emergency kit and O2 Administer glucocorticosteroid, if available and ifAdminister glucocorticosteroid, if available and if history of insufficiencyhistory of insufficiency
- 30. Consider additional management; provide BLS,Consider additional management; provide BLS, O2, glucocorticosteroid, as needed, establishO2, glucocorticosteroid, as needed, establish IV lineIV line
- 31. Unconscious patientUnconscious patient Recognize UnconsciousRecognize Unconscious supine with feet elevated slightlysupine with feet elevated slightly A-B-C provide BLS, as neededA-B-C provide BLS, as needed
- 32. monitor vital signs, medicalmonitor vital signs, medical assistance, obtain emergency kitassistance, obtain emergency kit and O2, Administerand O2, Administer glucocorticosteroidglucocorticosteroid
- 33. Establish IV line,Establish IV line, if possible TRANSFER TOif possible TRANSFER TO HOSPITALHOSPITAL