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Questions and Answers
What is the primary factor that affects the absorption of drugs across cell membranes?
Which route of administration guarantees 100% absorption of a drug?
Which of the following statements about pKa is true?
What does bioavailability refer to in pharmacokinetics?
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When considering drug absorption in the gastrointestinal tract, which section has the lowest pH?
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What is the term for the metabolism of a drug that occurs before it enters systemic circulation?
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Which factor predominantly influences the bioavailability of orally administered drugs?
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What is a primary characteristic of drugs that can enhance their absorption across cell membranes?
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What oral health issue is commonly observed in patients with hypothyroidism?
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Which adverse effect is associated with hyperthyroidism during dental procedures?
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What is the most common oral manifestation during pregnancy?
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Which dental intervention is considered safe during the second trimester of pregnancy?
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What systemic change during menopause can impact oral health?
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Which of the following is a link between polycystic ovarian syndrome (PCOS) and oral health?
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What is a primary concern for dental care in patients with diabetes?
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What role do Advanced Glycation End products (AGEs) play in periodontal disease linked to diabetes?
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What is a significant risk factor for caries during pregnancy?
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What is the appropriate analgesic for pregnant patients needing dental treatment?
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What is the primary effect of growth hormone deficiency in children?
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What condition is primarily associated with pituitary gigantism?
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Which of the following best describes the craniofacial changes in acromegaly?
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What is the leading oral health issue associated with antidiuretic hormone deficiency?
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What autoimmune disorder is the most common cause of hyperthyroidism?
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What condition is characterized by excessive osteoclast activity leading to bone lesions?
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Which of these is a characteristic sign of Addison disease?
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What distinguishes type 1 diabetes from type 2 diabetes?
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What is a primary contributing factor to osteoporosis in women post-menopause?
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What best characterizes Cushing syndrome?
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What is a common dental concern for patients with diabetes mellitus?
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How does PCOS affect women’s health?
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What impacts the insulin response in type 2 diabetes?
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What role do incretins play in diabetes management?
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Study Notes
Endocrine Dysfunction
- Endocrine glands produce hormones that regulate various bodily functions.
- Dysfunction can be primary, secondary, or tertiary.
Primary Dysfunction
- Originates within the endocrine gland itself.
Secondary Dysfunction
- Caused by defective levels of stimulating hormones from the pituitary gland.
Tertiary Dysfunction
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Results from hypothalamic dysfunction, affecting pituitary function.
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All forms of endocrine disturbance can impact oral health and influence the safe management of dental patients.
Pituitary Disorders
Growth Hormone Deficiency
Children
- Short stature and immature facial features.
- Impacts linear bone growth and delays tooth eruption.
- Delayed puberty.
- May cause malocclusion due to smaller dental arches.
- Normal intelligence.
Adults
- Primarily affects metabolism.
- Increased risk of osteoporosis and fractures.
Growth Hormone Excess
Pituitary Gigantism
- Usually caused by a pituitary adenoma.
- Leads to abnormal height and weight but normal body proportions.
- May cause hyperglycemia and type 2 diabetes.
- Characterized by enlarged hands, feet, face, tongue, nose, lips, and jaw.
- Can lead to death in early childhood.
Acromegaly
- Bones become thicker and more deformed.
- Protrusion of the lower jaw and hunchback.
- Enlargement of soft tissue organs.
- Increased risk of bronchitis, diabetes, and heart failure.
- Common craniofacial changes include:
- Mandibular prognathism and thickening.
- Increased thickness and height of the alveolar process.
- Spacing and flaring of anterior teeth.
- Enlargement of the tongue.
- Spiky exostosis-like growths in the alveolar bone.
Antidiuretic Hormone Deficiency (Diabetes Insipidus)
- ADH stimulates water reabsorption in the kidneys.
- Deficiency leads to excessive water loss and xerostomia.
Thyroid Disorders
Hyperthyroidism
- Caused by Graves’ disease, thyroid nodules, thyroiditis, excessive iodine intake, or pituitary tumors
- Common signs and symptoms:
- Excessive sweating and increased skin temperature.
- Tachycardia or irregular heartbeat.
- Tiredness and muscle weakness.
- Anxiety and nervousness, as well as difficulty sleeping.
- Exophthalmos (protruding eyes with lid retraction).
- Increased sensitivity to catecholamines.
Hypothyroidism
Acquired
- Caused by drugs like lithium, iodine deficiency or excess, and autoimmune diseases like Hashimoto thyroiditis..
- Impacts metabolism, leading to fatigue, weight gain, cold intolerance, and other symptoms.
- May cause myxedema (puffy appearance) and potentially myxedema crisis.
Congenital (Cretinism)
- Complete or partial loss of thyroid function in infants.
- Commonly caused by iodine deficiency in the mother's diet.
- Can lead to impaired neurological function, stunted growth, physical deformities, thickening of the lips, and macroglossia.
Parathyroid Glands
Hyperparathyroidism
- Usually caused by a tumor or hyperplasia of the gland, leading to excessive osteoclast activity.
- Characterized by bone lesions, malocclusion, and drifting of teeth. Increased risk of fractures.
Hypoparathyroidism
- Mainly affects nerve and muscle activity and can cause enamel hypoplasia, delayed tooth eruption, and unerupted teeth.
- Increased risk of dental caries.
Adrenal Disorders
Addison Disease
- Primary adrenal cortical insufficiency caused by autoimmune disorders, infections, hemorrhage, trauma, or cancer.
- Symptoms include:
- Glucocorticoid deficiency: Poor stress tolerance, fatigue, hypoglycemia, nausea, vomiting.
- Mineralocorticoid deficiency: Dehydration, low blood pressure, fatigue.
- Hyperpigmentation due to increased ACTH levels.
Addisonian Crisis
- Life-threatening condition due to the body's inability to respond to stress.
- Requires supplemental doses of corticosteroids.
Cushing Syndrome
- Results from long-term excess cortisol.
- May be caused by hypersecretion of ACTH from the pituitary gland or non-pituitary tumors.
- May also be caused by the administration of exogenous corticosteroids.
- Signs and symptoms:
- Altered fat metabolism and abnormal fat distribution, leading to a "moon face."
- Muscle wasting and protein breakdown.
- Thin and easily bruised skin.
- Osteoporosis.
- Hyperglycemia and increased insulin requirement.
- Immune suppression.
- Increased risk of gastric ulcers.
- Emotional and sleep disturbances.
Dental Concerns for Cushing Syndrome
- Increased risk of infection, alveolar bone loss, and impaired wound healing.
- Comorbidities like obesity, osteoporosis, and diabetes may affect periodontal health.
Diabetes Mellitus
- Metabolic condition caused by an imbalance between the body's need for glucose and insulin availability.
- Lack of insulin or reduced insulin activity leads to hyperglycemia and complications.
Type 1 Diabetes
- Prone to ketoacidosis due to uncontrolled conversion of free fatty acids to ketones in the liver.
- Requires insulin replacement therapy to stop fat and protein catabolism and prevent ketoacidosis.
Type 2 Diabetes
- Lifestyle disease involving both insulin deficiency and resistance.
- Characterized by hyperglycemia, glucosuria, and polyuria.
- Can lead to absolute insulin deficiency requiring therapy.
Other Types of Diabetes
- Diabetes associated with other conditions, syndromes, pancreatic diseases, endocrine disorders, environmental agents, drugs, PCOS, and pregnancy (gestational diabetes).
Diabetes Diagnosis and Treatment
Diagnostic Tests
- Blood tests based on fasting or casual plasma glucose levels or a glucose challenge test.
- Glycated hemoglobin test (HbA1c) to assess long-term glycemic control.
Lifestyle Management
- Normalize blood glucose levels through diet and exercise.
- Insulin replacement therapy for Type 1 Diabetes.
- Target glucose, lipid, and blood pressure goals for Type 2 Diabetes.
Drug Management
- Incretins (GLP-1 and GIP) stimulate insulin secretion, slow gastric emptying, and reduce appetite.
Osteoporosis
- Decrease in bone mass due to declining estrogen levels, particularly after menopause.
- Bone resorption by osteoclasts outpaces bone deposition by osteoblasts.
- Contributing factors include poor diet, lack of exercise, smoking, and diabetes.
- Medications like bisphosphonates can decrease osteoclast activity but may cause Medication-Related Osteonecrosis of the Jaw (MRONJ).
Polycystic Ovarian Syndrome (PCOS)
- Most common endocrine disorder among women of reproductive age.
- Characterized by irregular or absent menstrual periods, infertility, acne, excess hair growth, and weight gain.
- Associated with insulin resistance, obesity, cardiovascular disease, and periodontal disease.
- May be linked to altered GnRH secretion, androgen synthesis defects, and insulin resistance.
Thyroid Disorders in Dental Practice
Hypothyroidism
- Patients generally tolerate dental treatment well.
- Cardiovascular health is a primary concern.
- Delayed wound healing due to decreased fibroblast activity and increased susceptibility to infection.
- Use sedatives with caution due to increased sensitivity.
Hyperthyroidism
- Increased risk of caries and periodontal disease, as well as other oral problems like burning mouth syndrome.
- Patients are sensitive to adrenaline-containing products and may experience a hypertensive crisis.
- Invasive dental procedures may elicit a thyrotoxic crisis.
Parathyroid Glands in Dental Practice
- Hypoparathyroidism may be a concern due to delayed tooth eruption and enamel hypoplasia.
Pregnancy in Dental Practice
- Common oral health issue is pregnancy gingivitis due to estrogen and progesterone's effect on the inflammatory response.
- Pregnancy granulomas (epulis gravidarum) may occur but usually regress after childbirth.
- Increased risk of caries, largely due to snacking, reduced oral hygiene, morning sickness, and hormone-induced xerostomia.
- Routine dental care is safe during pregnancy and benefits both mother and child.
- Most comfortable time for dental visits is between weeks 14-20.
- Drug use is a concern, especially during the first trimester.
- Lidocaine and mepivacaine are safe, but the use of other drugs like NSAIDs should be avoided, and sedation should be avoided unless medically necessary.
Menopause
- Declining estrogen and progesterone impact oral health.
- Hormonal replacement therapy is controversial.
- Good oral hygiene is essential.
Polycystic Ovarian Syndrome in Dental Practice
- May contribute to periodontal disease due to chronic inflammation.
- Gingivitis might be difficult to treat due to underlying inflammation.
- Sex hormone imbalance may compromise collagen maintenance and repair.
- Patients may be at risk of bone loss density.
- Good oral hygiene is important in managing symptoms.
Diabetes in Dental Practice
Oral Signs of Diabetes
- Xerostomia caused by polyuria and dehydration.
- Increased rate and severity of periodontal disease.
- Increased incidence of root caries due to increased root exposure and xerostomia.
- Increased risk of oral infections and mucosal disorders.
- Poor wound healing due to vascular and immune dysfunction.
Advanced Glycation End Products (AGEs)
- AGEs are pro-inflammatory mediators that link diabetes to periodontal disease.
- Accumulate in periodontal tissues, leading to inflammation and bone loss.
- Uncontrolled diabetes is linked to alveolar bone loss.
Pharmacokinetics
- Pharmacology: Study of drugs' effects on living systems.
- Pharmacokinetics: How a drug is absorbed, distributed, metabolized, and excreted.
- Study of how the body affects the drug.
- Pharmacodynamics: How the drug affects the body.
- LADME: Liberation, Absorption, Distribution, Metabolism, Excretion.
Absorption
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Drugs must enter circulation to exert their effects.
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They must cross various barriers:
- Epithelial lining of the GI tract.
- Endothelial lining of blood vessels.
- Cell membranes of target cells.
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Mostly passive diffusion between cells based on concentration gradients.
Factors Influencing Drug Absorption:
- Formulation
- Administration route
- Surface area
- Blood flow
- Facilitated transport/receptors
- Solubility
- pKa and environmental pH
Routes of Administration
- Oral and rectal: Most common.
- Intravenous: 100% absorption.
- Percutaneous: Skin.
- Intramuscular: Muscle.
- Intrathecal: Cerebrospinal fluid.
- Inhalation: Lungs.
Other Routes
- Ocular (eyes)
- Buccal (cheek)
- Sublingual (under the tongue)
- Transdermal (through the skin)
Drug Properties
- Small molecules:
- Chemical structures: Weak acids, bases, ionized and non-ionized forms.
- The proportions of ionized and non-ionized forms depend on pH and pKa.
- Ionized forms: A- , H+ (hydrophilic)
- Non-ionized forms: AH (lipophilic)
pKa
- Acid dissociation constant. Predicts drug behavior at a specific pH.
- pH value at which half the drug is ionized.
- Drugs must be non-ionized to cross cell membranes.
Absorption in the Gastrointestinal Tract
- Oesophagus: pH 7.
- Stomach: pH 1-2.5 (5 when fed).
- Proximal small intestine: pH 6.15-7.
- Descending colon: pH 5.2-7.
- Distal small intestine: pH 6.8-7.8.
- Ascending colon: pH 5.2-6.7.
Blood Flow
- More blood flow increases adsorption.
Absorption of Oral Drugs
- Molecules absorbed in the GI tract enter the hepatic portal vein.
- Hepatic first pass: First pass through the liver before reaching systemic circulation.
Hepatic First Pass
- Bioavailability: Percentage of the administered dose that reaches systemic circulation.
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Hepatic extraction ratio: Amount of drug removed by liver cells.
- High hepatic extraction ratio (>.8) leads to less bioavailability.
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Description
Explore the complexities of endocrine dysfunctions and their implications on oral health. This quiz covers primary, secondary, and tertiary dysfunctions, including the impact on dental management. Learn about growth hormone deficiencies and excesses in both children and adults, along with their effects on growth and health.
