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Steroid Treatment in Oral Cancer Patient. Oral Maxillofacial section, VGH-Tpe Reporter: 王奕凱 Supervisor: 高壽延 主任 雷文天 醫師. Introduction Clinical application of corticosteroid Complication of corticosteroid Dental uses of corticosteroid

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steroid treatment in oral cancer patient

Steroid Treatment in Oral Cancer Patient

Oral Maxillofacial section, VGH-Tpe

Reporter: 王奕凱

Supervisor: 高壽延 主任

雷文天 醫師

slide2
Introduction
  • Clinical application of corticosteroid
  • Complication of corticosteroid
  • Dental uses of corticosteroid
  • Management of corticosteroid-use dental patients
introduction
Introduction
  • Adrenal gland: Cortex and Medulla
  • Adrenal cortex: 3-layer

Outer: zona glomerulosa:

Middle: zona fasciculata

Inner: zona reticularis

physiopharmacology of corticosteroids
Physiopharmacology of corticosteroids
  • 其基本構造包含17個碳做骨架核,常用之 類固醇共有 21 個碳原子。在位置1,2 間改為雙鍵, 即成 Prednisolone, 其抗發炎作用增強四倍, 如C16再改為甲基,C9 改為氟離子,則成 Dexamethasone , 抗發炎作用 增加30倍而鈉滯留作用消失
functions of corticosteroid
Functions of corticosteroid
  • Regulation of carbohydrate, fat, protein
  • Anti-inflammation action by inhibit lysosome, prostaglandin, cytokines release.
  • Regulate the function of lekocyte.
  • Increase gluconeogenic, proteolysis, lipolysis and blood sugar
clinical application of steriod
Clinical application of steriod
  • Immunosuppressive: Rheumatoid arthritis, SLE, organ transplantation, asthma…
  • Anti-inflammation: hepatitis, dermatoses, mucositis, post-op edema…
  • Analgesia: reduction of pain
  • Replacement for adrenal insufficiency
adverse effect of corticosteroids
Adverse effect of corticosteroids
  • Receive long-term, high-dose steroid
  • Hypertension, heart failure
  • Osteoporosis, DM, impaired wound healing, metal depression and psychosis
  • Peptic ulcer, Cataract, glaucoma, growth suppression, hypocalcemia, PTH increased
  • Cushing syndrome
  • Secondary adrenal insufficiency
dental uses of corticosteroids
Dental uses of corticosteroids
  • Topical use: non-infections, ulcerative diseases in oral cavity. Inhibit the inflammatory reaction, redness and edema
  • Systemic use: third molar extraction, pre-prosthetic surgery, reconstructive oral surgery, orthognatic surgery
slide18

condition

administration

不建議使用於herpetic infections

nincort ointment
Nincort ointment
  • Acute and chronic oral lesions
  • 成分:0.1% triamcinolone acetonide

3.5 g/ tube (17.5 mg cortisol/tube)

  • 用法: apply a small dab (about ¼ inch )

to the lesion at bed time, or 2-

3times a day after meals

dexaltin ointment
Dexaltin ointment
  • Indication: inflammation manifestation of corticosteroid-responsive dermatoses in oral cavity
  • 成分: 0.1% dexamethasone 5g / tube

( 133 mg cortisol/ tube )

pbk solution
PBK solution
  • Indication: oral ulcer
  • 成分: susp 100ml/ bot

prednisolone 100mg(400mg cortisol)

benadryl 8.33 mg

kaopectin 33.33 mg

  • 用法:gargling in mouth for 5 min.

5-10 ml Bid

adrenal crisis acute adrenal insufficiency
Adrenal crisis( acute adrenal insufficiency)
  • Hypotension
  • Severe weakness
  • Progressive mental confusion
  • Nausea and vomiting
  • Abdominal, lower back or leg pain
  • Hyperthermia
  • Hypoglycemia
  • Hyperkalemia
  • Improve CAD
  • Loss of consciousness
  • Coma
  • death
dental patient taking steroid supplementation not required
Dental patient taking steroid supplementation not required
  • Patient taking low dose (<20 mg of cortisol daily)
  • Patient taking large dose:

for less than 2 weeks

for minor dental procedure with minimal stress

dental patient taking steroid supplementation required
Dental patient taking steroid supplementation required
  • Patient taking large dose:

for greater than 2 weeks

for extensive major or stressful dental procedure

# Double usual daily dose on the day before, the day

of, and the day after surgery

# Appt in the morning

# Good pain control

# Resume normal maintenance dose post-op 2 days.

dental patient taking steroid supplementation required27
Dental patient taking steroid supplementation required
  • If the patient received at least 20mg of cortisol for more than 2 weeks within past year

#60mg cortisol(or equivalent) the day before

and the day of surgery at morning

# On first 2 post-op days, 40mg cortisol

# Then take 20mg cortisol thereafter, until

post-op 6 days.

management of adrenal crisis
Management of adrenal crisis
  • Place the patient in a supine position with leg elevated
  • 200 mg hydrocortisone IV stat repeated as necessary
  • Oxygen and CPR if necessary
  • Transportation to a medical facility as soon as possible