Abstract:
:Glucocorticoids (GC) in all its various forms and formulations are likely one of the most commonly used pharmacologic agents in medicine. Their use can be profoundly therapeutic but are also associated with a myriad of acute and chronic side effects. It is fairly well-accepted in the medical community that GC can be life-saving when used in critically ill patients with severe exacerbations of asthma and chronic obstructive pulmonary disease, HIV-associated pneumocystosis, and systemic vasculitides. However, the adjunctive role of GC is much more controversial in acute respiratory distress syndrome (ARDS), septic shock, community-acquired pneumonia, and several other serious medical conditions. Despite such controversies, GC should at least be considered for patients with fulminant manifestations of the following conditions as there is equipoise to indicate that GC may improve outcome with acceptable risks: (i) severe ARDS with refractory hypoxemia despite one to two weeks of state-of-the-art management, (ii) recalcitrant, vasopressor-dependent septic shock, (iii) non-influenza, severe community-acquired pneumonia, and (iv) severe alcoholic hepatitis. The bases for these controversies is likely due to both host factors (e.g., differences in GC resistance and susceptibility to adverse effects) and different phenotypes of any one disease state; e.g., different pathogenesis and pathogens under the rubric of "sepsis." Elucidation of better biomarkers to determine the underlying pathogenic phenotype will significantly advance our understanding and prediction of which critically ill patients will benefit from GC and who would experience a deleterious effect from its use.
journal_name
Pharmacol Therjournal_title
Pharmacology & therapeuticsauthors
Chan ED,Chan MM,Chan MM,Marik PEdoi
10.1016/j.pharmthera.2019.107428subject
Has Abstractpub_date
2020-02-01 00:00:00pages
107428eissn
0163-7258issn
1879-016Xpii
S0163-7258(19)30180-9journal_volume
206pub_type
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
pub_type: 杂志文章,评审
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
pub_type: 杂志文章,评审
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更新日期:1991-01-01 00:00:00
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journal_title:Pharmacology & therapeutics
pub_type: 杂志文章,评审
doi:10.1016/j.pharmthera.2003.12.001
更新日期:2004-03-01 00:00:00
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journal_title:Pharmacology & therapeutics
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更新日期:2017-01-01 00:00:00
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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journal_title:Pharmacology & therapeutics
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更新日期:2017-03-01 00:00:00
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journal_title:Pharmacology & therapeutics
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abstract::Substantial progress in the identification of genes encoding for a large number of proteins responsible for various aspects of neurotransmitter release, postsynaptic detection and downstream signaling, has advanced our understanding of the mechanisms by which neurons communicate and interact. Nicotinic acetylcholine r...
journal_title:Pharmacology & therapeutics
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更新日期:2013-01-01 00:00:00
abstract::Dysregulation of inflammation is central to the pathogenesis of innumerable human diseases. Understanding and tracking the critical events in inflammation are crucial for disease monitoring and pharmacological drug discovery and development. Recent progress in molecular imaging has provided novel insights into spatial...
journal_title:Pharmacology & therapeutics
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更新日期:2012-08-01 00:00:00