Role of corticosteroids in the management of acute respiratory distress syndrome

Prescriptions written for topical steroids should include explicit instructions about where and how often to apply the preparation, and the body areas where use must be avoided.  Pharmacists should ensure these directions are included on the dispensing label.  Prescribers should bear in mind that patients may keep unused or leftover corticosteroid skin preparations for some time after they are prescribed and thus forget the original indication or instructions for use.  The prescribing of unnecessarily large quantities should be avoided.  Patients should be warned not to share their topical steroid preparation with other people as this may result in unsafe application to unsuitable areas such as the face, as well as the potentially inappropriate treatment of undiagnosed skin conditions.

Drugs can inhibit PCSK9, leading to lowered circulating LDL particle concentrations. Since LDL particle concentrations are a driver of cardiovascular disease like heart attacks , it is plausible that these drugs may also reduce the risk of such diseases. Clinical studies, including phase III clinical trials , are now underway to describe the effect of PCSK9 inhibition on cardiovascular disease, and the safety and efficacy profile of the drugs. [63] [64] [65] [66] [67] Among those inhibitors under development in December 2013 were the antibodies alirocumab , evolocumab , 1D05-IgG2 ( Merck ), RG-7652 and LY3015014, as well as the RNAi therapeutic inclisiran . [68] PCSK9 inhibitors are promising therapeutics for the treatment of people who exhibit statin intolerance, or as a way to bypass frequent dosage of statins for higher LDL concentration reduction. [69] [70]

The administration of systemic corticosteroids for patients with exacerbations of chronic obstructive pulmonary disease (COPD) has become common practice over the past 25 years. This practice remained somewhat controversial because corticosteroids can have serious adverse effects and initial clinical trials provided inconclusive evidence concerning their efficacy. Results from recent clinical trials indicate that systemic corticosteroids are modestly effective in shortening the duration of severe exacerbations of COPD. Systemic corticosteroids administered intravenously or orally to hospitalized patients with exacerbations of COPD reduced the absolute treatment failure rate by about 10%, increased the forced expiratory volume in 1 second (FEV1) by about 100 ml, and shortened the hospital stay by 1 to 2 days. Oral corticosteroids probably confer similar benefits when used for treating moderately severe COPD exacerbations in an out-patient setting. The optimal starting dose of corticosteroids is not known, but the duration of treatment should not extend longer than 2 weeks. Hyperglycemia is the most common adverse event, but secondary infections, mental disturbances, and myopathies may also occur.

Role of corticosteroids in the management of acute respiratory distress syndrome

role of corticosteroids in the management of acute respiratory distress syndrome

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