Glucocorticoids for therapeutic immunosuppression: Clinical pearls for the practicing neurologist

被引:23
作者
Galati, Alexandra [1 ]
Brown, E. Sherwood [2 ]
Bove, Riley [1 ]
Vaidya, Anand [3 ,4 ]
Gelfand, Jeffrey [1 ]
机构
[1] Univ Calif San Francisco, Dept Neurol, Div Neuroimmunol & Glial Biol, San Francisco, CA 94143 USA
[2] Univ Texas Southwestern Med Ctr Dallas, Dept Psychiat, Dallas, TX 75390 USA
[3] Brigham & Womens Hosp, Ctr Adrenal Disorders, 75 Francis St, Boston, MA 02115 USA
[4] Harvard Med Sch, Boston, MA 02115 USA
关键词
Neurology; Glucocorticoid; Risk mitigation; Side effect; 1ST TRIMESTER EXPOSURE; RHEUMATOID-ARTHRITIS; CORTICOSTEROIDS; TRIAL; METHYLPREDNISOLONE; COMPLICATIONS; PREVENTION; MANAGEMENT; DISEASE; PREDNISOLONE;
D O I
10.1016/j.jns.2021.120004
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Given widespread use of glucocorticoid therapy in neurologic disease, understanding glucocorticoid pharmacology and risk is paramount for the practicing neurologist. While dosing and tapering regimens vary depending on the neurological disease and indication being treated, there are important general principles of glucocorticoid prescribing and monitoring that can guide clinical decision-making. Glucocorticoid-related toxicities can occur across multiple organ systems, including hypertension; dyslipidemia; weight gain; hyperglycemia; osteoporosis and avascular necrosis; myopathy; gastrointestinal bleeding; infection; and neuropsychiatric effects with sleep, mood disturbance and cognition. This narrative review provides a practical framework for safe and responsible prescribing of this therapeutic class of medications, including appreciation of immunosuppressive consequences, risk mitigation strategies, dosing and tapering, and recognition of adrenal insufficiency and glucocorticoid withdrawal.
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页数:8
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