Corticot

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Indications for Drugs ::

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

 

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Drug Dose ::

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

 

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Contraindication ::

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

 

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Drug Precautions ::

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

 

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Drug Side Effects ::

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).

 

 Indications Diagnostic testing of adrenocortical function; incude diuresis or remission of proteinuria in the nephrotic syndrome without uremia of the idiopathic type or that caused by lupus erythematosus; treatment of nonsuppurative thyroiditis, hypercalcemia associated with cancer, acute exacerbations of multiple sclerosis, tuberculous meningitis when accompanied by antituberculous chemotherapy, trichinosis with neurologic or myocardial involvement, and treatment of glucocorticoid responsive rheumatic, collagenous, dermatologic, allergic, ophthalmic, respiratory, hematologic, neoplastic, and GI diseases.

Treatment of infantile spasms.

 

 Contraindications Scleroderma; osteoporosis; systemic fungal infections; ocular herpes simplex; recent surgery; history or presence of peptic ulcer; CHF; hypertension; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or adrenocortical hyperfunction. IV administration is contraindicated, except in treatment of idiopathic thrombocytopenic purpura or diagnostic testing of adrenocortical function.

 

 Route/Dosage

Repository Injection

IM/SC 40 to 80 U q 24 to 72 hr. Not suitable for IV use.

Acute Exacerbations of Multiple Sclerosis

IM 80 to 120 U/day for 2 to 3 wk.

 

 Interactions

Anticholinesterases: Effects of these agents may be antagonized in myasthenia gravis. Barbiturates: May decrease effects of corticotropin.

 

 Lab Test Interferences May decrease I¹³¹ uptake; possible suppression of skin test reactions; falsely decreased urinary estradiol and estriol concentrations with Brown method; falsely decreased urinary estrogen concentrations with colorimetry and fluorometry.

 

 Adverse Reactions

CARDIOVASCULAR: Hypertension; CHF; necrotizing angiitis. CNS: Convulsions; vertigo; headache; increased intracranial pressure with papilledema; pseudotumor cerebri. DERMATOLOGIC: Impaired wound healing; petechiae and ecchymoses; increased sweating; hyperpigmentation; thin, fragile skin; facial erythema; acne. EENT: Posterior subcapsular cataracts; increased IOP; glaucoma with possible optic nerve damage; exophthalmos. GI: Pancreatitis; ulcerative esophagitis; abdominal distention; peptic ulcer. METABOLIC: Negative nitrogen balance because of protein catabolism; fluid and electrolyte disturbances (eg, sodium and fluid retention, potassium and calcium loss, hypokalemic alkalosis); antibody production and loss of stimulatory effect of ACTH with prolonged use. OTHER: Infection; musculoskeletal disturbances (eg, weakness, myopathy, loss of muscle mass, osteoporosis, vertebral compression fractures, pathologic fracture of long bones, aseptic necrosis of femoral and humeral heads); endocrine abnormalities (eg, menstrual irregularities, growth suppression in children, hirsutism, cushingoid state, glucose intolerance, decreased carbohydrate tolerance, increased requirement for insulin or oral hypoglycemic agent in diabetic patients, secondary adrenocortical, pituitary unresponsiveness.

 

 Precautions

Pregnancy: Category C. Lactation: Undetermined. CHILDREN: Because prolonged use inhibits skeletal growth, careful monitoring is necessary. Fluid and electrolyte balance: Drug may elevate BP, cause salt and water retention, and increase potassium and calcium excretion. Immunosuppression: Live vaccine immunization is usually contraindicated, especially with high doses of corticotropin. Infection: Drug may mask signs of infection; resistance to infection may be decreased. Long-term administration: May lead to irreversible adverse effects. Complications are dependent on dose and duration of treatment. Prolonged use increases risk of hypersensitivity reactions and ocular effects. Sensitivity to porcine proteins: Perform skin testing in patients with suspected sensitivity to porcine proteins. Observe for sensitivity reactions during or after administration. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during, and after stressful situations.

PATIENT CARE CONSIDERATIONS

 

 Administration/Storage

• Medication may be given via IM or SC route. Do not use IV route.
• If patient is sensitive to porcine proteins, skin tests must be performed before administration.
• Standard tests for adrenal responsiveness to corticotropin are performed via same route that will be used for administration of drug.

Corticotropin repository injection

• Note that this form is for IM or SC use only, not for IV administration.
• Store repository corticotropin injection in refrigeration.

 

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Observe patient for possible hypersensitivity reaction. Have epinephrine 1:1000 available for emergency use.
• Take patient’s vital signs and monitor throughout therapy.
• Monitor I&O and weight.
• Monitor serum potassium and sodium levels.
• In patients with diabetes, monitor blood glucose frequently because dosage of insulin or oral hypoglycemic agent may need to be increased.
• Assess for recurrent symptoms that may result from sudden withdrawal of medication after prolonged use.
• If any of these signs occur, report them to health care provider: fluid retention; muscle weakness; abdominal pain; seizures; headache; adrenal insufficiency (eg, fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness, dizziness); visual disturbances; cushingoid symptoms.

 

 Patient/Family Education

• Counsel patient to follow dietary regimen carefully (eg, salt restriction, potassium supplementation).
• Advise patient to avoid receiving live virus vaccinations while taking this medication.
• Instruct patient to have periodic eye examinations while taking medication as long-term therapy.
• If patient has diabetes, instruct to monitor blood glucose regularly throughout therapy since dosage of insulin or oral hypoglycemic agent may need to be increased.
• Advise patient to contact health care provider before discontinuing medication.
• Instruct patient to notify health care provider at first sign of infection: prolonged cold symptoms, sore throat, weight gain, GI upset, heart irregularities, delayed wound healing or changes in mood behavior.
• Tell patient to report these symptoms to health care provider: fluid retention, muscle weakness, abdominal pain, seizures, headaches.
• Instruct patient not to take OTC medications without consulting health care provider.

Drug Mode of Action ::  

(core-tih-koe-TROE-pin)

ACTH

Powder for Injection: 40 units/vial

Acthar

Powder for Injection: 25 units/vial

Powder for Injection: 40 units/vial

Class: Adrenal cortical steroid

 

 Action Stimulates adrenal cortex to produce and secrete adrenocortical hormones (eg, corticosteroids, glucocorticoids).