CORTICOTROPIN REPOSITORY

CORTICOTROPIN REPOSITORY
(kor-ti-koe-troe'pin)
H.P. Acthar Gel
Classifications: hormone; adrenal corticosteroid;
Therapeutic: hormone
; adrenal corticosteroid
Prototype: Prednisone
Pregnancy Category: C

Availability

40 units/mL, 80 units/mL

Action

Adrenocorticotropic hormone (ACTH) extracted from pituitary of domestic animals (usually pigs). Stimulates functioning adrenal cortex to produce and secrete corticosterone, cortisol (hydrocortisone), several weak androgens, and limited amounts of aldosterone.

Therapeutic Effect

Therapeutic effects appear more rapidly than do those of prednisone. Suppresses further release of corticotropin by negative feedback mechanism. Chronic administration of exogenous corticosteroids decreases ACTH store and causes structural changes in pituitary.

Uses

Diagnostic test of adrenocortical function and adjunctively to treat adrenal insufficiency secondary to inadequate corticotropin secretion. Effective in treatment of adrenocorticoid-responsive diseases, such as multiple sclerosis, but adrenocorticoid therapy is preferred.

Contraindications

Ocular herpes simplex; recent surgery; CHF; scleroderma; osteoporosis; systemic fungoid infections; hypertension; adrenal insufficiency; heart failure; herpes infection, active infection; scleroderma; sensitivity to porcine proteins; conditions accompanied by primary adrenocortical insufficiency or hyperfunction; long-term use in children, pregnancy (category C), lactation.

Cautious Use

Patients with latent tuberculosis or those reacting to tuberculin; hypothyroiditis, diabetes mellitus; seizure disorders; renal disease; psychosis, emotional instability; thromboembolic disease; GI disease; impaired hepatic function.

Route & Dosage

Therapeutic
Adult: IM/SC 40–80 U q24–72h
Child: IM/IV/SC 0.8 U/kg/d divided q12h

Acute Multiple Sclerosis
Adult: IM/SC 80–120 U/d for 2–3 wk

Administration

Subcutaneous/Intramuscular
  • Dosage is individualized. Changes in dosage regimen are gradual and only after full drug effects have become apparent.
  • Corticotropin repository is only for SC and IM use. Do not use IV.
  • Shake corticotropin zinc hydroxide bottle well before injecting drug deep into gluteal muscle.
  • Give deep IM into a large muscle.
Intravenous
  • IV administration to infants and children: Verify correct IV concentration and rate of infusion with physician.

PREPARE: Continuous: Use only the vial labeled for IV use. Dilute powder with 2 mL sterile water or NS for injection; desired dose is withdrawn from vial and further diluted with 500 mL of D5W.  

ADMINISTER: Continuous: Give over 8 h.  

INCOMPATIBILITIES Solution/additive: Aminophylline, sodium bicarbonate.

  • Administration of the hormone at high dosage levels is tapered rather than withdrawn suddenly. A 2–5 d period of adrenocortical hypofunction follows discontinuation of corticotropin.
  • Storage: Corticotropin for injection (reconstituted solution) is stable for 24 h or 7 d, depending on product, when stored at 2°–8° C (36°–46° F). Store corticotropin repository at 2°–15° C (36°–59° F). Store corticotropin zinc hydroxide at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

Body as a Whole: Loss of muscle mass, hypersensitivity, activation of latent tuberculosis, vertebral compression fracture. GI: Nausea, vomiting, abdominal distention, peptic ulcer with perforation and hemorrhage. Endocrine: Hirsutism, amenorrhea, osteoporosis, cushingoid state, activation of latent diabetes mellitus. Metabolic: Sodium and water retention; potassium and calcium loss, negative nitrogen balance, hyperglycemia. CNS: Euphoria, insomnia, headache, convulsions, papilledema, mood swings, depression. Skin: Acne, impaired wound healing, fragile skin, petechiae, ecchymosis. Special Senses: Cataract, glaucoma.

Interactions

Drug: Aspirin, nsaids increase potential for hypoprothrombinemia; barbiturates, phenytoin, rifampin decrease effects of corticotropin; estrogens may increase corticotropin binding and effects; amphotericin B, thiazide and loop diuretics increase potassium loss.

Pharmacokinetics

Onset: 6 h. Duration: 12–24 h repository. Distribution: Concentrated in many tissues; not known if crosses placenta or distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: <20 min.

Nursing Implications

Assessment & Drug Effects

  • Before giving corticotropin to patient with suspected sensitivity to porcine proteins, hypersensitivity skin testing should be performed.
  • Observe patient closely for 15 min for hypersensitivity reactions during IV administration or immediately after SC or IM injections (urticaria, pruritus, dizziness, nausea, vomiting, anaphylactic shock). Epinephrine 1:1000 should be readily available for emergency treatment.
  • Prolonged use of corticotropin increases risk of hypersensitivity reaction (see Appendix F).
  • Adrenal response to corticotropin is measured against a baseline plasma cortisol level 1 h before the 8 h test. Another plasma level is determined after at least 1 h of the infusion.
  • Corticotropin may suppress S&S of chronic disease.
  • New infections can appear during treatment. Because of decreased resistance and inability to localize the infection, it may be severe. Report immediately.
  • Monitor carefully growth and development of a child receiving this drug.

Patient & Family Education

  • Corticotropin administration increases requirements for insulin and oral antidiabetic agents. If you have diabetes mellitus, monitor blood glucose closely until response to the drug is stabilized.
  • Monitor weight and report a steady gain, especially if accompanied by edema. Also promptly report headache, muscle weakness, abdominal pain.
  • Do not self-medicate with OTC drugs without consulting physician.
  • Eye examinations should be done before initiation of expected long-term therapy and periodically during treatment. Report to physician if blurred vision occurs.
  • Dietary salt restriction and potassium supplementation may be necessary to minimize edema caused by overstimulation of the adrenal cortex by corticotropin.
  • Do not receive live vaccine immunizations while receiving corticotropin.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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