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Action/Kinetics:
The hormone stimulates the functional adrenal cortex to secrete its entire spectrum of hormones, including the corticosteroids. Thus, the overall physiologic effects of corticotropin are similar to those of cortisone. Since the latter is more easily obtainable, is more predictable, and has more prolonged activity, it is usually used for therapeutic purposes. Is useful for the diagnosis of Addison's disease and other conditions in which the functionality of the adrenal cortex is to be determined.
Corticotropin cannot elicit a hormonal response from a nonfunctioning adrenal gland.
Peak plasma levels (corticotropin injection): 1 hr.
t
1/2: 15 min. The repository injection contains ACTH in a gelatin base to delay the rate of absorption and increase the duration.
Duration (repository form): Up to 3 days.
Uses:
Diagnosis of adrenal insufficiency syndromes, nonsuppurative thyroiditis, hypercalcemia associated with cancer, tuberculous meningitis with subarachnoid block or impending block (with tuberculostatic drugs).
Investigational: Infant spasm, multiple sclerosis. For same diseases as glucocorticosteroids.
Additional Contraindications:
Cushing's syndrome, psychotic or psychopathic clients, active tuberculosis, active peptic ulcers. Lactation.
Special Concerns:
Use with caution in clients who have diabetes and hypotension.
Additional Side Effects:
In the treatment of myasthenia gravis, corticotropin may cause severe muscle weakness 2-3 days after initiation of therapy. Equipment for respiratory assistance must be on hand for such emergencies. Muscle strength returns and increases 2-7 days after cessation of treatment, and improvement lasts for about 3 months.
Laboratory Test Alterations:
I
131 uptake and suppress skin test reactions. False
levels of estradiol and estriol using the Brown method. False - estrogens using colorimetric or fluorometric tests.
How Supplied:
Corticotropin injection:
Powder for injection: 25 U.
Corticotropin repository injection:
Injection: 80 U/mL.
Dosage
?Injection: SC, IM, or Slow IV Drip
Most uses.
Highly individualized. Usual, using aqueous solution IM or SC: 20 units q.i.d.
IV: 10-25 units of aqueous solution in 500 mL 5% dextrose injection over period of 8 hr. Infants and young children require larger dose per body weight than do older children or adults.
Acute exacerbation of multiple sclerosis.
IM: 80-120 units/day for 2-3 weeks.
Infantile spasms.
IM: 20-40 units/day or 80 units every other day for 3 months (or 1 month after cessations of seizures).
?Repository Gel: IM, SC
40-80 units q 24-72 hr. A dose of 12.5 units q.i.d. causes little metabolic disturbance; 25 units q.i.d. causes definite metabolic alterations.
As a general rule, clients are started on 10-12.5 units q.i.d. If no clinical effect is noted in 72-96 hr, dosage is increased by 5 units every few days to a final maximum of 25 units q.i.d.
