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(CORE-tih-sone)
Cortone Acetate
Class: Corticosteroid

 Action As short-acting glucocorticoid; depresses formation, release and activity of endogenous mediators of inflammation; has some salt-retaining properties.

 Indications Treatment of primary or secondary adrenal cortex insufficiency; rheumatic disorders; collagen diseases; dermatologic diseases; allergic states; allergic and inflammatory ophthalmic processes; respiratory diseases; hematologic disorders; neoplastic diseases; edematous states (caused by nephrotic syndrome); GI diseases; multiple sclerosis; tuberculous meningitis; trichinosis with neurologic or myocardial involvement.

 Contraindications Systemic fungal infections; administration of live virus vaccines in patients receiving immunosuppressive doses.

 Route/Dosage

ADULTS: PO 25–300 mg/day. Use lowest possible effective dose. ALTERNATE-DAY THERAPY: Provides at least twice usual daily dosage of short- to intermediate-acting medication. ADULTS: IM 20–300 mg/day. In less severe cases < 20 mg/day may be sufficient, in severe cases > 300 mg/day may be required.

 Interactions

Anticholinesterases: Drug may antagonize anticholinesterase effects in myasthenia gravis. Anticoagulants, oral: Drug may increase or decrease anticoagulant dose requirements. Barbiturates: May decrease pharmacologic effect of cortisone. Phenytoin: May decrease therapeutic efficacy of cortisone. Rifampin: May decrease therapeutic efficacy of cortisone. Salicylates: Drug may reduce serum levels and efficacy of salicylates. Troleandomycin: May increase effects of cortisone.

 Lab Test Interferences False-negative nitroblue tetrazolium test.

 Adverse Reactions

CV: Thromboembolism or fat embolism; thrombophlebitis; necrotizing angiitis; cardiac arrhythmias or ECG changes; syncopal episodes; hypertension; myocardial rupture after recent MI; CHF. CNS: Convulsions; increased intracranial pressure with papilledema; vertigo; headache; neuritis/paresthesias; psychosis; fatigue; insomnia. DERM: Impaired wound healing; petechiae and ecchymoses; erythema; lupus erythematosus–like lesions; suppression of skin test reactions; subcutaneous fat atrophy; purpura; hirsutism; acneiform eruptions; allergic dermatitis; urticaria; angioneurotic edema; perineal irritation; hyperpigmentation or hypopigmentation. EENT: Cataracts; increased IOP; glaucoma; exophthalmos. GI: Pancreatitis; abdominal distention; ulcerative esophagitis; nausea; vomiting; increased appetite and weight gain; peptic ulcer; small bowel and large bowel perforation, especially in inflammatory bowel disease. GU: Increased or decreased motility and number of spermatozoa. HEMA: Leukocytosis. META: Sodium and fluid retention; hypokalemia; hypokalemic alkalosis; metabolic alkalosis; increased serum cholesterol; hypocalcemia; hypothalamicpituitary-axis suppression; endocrine abnormalities (decreased T3, T4 and 131I uptake, menstrual irregularities, cushingoid state, growth suppression in children, increased sweating, decreased carbohydrate tolerance, hyperglycemia, glycosuria, increased insulin or sulfonylurea requirements, manifestations of latent diabetes mellitus, negative nitrogen balance because of protein catabolism, hirsutism). OTHER: Musculoskeletal effects (eg, muscle weakness, myopathy, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures; anaphylactoid reactions; aggravation or masking of infections; malaise.

 Precautions

Pregnancy: Pregnancy category undetermined. Lactation: Excreted in breast milk. Children: Observe growth and development of infants and children undergoing prolonged therapy. Elderly patients: May require lower doses. Adrenal suppression: Prolonged therapy may lead to hypothalamic-pituitary-adrenal suppression. Withdraw gradually after prolonged therapy. Cardiovascular disease: Use with caution in patients with recent MI. Fluid and electrolyte balance: Drug can cause elevated BP, salt and water retention, increased potassium and calcium excretion. Dietary salt restriction and potassium supplementation may be necessary. Hepatitis: Drug may be harmful in chronic active hepatitis that is positive for hepatitis B surface antigen. Hypersensitivity: Anaphylactoid reactions have occurred rarely. Infections: Drug may mask signs of infection and decrease host-defense mechanisms that prevent dissemination of infection. Ocular effects: Use cautiously in ocular herpes simplex because of possible corneal perforation. Peptic ulcer: Drug may contribute to peptic ulceration, especially in large doses. Renal impairment: Use cautiously. Stress: Increased dosage of rapid-acting corticosteroid may be needed before, during and after stressful situations.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

Oral only

  • Administer with meals or snacks to avoid GI irritation.
  • Give single daily dose or alternate-day dose before 9 AM to obtain maximum benefit.
  • Space multiple doses evenly throughout day.
  • When giving large doses of cortisone, administer antacids between meals.

Oral and Injection

  • Store at room temperature in tightly closed container. Protect from heat and freezing.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies.
  • Note any sensitivity to sulfites, tartrazine and aspirin.
  • Be prepared for emergency treatment of hypersensitivity reaction.
  • Obtain baseline weight, vital signs, chemistry profile, 2 hr postprandial blood glucose and chest x-ray.
  • Monitor I&O and weight daily. Observe for edema, and report steady weight gain to physician.
  • Monitor renal function throughout therapy.
  • Monitor for development of steroid psychosis, manifested by changes in mood behavior.
  • If patient has diabetes, monitor blood glucose frequently.
  • Monitor drug withdrawal carefully. Drug must be discontinued gradually to avoid adrenal insufficiency.
  • Observe for signs of infection: depression, malaise, anorexia and delayed healing.
  • Observe growth and development of infants and children undergoing prolonged therapy.
  • Report signs of adrenal insufficiency to physician: fatigue, anorexia, nausea, vomiting, diarrhea, weight loss, weakness and dizziness.
  • Report signs of cushingoid symptoms to physician.
  • Monitored patient closely for signs that might require dosage adjustments including changes as a result of remissions or exacerbations of the disease, individual drug responsiveness and the effect of stress.

Injection only

  • After a favorable initial response, the proper maintenance dosage should be determined by decreasing the initial dosage in small amounts to the lowest dosage that maintains adequate clinical response.

OVERDOSAGE: SIGNS & SYMPTOMS
  Acute adrenal insufficiency caused by too rapid withdrawal: fever, myalgia, arthralgia, malaise, anorexia, nausea, desquamation of skin, orthostatic hypotension, dizziness, fainting, dyspnea, hypoglycemia. Cushingoid changes from chronic use of too large dose: Moonface, central obesity, striae, hirsutism, acne, eccymoses, fluid and electrolyte imbalance, hypertension, osteoporosis, myopathy, sexual dysfunction, diabetes, hyperlipidemia, peptic ulcer

 Patient/Family Education

  • Instruct patient to take with meals to avoid GI upset.
  • Tell patient to take single daily dose before 9 AM.
  • Instruct patient to monitor weight daily and to report steady gain to physician.
  • Inform patients with diabetes to monitor blood glucose regularly.
  • Instruct elderly patients undergoing long-term therapy to have BP, blood glucose and electrolytes checked every 6 mo.
  • Advise patient to avoid receiving live virus vaccine during therapy.
  • Instruct patients undergoing longterm therapy to have an annual eye examination and to carry ID card.
  • For discontinuation after long-term therapy, instruct patient to adhere to tapering schedule.
  • Advise patient to notify physician before discontinuing medication.
  • Instruct patient to report these symptoms to physician: cold, infection or prolonged sore throat; change in vision; swelling of extremities; weakness; black tarry stools; irregular heartbeat; menstrual irregularities; changes in mood or behavior; fatigue; anorexia; nausea; vomiting; diarrhea; weight loss.

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