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(koe-sin-TROE-pin)
Cortrosyn
Class: Adrenal cortical steroid

 Action Exhibits full corticosteroidogenic activity of natural ACTH, stimulating adrenal cortex to produce and secrete adrenocortical hormones.

 Indications Diagnostic testing of adrenal function.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS: IM/IV (direct injection) 0.25–0.75 mg. IV infusion 0.25 mg in D5W or 0.9% saline administered at 0.04 mg/hr over 6 hr. CHILDREN £ 2 YR: IM/IV 0.125 mg often will be sufficient.

 Interactions

Anticholinesterases: May antagonize anticholinesterase effects in myasthenia gravis. Barbiturates: May decrease pharmacologic effect of cosyntropin. Hydantoins: May increase clearance and decrease therapeutic efficacy of cosyntropin.

 Lab Test Interferences None well documented.

 Adverse Reactions

OTHER: Rare hypersensitivity.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Hypersensitivity: Exhibits slight immunologic activity but is less likely to cause reactions than natural ACTH.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Before administration, be prepared to treat possible acute hypersensitivity reaction.
  • Administer by IM route, direct IV injection or IV infusion.
  • Reconstitute 0.25 mg vial with 1 ml of 0.9% Sodium Chloride for Injection.
  • Administer reconstituted drug via IM route or by direct IV injection over 2 min or further dilute in D5W or normal saline and infuse over 4–8 hr.
  • Do not allow cosyntropin to mix with blood or plasma infusions.
  • Reconstituted preparations should not be retained.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note hypersensitivity to natural corticotropin.
  • Measure plasma cortisol concentrations prior to and 30–60 min after administration. Collect blood sample of 6–7 ml in heparinized tube.
  • Alternatively, measure urinary steroids before and after IV infusion.

 Patient/Family Education

  • Explain purpose of the test.
  • Emphasize importance of lab tests.
  • Instruct patients taking corticosteroids or aldosterone to omit doses on day of test.

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