Cortrosyn

cosyntropin

(koe-sin-troe-pin) cosyntropin,

Cortrosyn

(trade name)

Classification

Therapeutic: diagnostic agents
Pharmacologic: hormones
Pregnancy Category: C

Indications

Adrenocortical insufficiency.

Action

A synthetic form of corticotropin (ACTH); stimulates the adrenal gland to primarily produce corticosteroids (hydrocortisone) and a small amount of mineralocorticoids (aldosterone). Action requires intact adrenal responsiveness.

Therapeutic effects

Production of adrenal steroids after administration.

Pharmacokinetics

Absorption: Rapidly absorbed.Distribution: Removed from plasma to many tissues.Metabolism and Excretion: Unknown.Half-life: Unknown.

Time/action profile (effects on plasma cortisol levels)

ROUTEONSETPEAKDURATION
IM, IV5 min45–60 minunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity.Use Cautiously in: Obstetric / Lactation: Pregnancy or lactation (safety not established).

Adverse Reactions/Side Effects

Miscellaneous

  • hypersensitivity reactions including anaphylaxis (life-threatening)

Interactions

Drug-Drug interaction

Corticosteroids, estrogens, and spironolactone alter the results of testing.

Route/Dosage

Intramuscular Intravenous (Adults and Children >2 yr) 0.25 mg.Intramuscular Intravenous (Children <2 yr) 0.125 mg.

Availability (generic available)

Powder for injection: 0.25 mg/vial

Nursing implications

Nursing assessment

  • In patients with a history of allergic reactions, monitor for hypersensitivity response (wheezing, rash or hives, and erythema) Cosyntropin is less likely than ACTH to cause such a response.
  • Lab Test Considerations: Plasma cortisol concentrations will be measured before and 30 or 60 min after administration of cosyntropin. Therapeutic response is a rise in the plasma cortisol of at least 7 mcg/dL above baseline or a final concentration of at least 18 mcg/dL. In patients with septic shock, a therapeutic response is defined as a rise in the plasma cortisol of at least 9 mcg/dL. Administration of corticosteroids, estrogens, or spironolactone on day of test will interfere with test results by causing elevated baseline plasma cortisol concentrations.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Do not confuse Cortrosyn with colchicine.
  • May be administered IM, direct IV, and by IV infusion.
    • Reconstitute 250-mcg vial with 1 mL of 0.9% NaCl for IM injection.
    • Discard unused reconstituted cosyntropin.
  • Intravenous Administration
  • Reconstitute 250-mcg vial with 2–5 mL of 0.9% NaCl for direct IV injection.
  • Rate: Administer over 2 min
  • Intermittent Infusion: Diluent: May be further diluted in 50 mL of D5W or 0.9% NaCl. Stable for 12 hr at room temperature or 21 days if refrigerated.
  • Rate: Infuse at a rate of 40 mcg/hr over 6 hr.

Patient/Family Teaching

  • Explain purpose of cosyntropin and need for lab tests.

Evaluation/Desired Outcomes

  • Differentiation of primary from secondary adrenocortical insufficiency.

Cortrosyn

(kôr′trə-sĭn′) A trademark for the drug cosyntropin.