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CORTISONE ACETATE

Medical Diagnosis and Drugs, Medications
CORTISONE ACETATE
(kor'ti-sone)
Cortistan, Cortone
Classifications: hormone; synthetic adrenal corticosteroid; glucocorticoid; antiinflammatory;
Therapeutic:antiinflammatory; corticosteroid replacement; immunosuppressant
Prototype: Prednisone
Pregnancy Category: D

Availability

5 mg, 10 mg, 25 mg tablets; 50 mg/mL injection

Action

Short-acting synthetic steroid with prominent glucocorticoid activity and minimal mineralocorticoid effects. Therapeutic activity of cortisone results from its conversion in body to cortisol, resulting in metabolic effects including promotion of protein, carbohydrate, and fat metabolism and interference with linear growth in children.

Therapeutic Effect

Has antiinflammatory and immunosuppressive actions. Glucocorticoids prevent or suppress inflammation caused by various events including radiant, mechanical, chemical, and infectious stimuli. Also suppress immune responses in diseases caused by undesirable immune reactions, such as in asthma, urticaria, or renal allograft.

Uses

Replacement therapy for primary or secondary adrenocortical insufficiency and inflammatory and allergic disorders.

Contraindications

Hypersensitivity to glucocorticoids; psychoses; viral, fungal, or bacterial diseases of skin; Cushing's syndrome, immunologic procedures; pregnancy (category D), lactation.

Cautious Use

Diabetes mellitus; hypertension, CHF; older adults; active or arrested tuberculosis; coagulopathy; hepatic disease; psychosis, emotional instability; renal disease, seizure disorders; active or latent peptic ulcer.

Route & Dosage

Replacement or Inflammatory Disorders
Adult: PO/IM 20–300 mg/d in 1 or more divided doses, try to reduce periodically by 10–25 mg/d to lowest effective dose
Child: PO 2.5–10 mg/kg/d divided q6–8h IM 1–5 mg/kg/d divided q12–24h

Administration

Oral
  • Administer cortisone (usually in a.m.) with food or fluid of patient's choice to reduce gastric irritation.
  • Sodium chloride and a mineralocorticoid are usually given with cortisone as part of replacement therapy.
Intramuscular
  • Parenteral cortisone is a suspension (25 mg/mL) and therefore should not be used IV. Shake bottle well before withdrawing dose.
  • Give deep IM into a large muscle.
  • Drug must be gradually tapered rather than withdrawn abruptly.
  • Store at 15°–30° C (59°–86° F) in tightly closed container unless otherwise directed by manufacturer. Protect from heat and freezing.

Adverse Effects (≥1%)

CV: CHF, hypertension, edema. GI: Nausea, peptic ulcer, pancreatitis. Endocrine: Hyperglycemia. Hematologic: Thrombocytopenia. Musculoskeletal: Compression fracture, osteoporosis, muscle weakness. CNS: Euphoria, insomnia, vertigo, nystagmus. Skin: Impaired wound healing, petechiae, ecchymosis, acne. Special Senses: Cataracts, glaucoma, blurred vision.

Interactions

Drug: barbiturates, phenytoin, rifampin decrease effects of cortisone.

Pharmacokinetics

Absorption: Readily absorbed from GI tract. Onset: Rapid PO; 24–48 h IM. Peak: 2 h PO; 24–48 h IM. Duration: 1.25–1.5 d. Distribution: Concentrated in many tissues; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine. Half-Life: 0.5 h; HPA suppression: 8–12 h.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of Cushing's syndrome (see Appendix F), especially in patients on long-term therapy.
  • Lab tests: Periodic blood glucose and CBC with platelet count.
  • Cortisone may mask some signs of infection, and new infections may appear.
  • Be alert to clinical indications of infection: malaise, anorexia, depression, and evidence of delayed healing. (Classic signs of inflammation are suppressed by cortisone.)
  • Report ecchymotic areas, unexplained bleeding, and easy bruising.

Patient & Family Education

  • Take drug exactly as prescribed. Do not alter dose intervals or stop therapy abruptly.
  • Monitor weight and report a steady gain especially if it is accompanied by signs of fluid retention (e.g., edema of ankles or hands).
  • Report changes in visual acuity, including blurring, promptly.
  • Inform physician or dentist that cortisone is being taken. Carry identification card or jewelry that states drug being taken and physician's name.

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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