Adrenocorticotropic hormone agents

See Table 15-6. Potassium-sparing diuretics are most useful in states of mineralocorticoid excess or hyperaldosteronism (also called aldosteronism), due either to primary hypersecretion (Conn s syndrome, ectopic adrenocorticotropic hormone production) or secondary hyperaldosteronism (evoked by heart failure, hepatic cirrhosis, nephrotic syndrome, or other conditions associated with diminished effective intravascular volume). Use of diuretics such as thiazides or loop agents can cause or exacerbate volume contraction and may cause secondary hyperaldosteronism. In the setting of enhanced mineralocorticoid secretion and excessive delivery of Na+ to distal nephron sites, renal K+ wasting occurs. Potassium-sparing diuretics of either type may be used in this setting to blunt the K+ secretory response. 

Colchicine (an alkaloid obtained from meadow saffron or autumn crocus) may be used both diagnostically to ascertain the presence of gout and prophylactically to prevent its further occurrence. Usually, 0.5-mg oral doses of colchicine are given hourly until either the therapeutic effects appear or the side effects develop. In addition to colchicine, phenylbutazone, indomethacin, adrenocorticotropic hormone (ACTH), and steroidal anti-inflammatory agents may be used to treat the acute attack of gout. 

Corticosteroids and adrenocorticotropic hormone have been widely used for the treatment of ulcerative cohtis and Crohn s disease, given parenterally, orally, or rectally. Corticosteroids are believed to modulate the immune system and inhibit production of cytokines and mediators. It is not clear whether the most important steroid effects are systemic or local (mucosal). Budesonide is a corticosteroid that is administered orally in a controlled-release formulation. The drug undergoes extensive first-pass metabolism, so systemic exposure is thought to be minimized. Immunosuppressive agents such as azathioprine, mercaptopurine (a metabolite of azathioprine), methotrexate, or cyclosporine are sometimes used for the treatment of IBD. ... 

One of the best-known examples of this class is interferon (a glycoprotein), which has shown much promise as an antiviral agent and in the treatment of cancer (71). Numerous polymers (mostly polyelectrolytes) are effective in inducing the production of interferon in animals (72). Other well-known bioactive polypeptides are insulin, adrenocorticotropic hormone (ACTH), human growth hormone (HGH), prolactin, follicle stimulating hormone (FSH), and luteinizing hormone most of these have been synthesized, and some derivatives have been prepared (73). Some small bioactive polypeptides are the nonapeptides bradykinin, vasopressin, and oxytocin bioactive derivatives have been made for many of these also (74). 

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