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INTRODUCTION

acetylcysteine (a-se-til-sis-teen)

Acetadote, imageMucomyst, Mucosil

Classification

Therapeutic: antidotes (for acetaminophen toxicity), mucolytics

Indications

PO: Antidote for the management of potentially hepatotoxic overdosage of acetaminophen (should be administered within 24 hr of ingestion). IV: Antidote for the management of potentially hepatotoxic overdosage of acetaminophen (should be administered within 8–10 hr of ingestion). Inhaln: Mucolytic in the management of conditions associated with thick viscid mucous secretions. Unlabeled Use: Prevention of radiocontrast-induced renal dysfunction (oral).

Action

PO: Decreases the buildup of a hepatotoxic metabolite in acetaminophen overdosage. IV: Decreases the buildup of a hepatotoxic metabolite in acetaminophen overdosage. Inhaln: Degrades mucus, allowing easier mobilization and expectoration. Therapeutic Effects: PO: Prevention or lessening of liver damage following acetaminophen overdose. Inhaln: Lowers the viscosity of mucus.

Adverse Reactions/Side Effects

CNS: drowsiness. CV: vasodilation. EENT: rhinorrhea. Resp: bronchospasm, bronchial/tracheal irritation, chest tightness, increased secretions. GI: nausea, vomiting, stomatitis. Derm: pruritus, rash, urticaria, clamminess. Misc: allergic reactions (primarily with IV), including anaphylaxis, ANGIOEDEMA, chills, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

  • Monitor signs of angioedema, including rashes, raised patches of red or white skin (welts), burning/itching skin, swelling in the face, and difficulty breathing. Notify physician of these signs immediately.

  • Monitor other signs of allergic reactions and anaphylaxis, especially after IV administration. Signs include pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) and skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

  • Monitor signs of bronchospasm and respiratory irritation, including wheezing, cough, dyspnea, increased secretions, and tightness in the chest and throat. Report excessive or prolonged respiratory problems to the physician.

  • When used as a mucolytic, assess the quantity and consistency of sputum to help document whether this drug is successful in reducing the viscosity of respiratory secretions.

Interventions

  • When implementing airway clearance techniques, attempt to intervene when the drug has produced maximum mucolytic effects. Peak responses typically occur 5–10 min after inhalation.

Patient/Client-Related Instruction

  • If treating acetaminophen overdose, make sure patient understands the purpose of drug therapy, and that the patient should consult the physician before resuming use of products containing acetaminophen.

  • When used as a mucolytic, counsel patient on proper inhalation techniques, and advise patient not to exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm or other respiratory symptoms are increased by drug inhalation.

  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged drowsiness, chills, fever, nasal inflammation, or GI problems (nausea, vomiting, irritation in/around the mouth).

Pharmacokinetics

Absorption: Absorbed from the GI tract following oral ...

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