GENERIC NAME: Acetylcysteine DRUG CLASS: Mucolytic PHARMACODYNAMICS: Mucolytic that reduces the viscosity of pulmonary secretions by splitting

disulfide linkages between mucoprotein molecular complexes. Also, restores liver stores of glutathione to treat acetaminophen toxicity. DOSAGE: Adults and children: 1 to 2 ml 10% or 20% solution by direct instillation into trachea as often as q hour. Or, 1 to 10 ml of 20% solution or 2 to 20 ml of 10% solution by nebulization q 2 to 6hours, prn Adults and children: Initially, 140 mg/kg P.O. then 70 mg/kg P.O. q 4 hours for 17 doses. Or, a loading dose of 150mg/kg IV over 15 minutes; then IV maintenance dose of 50 mg/kg infused over 4 hours, followed by 100 mg/kg infused over 16 hours. CONTRAINDICATIONS: Contraindicated in patients hypersensitive to drug. Use cautiously in elderly or debilitated patients with severe respiratory insufficiency. Use I.V. formulation cautiously in patients with asthma or a history of bronchospasm. ADVERSE EFFECTS: CNS: fever, drowsiness, abnormal thinking, gait disturbances CV: tachycardia, hypotension, hypertension, flushing, chest tightness EENT: rhinorrhea, ear pain, eye pain, pharyngitis, throat tightness GI: stomatitis, nausea, vomiting Respiratory: rhonchi, bronchospasm, cough, dyspnea Skin: rash, clamminess, diaphoresis, pruritus, urticaria Other: angioedema, chills, anaphylactoid reaction NURSING RESPONSIBILITIES: 1.Observe 10 rights in drug administration. 2.Use plastic, glass, stainless steel, or another nonreactive metal when giving by nebulization. Hand-bulb nebulizers arent recommended because output is too small and particle size too large. 3.Drug is physically or chemically incompatible with tetracyclines, erythromycin lactobionate, amphotericin B, and ampicillin sodium. If given by aerosol inhalation, nebulize these drugs