Republic of the Philippines

Cebu Normal University

Osmeña Blvd. Cebu City, 6000 Philippines

College of Nursing
Center of Excellence (COE) | Level IV Re-
Accredited (AACCUP) Telephone No.: (032) 254
4837
Email:
cn@cnu.edu.ph/secretary@cnunursi
ng.org Website: www.cnu.edu.ph
DRUG STUDY

Patient’sInitials: Dateof Admission: Diagnosis:

Age: Height/Weight: ClinicalIntervention:
Sex: Ward: BedNo.: Name ofPhysician:

Nursing
Name of Drug Classification Mechanism of Action Indication Contraindication Side Effects
Responsibilities

Generic Name Therapeutic Class: Acetylcysteine protects Acetylcysteine is used Contraindicated in General Before:
Acetylcysteine mucolytic, antidote for against acetaminophen patients hypersensitive The most common 1.)Empty stomach
mainly as a mucolytic
Brand Names acetaminophen overdose-induced to drug. Use cautiously in adverse events were promptly by lavage or
and in the
Acetadote, CETYLEV, overdose hepatotoxicity by management of geriatric or debilitated anaphylactoid reaction, inducing emesis with
Mucomyst, Mucosil maintaining or restoring patients with severe nausea, vomiting, syrup of ipecac.
paracetamol
Acetylcysteine, NAC, N- Pharmacologic Class: hepatic concentrations respiratory insufficiency flushing, and skin rash. 2.)Activated charcoal
A-C Sustain amino acid (l-cysteine) of glutathione. It does
(acetaminophen) may be indicated for a
Hypersensitivity
derivative this by producing the
overdose. Interactions Anaphylactoid symptoms mixed drug overdose,
For ADULTS glutathione precursor L- Drug-drug. Activated include airway but if used, lavage before
Acetaminophen AU TGA pregnancy cysteine. In charcoal: Absorbs orally obstruction administering
Overdose category: B2 acetaminophen administered (bronchospasm),  acetylcysteine. Activated
Minimum Dose: overdose cases, acetylcysteine, angioedema, dyspnea, h charcoal adsorbs
Injectable: US FDA pregnancy excessive quantities of preventing its ypotension, shock,  acetylcysteine in vitro
The total dose is 300 category: B this metabolite are absorption. Remove tachycardia,  urticaria, and may reduce its
mg/kg, given as 3 formed because the charcoal before and injection site effectiveness.
separate doses, primary metabolic acetylcysteine reaction (including rash) 3.)Draw blood for
administered over a total (glucuronide and sulfate administration. Gastrointestinal predetoxification
of 21 hrs. conjugation) pathways Amphotericin B, Nausea, Vomiting acetaminophen plasma
Dose preparation is become saturated. ampicillin, Respiratory assay and baseline SGOT,
weight based Acetylcysteine may act chlortetracycline, Respiratory symptoms,  SGPT, bilirubin,
Diagnostic by reducing the chymotrypsin, pharyngitis, rhinorrhea, prothrombin time,
Bronchograms: metabolite to the parent erythromycin rhonchi, throat tightness creatinine, BUN, blood
Nebulized into a face compound and/or by lactobionate, hydrogen Cardiovascular sugar and electrolytes.
mask, mouth piece, or providing sulfhydryl for peroxide, iodized oil, Tachycardia 4.)Determine serum
tracheostomy: conjugation of the oxytetracycline, Dermatologic acetaminophen level at
least 4 hours after
Recommended dosage: 3 metabolite. The tetracycline, Urticaria/facial flushing, ingestion of suspected
to 5 mL of 20% solution, mechanisms of action for trypsin: Incompatible rash NOS, pruritus, overdose to determine
or 6 to 10 mL of 10% acetylcysteine’s well- with these flushing the need for treatment
solution, 3 to 4 times a known mucolytic effects drugs. Administer drugs Metabolic with acetylcysteine.
5.)Dilute in diet cola or
day are different. In separately. Edema other diet soft drink; if
Minimum Dose: 1 to 10 particular, when inhaled, giving via g-tube or
mL of 20% solution, acetylcysteine (and its Miller-Abbott tube, may
every 2 to 6 hours metabolic byproduct dilute with water.
During:
Maximum Dose: 2 to 20 cysteine) exerts its 1.)Administer the loading
mL of 10% solution, mucolytic action through dose of acetylcysteine.
every 2 to 6 hours its free sulfhydryl group, 2.)Administer within 8
Mucolytic which reduces the hours from
Nebulized into a face disulfide bonds in the acetaminophen ingestion
mask, mouth piece, or mucus matrix and lowers for maximal protection
tracheostomy: mucus viscosity. This against hepatic injury for
Recommended dosage: 3 action increases with patients whose serum
to 5 mL of 20% solution, increasing pH and is acetaminophen levels
or 6 to 10 mL of 10% most significant at pH 7 fall above the "possible"
solution, 3 to 4 times a to 9. The mucolytic toxicity line on the
day action of acetylcysteine Rumack-Matthew
Minimum Dose: 1 to 10 is not affected by the nomogram (line
mL of 20% solution, presence of DNA. connecting 150 mcg/mL
every 2 to 6 hours Acetylcysteine is also an at 4 hours with 37.5
Maximum Dose: 2 to 20 antioxidant and reduces mcg/mL at 12 hours); the
mL of 10% solution, oxidative stress. manufacturer product
every 2 to 6 hours Acetylcysteine serves as information should be
a prodrug to L-cysteine consulted.
For PEDIA which is a precursor to 3.)Administer
Acetaminophen the biologic antioxidant, immediately if time of
Overdose glutathione and hence ingestion is unknown, or
Injectable: administration of serum acetaminophen
The total dose is 300 acetylcysteine level is not
mg/kg, given as 3 replenishes glutathione
separate doses, stores. L-cysteine also available/cannot be
administered over a total serves as a precursor to interpreted/is not
of 21 hrs. cystine which in turn available within 8 hours
Dose preparation is serves as a substrate for of ingestion.
weight based the cystine-glutamate 4.)Administer
Diagnostic antiporter on astrocytes immediately if 24 hours
Bronchograms hence increasing or less have elapsed
Nebulized into a face glutamate release into from the reported time
mask, mouth piece, or the extracellular space. of overdose, regardless
tracheostomy: Acetylcysteine also of the ingested quantity
Recommended dosage: 3 possesses some anti- reported.
to 5 mL of 20% solution, inflammatory effects After:
or 6 to 10 mL of 10% possibly via inhibiting 1.)Clean nebulizing
solution, 3 to 4 times a NF-κB through redox equipment immediately
day activation of the nuclear after use; residues may
Minimum Dose: 1 to 10 factor kappa kinases clog smaller orifices or
mL of 20% solution, thereby modulating corrode metal parts.
every 2 to 6 hours cytokine synthesis. 2.)Monitoring
Maximum Dose: 2 to 20 (acetaminophen
mL of 10% solution, Absorption: overdose):
every 2 to 6 hours Bioavailability is 6–10% -Determine aspartate
Mucolytic following oral aminotransferase (AST,
Nebulized into a face administration and less SGOT), alanine
mask, mouth piece, or than 3% following topical aminotransferase (ALT,
tracheostomy: administration. SGPT), bilirubin,
Recommended dosage: 3 Volume of prothrombin time,
to 5 mL of 20% solution, Distribution: creatinine, blood urea
or 6 to 10 mL of 10% Not Available nitrogen (BUN), blood
solution, 3 to 4 times a Protein Binding: 83% glucose, and electrolytes
day Metabolism: to monitor hepatic and
Minimum Dose: 1 to 10 Hepatic. Deacetylated by renal function, and
mL of 20% solution, the liver to cysteine and electrolyte and fluid
every 2 to 6 hours subsequently balance.
Maximum Dose: 2 to 20 metabolized. -Repeat SGOT, SGPT,
mL of 10% solution, Excretion: Not bilirubin, prothrombin
every 2 to 6 hours Available time, creatinine, BUN,
Half life: 5.6 hours blood sugar and
Forms: (adults), 11 hours electrolytes daily if the
Oral capsule, Oral (neonates) acetaminophen plasma
powder, Oral solution Onset: rapidly absorbed level is in the potentially
Intravenous solution, with peak plasma toxic range.
Bibliography:
DrugBank. (2020, March 20). Acetylcysteine. Retrieved March 21, 2020 from www.drugbank.ca
Kizior, R. & Hodgson, K. (2018). Saunders Nursing Drug Handbook 2019. St. Louis, Missouri: Elsevier.
Multum, C. (2020, Jan 3). Acetylcysteine. Retrieved March 21, 2020 from www.drugs.com
Drug Study Scoring 10 pts.
Name of Drug 1 pts.
Classification 1 pts.
Mechanism of Action 1 pts.
Indication 1 pts.
Contraindication 1 pts.
Side Effects 1 pts.
Nursing Responsibilities 3 pts.
Sources 1 pts. (at least 2 references)
Scoring System Criterion Reference: 70%