Bronchiectasis treatment

bronchiectasis treatment

N -acetylcysteine

a mucolytic agent used to reduce the viscosity of secretions of the respiratory tract. The principal method of administration is by aerosol, which in animals requires the use of a face mask or aerosol chamber. Also used parenterally in the treatment of acetaminophen poisoning in cats where it aids in detoxification of the drug and enhances its elimination, and topically in the treatment of collagenase-associated corneal ulcers.

acetylcysteine (N-acetylcysteine)

Acetadote, Mucomyst (CA), Mucosil-10, Mucosil-20, Parovelex (CA) (UK)

Pharmacologic class: N -acetyl derivative of naturally occurring amino acid (L-cysteine)

Therapeutic class: Mucolytic, acetaminophen antidote

Pregnancy risk category B

Action

Availability

Injection: 200 mg/ml

Solution: 10%, 20%

Indications and dosages

➣ Mucolytic agent in adjunctive treatment of acute and chronic bronchopulmonary disease (bronchitis, bronchiectasis, chronic asthmatic bronchitis, emphysema, pneumonia, primary amyloidism of lungs, tuberculosis, tracheobronchitis), pulmonary complications of cystic fibrosis, atelectasis, or pulmonary complications related to surgery, posttraumatic chest conditions, tracheostomy care, or use during anesthesia

Adults and children: Nebulization (face mask, mouthpiece, tracheostomy )-6 to 10 ml of 10% solution or 3 to 5 ml of 20% solution three or four times daily. Dosage range is 2 to 20 ml of 10% solution or 1 to 10 ml of 20% solution q 2 to 6 hours.

Nebulization (tent or croupette )-Volume of 10% or 20% solution that will maintain heavy mist for desired period Instillation (direct )-1 to 2 ml of 10% to 20% solution q 1 hour p.r.n.

Instillation via syringe attached to percutaneous intratracheal catheter -2 to 4 ml of 10% solution or 1 to 2 ml of 20% solution q 1 to 4 hours

➣ Diagnostic bronchial studies

Adults and children: Two to three doses of 2 to 4 ml of 10% solution or 1 to 2 ml of 20% solution by nebulization or intratracheal instillation before procedure

➣ Acetaminophen overdose

Adults, elderly patients, children: Give immediately if 24 hours or less have elapsed since acetaminophen ingestion. Use the following protocol: empty stomach by lavage or emesis induction, and then have patient drink copious amounts of water. If activated charcoal has been given, perform lavage before giving acetylcysteine. Draw blood for acetaminophen plasma assay and baseline aspartate aminotransferase (AST), alanine aminotransferase (ALT), prothrombin time, bilirubin, blood glucose, blood urea nitrogen, electrolyte, and creatinine clearance levels. If ingested acetaminophen dose is in toxic range, give acetylcysteine 140 mg/kg P.O. as loading dose from 20% solution. Administer 17 maintenance doses of 70 mg/kg P.O. q 4 hours, starting 4 hours after loading dose. Repeat procedure until acetaminophen blood level is safe. If patient vomits loading dose or any maintenance dose within 1 hour of administration, repeat that dose.

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