Acetylcysteine: Mucolytic Medication

• Mucolytics are inhalant medications used to decrease the viscosity of mucous secretions.
• Acetylcysteine (Acetadote) is a mucolytic that also reverses acetaminophen (Tylenol) overdose; it can be administered orally or intravenously.

Prototype Medication

• Acetylcysteine is the prototype mucolytic medication.

Pharmacologic Action

• Mucolytics break the disulfide linkages of proteins in mucus, decreasing its viscosity.
• This action allows clients to expectorate mucus more easily.

Adverse Drug Reactions

• Bronchospasm may occur in some clients.
• Gastrointestinal distress is a common side effect.
• The rotten-egg smell of the medication can cause nausea, especially with copious secretions.

Interventions

• Monitor respiratory status, including auscultation of the lungs.
• A bronchodilator may be needed to enhance the mucolytic's effectiveness.
• Provide tissues and a disposable bag for clients with copious secretions, encouraging expectoration over swallowing.
• Have suction equipment readily available for clients who have trouble managing increased secretions, and assist with suctioning as needed.

Administration

• Mucolytics are typically given by inhalation through a nebulizer or direct instillation through a tracheotomy tube for clients with bronchopulmonary disease.
• Ensure equipment used does not contain metal or rubber parts, which can be damaged by acetylcysteine.
• Clear the client’s airway before aerosol administration.
• Check the client’s ability to cough before administration.
• Clean equipment thoroughly after treatment.
• Warn clients about the sulfur-like or rotten-egg odor of acetylcysteine.
• Administer an antiemetic if nausea is a problem.

Client Instructions

• Report any difficulty breathing or worsening cough.
• Expectoration of secretions should be encouraged instead of swallowing.
• Take antiemetics as prescribed for nausea.
• Practice proper cleaning of nebulizer equipment to prevent pulmonary infections and equipment damage.

Contraindications and Precautions

• Do not use oral mucolytics in clients at risk of or with actual gastric bleeding.
• Use with caution in clients with asthma, history of bronchospasm, or severe respiratory insufficiency.
• Have cardiopulmonary support equipment available for intravenous administration, in case of anaphylactic reaction.

Interactions

• There are no known medication or food interactions with mucolytics.
• Acetylcysteine may decrease the effectiveness of activated charcoal as an antidote.

Acetylcysteine is a mucolytic medication used to decrease mucus viscosity. It breaks down disulfide linkages in mucus proteins, making it easier to expectorate. Adverse effects include bronchospasm and GI distress.