• Adult: PO/IV 250 mg q4hr or 250 mg bid for short-term therapy

• Adult: PO/IV 250 mg 1-4 times per day or 500 mg EXTENDED RELEASE bid, max 1 g/day

• Child (unlabeled): PO 8-30 mg/kg/day in divided doses tid or qid, or 300-900 mg/m²/day, max 1 g/day; IV 5-10 mg q6hr, max 1 g/day

• Adult: PO/IV 250-375 mg/day

• Child (unlabeled): PO/IV 5 mg/kg/day or 150 mg/m² in AM

• Adult: PO/IV 8-30 mg/kg/day in 1-4 divided doses, usual range 375-1000 mg/day; EXTENDED RELEASE not recommended with seizures

• Adult: PO 250 mg twice daily starting the day before ascent and continuing for 2 to 3 days after reaching the target altitude or until descent is initiated

• Adult: PO/IV CCr 50-80 mL/min give dose q6hr regular release or IV; CCr 10-50 mL/min give dose q12hr; CCr 10 mL/min, avoid use

acetylcholine ophthalmic

See Appendix B

acetylcysteine (Rx)

(a-se-teel-sis′tay-een)

Acetadote, Mucomyst

Func. class.: Mucolytic; antidote-acetaminophen

Chem. class.: Amino acid l-cysteine

ACTION: Decreases viscosity of secretions by breaking disulfide links of mucoproteins; serves as a substrate in place of glutathione, which is necessary to inactivate toxic metabolites with acetaminophen overdose

USES:Acetaminophen toxicity; bronchitis; cystic fibrosis; COPD; atelectasis

Unlabeled uses: Prevention of contrast medium nephrotoxicity

CONTRAINDICATIONS: Hypersensitivity

Precautions: Pregnancy, breastfeeding, hypothyroidism, Addison's disease, CNS depression, brain tumor, asthma, renal/hepatic disease, COPD, psychosis, alcoholism, seizure disorders, bronchospasms, anaphylactoid reactions, fluid restriction, weight <40 kg, increased intracranial pressure, status asthmaticus

• Adult and child: PO 140 mg/kg, then 70 mg/kg q4hr × 17 doses to total of 1330 mg/kg; ≥41-100 kg IV loading dose 150 mg/kg over 60 min (dilution 150 mg/kg in 200 mL of D₅W); then 50 mg/kg over 4 hr (dilution 50 mg/kg in 500 mL D₅W); then 100 mg/kg over 16 hr (dilution 100 mg/kg in 1000 D₅W)

• Adult/child 21-40 kg: IV 150 mg/kg in 100 mL diluent over 1 hr, then 50 mg/kg in 250 mL over 4 hr, then 100 mg/kg in 500 mg over 16 hr

• Infant/child 5-20 kg: IV 150 mg/kg in 3 mL/kg diluent over 1 hr, then 50 mg/kg in 7 mL/kg diluent over 4 hr, then 100 mg/kg in 14 mL/kg diluent over 16 hr

• Adult and child 1-12 yr: INSTILL 1-2 mL (10%-20% solution) q6-8hr prn or 3-5 mL (20% solution) or 6-10 mL (10% sol) tid or qid; NEBULIZER (face mask, mouthpiece, tracheostomy) 1-10 mL of a 20% sol, or 2-20 mL of a 10% sol, q2-8hr; NEBULIZER (tent, croupette) may require large dose, up to 300 mL/treatment

• Adult/child: INSTILL 1-2 mL (10%-20% sol) q1-4hr directly into tracheostomy

• Adult/child: NEBULIZER 2-3 uses of 1-2 mL of 20% sol or 2-4 mL of 10% sol

• Adult: PO 600 mg bid × 2 days before radiocontrast

Available forms: Oral solution 10%, 20%; inj 20% (200 mg/mL); effervescent tablet for oral solution 500, 2500 mg

Administer:

• Antidotal use: give within 8 hr for best results; dilute 10% or 20% solution to a 5% solution with diet soda, may use water if giving via gastric tube; dilution of 10% solution 1:1, 20% sol 1:3, store open undiluted solution refrigerated ≤96 hr, repeat dose if vomited within 1 hr

• Dissolve in 100 mL water (50 mg/mL) 1-19 kg; in 150 mL water 20-59 kg; 300 mg/mL ≥60 kg

• By syringe: 1-2 mL of 10%-20% solution up to q1hr

• Decreased dose to geriatric patients; metabolism may be slowed

• Only if suction machine is available

• Only after patient clears airway by deep breathing, coughing

• Assistance with inhaled dose: bronchodilator if bronchospasm occurs; mechanical suction if cough insufficient to remove excess bronchial secretions

IV route

• 21-hr regimen: loading dose: dilute 150 mg/kg in 200 mL D₅W; maintenance dose 1: dilute 50 mg/kg in 500 mL D₅W; maintenance dose 2: dilute 100 mg/kg in 1000 mL D₅W; give loading dose over 15 min; give maintenance dose 1 over 4 hr; give maintenance dose 2 over 16 hr, administer sequentially without time between doses

• Store in refrigerator; use within 96 hr of opening