Drug Study Drug

I. Generic Name Acetylcysteine

II. Brand Name
III. Drug Classification Respiratory
inhalant,
IV. Dosage/ Stock Dose Bronchodilators should be
given 10–15 min before acetylcysteine.
ADULTS, ELDERLY, CHILDREN:╇ 3–5 ml
(20%
solution) 3–4 times a day or 6–10 ml (10%
solution) 3–4 times a day. Range: 1–10 ml
(20% solution) q2–6h or 2–20 ml (10%
solution) q2–6h. INFANTS:╇ 1–2 ml (20%)
or 2–4 ml (10%) 3–4 times a day.
Intratracheal:╇ ADULTS, CHILDREN:╇ 1–2
ml of 10% or 20% solution instilled into
tracheostomy q1–4h.
V. Indication Adjunctive treatment for abnormally
viscid mucous secretions present
in acute and chronic bronchopulmonary
disease and pulmonary complications
of cystic fibrosis and surgery, diagnostic
bronchial studies.
VI. Drug Action/ Therapeutic Effort Mucolytic splits linkage of mucoproteins,
reducing viscosity of pulmonary secretions.
Therapeutic Effect:╇ Facilitates
removal of pulmonary secretions by
coughing, postural drainage, mechanical
means. Protects against acetaminophen
overdose-induced hepatotoxicity.
VII. Contraindications Cautions: Pts with bronchial asthma; debilitated
pts
with severe respiratory insufficiency (increases
risk of anaphylactoid reaction).
VIII. Drug Interactions none
IX. Side Effects Inhalation: Stickiness
on face, transient unpleasant odor.
Occasional:╇ Inhalation: Increased
bronchial secretions, throat irritation,
nausea, vomiting, rhinorrhea. Rare:╇ Inhalation:
Rash. PO: Facial edema, bronchospasm,
wheezing, nausea, vomiting.
X. Adverse Effects Large doses may produce severe nausea/
vomiting. (Less than 2%): Serious anaphylactoid
reactions including cough,
wheezing, stridor, respiratory distress,
bronchospasm, hypotension, and death
have been known to occur with IV administration.
XI. Nursing Responsibilities Assessment
 Assess pretreatment respirations
for rate, depth, rhythm. IV antidote:
Obtain baseline labs and drug
screen. For use as antidote, obtain acetaminophen
level to determine need for
treatment with acetylcysteine.

Intervention
If bronchospasm occurs, discontinue
treatment, notify physician; bronchodilator
may be added to therapy. Monitor
rate, depth, rhythm, type of respiration
(abdominal, thoracic). Observe sputum
for color, consistency, amount. IV antidote:
Administer within 8 hrs of acetaminophen
ingestion for maximal hepatic
protection; ideally, within 4 hrs
after immediate-A�release and 2 hrs after
liquid acetaminophen formulations.

Teaching point
 Slight, disagreeable sulfuric odor from
solution may be noticed during
 initial administration but disappears
quickly.
 Adequate hydration is important part of
therapy.
 Follow guidelines for proper coughing and
deep breathing techniques.

Drug Study Drug

I. Generic Name Carbocisteine
II. Brand Name
III. Drug Classification Respiratory
inhalant,
IV. Dosage/ Stock Dose PO Initial: 2.25 g/day in 3-4 divided doses, then
reduce dose to 1.5 g/day in divided doses as
condition improves.
V. Indication Acts as mucolytic
VI. Drug Action/ Therapeutic Effort Carbocisteine is a mucolytic agent that reduces
goblet cell hyperplasia in the management of
respiratory disorders associated with abnormally
excessive or viscous mucus secretion.
VII. Contraindications Active peptic ulceration
VIII. Drug Interactions
IX. Side Effects Immune system disorders (there are reported cases
of anaphylactic shock in patients who have been
 treated with this drug)

Gastrointestinal bleeding
X. Adverse Effects Gastrointestinal disorders: Nausea, diarrhoea,
abdominal pain, vomiting, gastrointestinal
bleeding.
Surgical and medical procedures: Skin rashes,
itching, bullous dermatitis (e.g. Stevens-Johnson
syndrome, erythema multiforme).
XI. Nursing Responsibilities Assessment
Assess pretreatment respirations
for rate, depth, rhythm. IV antidote:
Obtain baseline labs and drug
screen. For use as antidote, obtain acetaminophen
level to determine need for
treatment with acetylcysteine.

Intervention
If bronchospasm occurs, discontinue
treatment, notify physician; bronchodilator
may be added to therapy. Monitor
rate, depth, rhythm, type of respiration
(abdominal, thoracic). Observe sputum
for color, consistency, amount. IV antidote:
Administer within 8 hrs of acetaminophen
ingestion for maximal hepatic
protection; ideally, within 4 hrs
after immediate-A�release and 2 hrs after
liquid acetaminophen formulations.

Teaching point
 Slight, disagreeable sulfuric odor from
solution may be noticed during
 initial administration but disappears
quickly.
 Adequate hydration is important part of
therapy.
 Follow guidelines for proper coughing and
deep breathing techniques.

Drug Study Drug

I. Generic Name Ambroxol
II. Brand Name
III. Drug Classification mucolytic
IV. Dosage/ Stock Dose Ambroxol 15 mg/5 ml syrup, 30 mg/5 ml syrup, 60
mg effervescent tablets, 30 mg tablets and
Ambroxol 10 mg/dose spray.
V. Indication It is used to treat acute and chronic respiratory
 diseases accompanied by an increased mucus
production.
VI. Drug Action/ Therapeutic Effort This medicine works by helping to break down the
structure of mucus in the lungs and therefore
facilitates expectoration.
VII. Contraindications Hypersensitivity
VIII. Drug Interactions None
IX. Side Effects nausea,
vomiting,
diarrhea,
abdominal pain,
digestive disorders,
Stevens-Johnson syndrome (a life-threatening skin
disorder),
allergy and others.
X. Adverse Effects GI disturbances, allergic reaction
XI. Nursing Responsibilities Assessment
Assess pretreatment respirations
for rate, depth, rhythm. IV antidote:
Obtain baseline labs and drug
screen. For use as antidote, obtain acetaminophen
level to determine need for
treatment with acetylcysteine.

Intervention
If bronchospasm occurs, discontinue
treatment, notify physician; bronchodilator
may be added to therapy. Monitor
rate, depth, rhythm, type of respiration
(abdominal, thoracic). Observe sputum
for color, consistency, amount. IV antidote:
Administer within 8 hrs of acetaminophen
ingestion for maximal hepatic
protection; ideally, within 4 hrs
after immediate-A�release and 2 hrs after
liquid acetaminophen formulations.

Teaching point
 Slight, disagreeable sulfuric odor from
solution may be noticed during
 initial administration but disappears
quickly.
 Adequate hydration is important part of
therapy.
 Follow guidelines for proper coughing and
deep breathing techniques.

Drug Study Drug

I. Generic Name Guaifenesin
II. Brand Name
III. Drug Classification Respiratory
expectorant.
IV. Dosage/ Stock Dose Ambroxol 15 mg/5 ml syrup, 30 mg/5 ml syrup, 60
mg effervescent tablets, 30 mg tablets and
Ambroxol 10 mg/dose spray.
V. Indication Helps loosen phlegm and thin bronchial
secretions, making cough more
productive.
VI. Drug Action/ Therapeutic Effort Stimulates respiratory tract secretions
by decreasing adhesiveness, viscosity of
mucus. Therapeutic Effect:╇ Promotes
removal of viscous mucus.
VII. Contraindications Contraindications:╇ None known.╇
Cautions:╇
Avoid OTC use in children younger than
2 yrs.
VIII. Drug Interactions None
IX. Side Effects Dizziness, headache, rash, diarrhea,
nausea, vomiting, abdominal pain.
X. Adverse Effects Overdose may produce nausea, vomiting.
XI. Nursing Responsibilities Assessment
Assess type, severity, frequency of cough.
Increase fluid intake, environmental humidity
to lower viscosity of lung secretions.

Intervention
Initiate deep breathing, coughing exercises,
particularly in pts with pulmonary
impairment. Assess for clinical improvement;
record onset of relief of cough.

Health Teaching
 Avoid tasks that require alertness, motor
skills until response to drug is established.
 Do not take for chronic cough.
 Report persistent cough if
 fever, rash, headache, sore throat is present
with cough.
 Maintain adequate hydration.