Acetylcysteine

Question 1

What are indications for the use of acetylcysteine?

Answer 1

• Paracetamol poisoning
• Help prevent contrast nephropathy
• Reduce resp. secretion viscosity

Question 2

What is the mechanism of action of acetylcycsteine?

Answer 2

Works by replenishing the body’s supply of gluthianone. Also has anti-oxidant effects, which may contribute to its effects in preventing contrast nephropathy

Question 3

How is paracetamol metabolised?

Answer 3

Mainly by conjugation with glucuronic acid and sulfate. A small amount is converted to NAPQI, which is hepatotoxic. Normally this is quickly detoxified by conjugation with glutathione

Question 4

Why does liver damage occur with paracetamol toxicity?

Answer 4

The body’s supply of glutathione is overwhelmed and NAPQI is left free to cause liver damage

Question 5

What are adverse effects of acetylcysteine?

Answer 5

• Anaphylactoid reaction
• Bronchospasm - nebulised form

Question 6

How is acetylcysteine administered?

Answer 6

Weight-adjusted doses are given as an IV infusion with 3 components

Question 7

How is it decided when to treat someone with acetylcysteine?

Answer 7

Based on plasma paracetamol concentration and time (hours) since overdose

Question 8

What monitoring would you do for acetylcysteine administration?

Answer 8

• INR
• LFTs
• Creatinine