So - guy comes in with an rx for Mucomyst 20%. Pt to take 600mg orally at 8PM tonight & another 600mg orally at 10PM. Dilute as directed. (written by a cardiologist).
Pt can speak rudimentary english (russian or a dialect primary).
He is due for a procedure tomoroow AM @ 6 (also got an rx for ntg 0.4mg). What is the procedure?
What would the mucomyst do for the procedure?
Would you know how to fill this rx & properly label & counsel the guy?
Just some food for ambulatory folks out there....
Elective cardiac catheterization
Acetylcysteine is used to protect the kidneys from radiocontrast induced nephropathy. It is proposed to be an antioxidant and thus a free radical scavenger. That is an interesting dosing regimen though, as it is not even close to how any of the influential clinical trials that showed a benefit did it (Tepel et. al. NEJM 2000;343:180-84, Marenzi et. al. NEJM 2006;354:2773-82). However, it probably does not matter how you dose it, as the evidence of efficacy is not great. Much more importantly, there should be some hydration strategy for the patient leading up to the procedure, as it is the only proven way to prevent CIN. I am partial to giving this medication orally as opposed to intravenously, as the renoprotective effect may be dependent upon the high first pass metabolism of acetylcysteine where it is converted to another antioxidant, glutathione. Most trials have been performed using the medication via the oral route. And cost, of course
I'm not sold on the strategy, but if someone is going to use it, they should at least follow the "evidence." I have been waiting for a study looking at whether acetylcysteine influences the secretion of creatinine rather than actually conferring some protective effect on the nephron.
Not sure on how you would fill this in the ambulatory setting, but it is 200 mg/mL, so two syringes containing 3 mL of acetylcysteine would be a start.
I would counsel like every other retail pharmacist does out there, send my technician over and have them passively ask the patient if they have any questions with a pen in their hand pointing to the line where he needed to sign......
i read the post again...russian. my bad.
