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Sunday, February 6, 2011

Clopidogrel

Posted by Sampil 10:04 PM, under | No comments

clopidogrel
(cloe pid' oh grel)
Plavix

Pregnancy Category B

Drug classes
Adenosine diphosphate (ADP) receptor antagonist
Antiplatelet

Therapeutic actions
Inhibits platelet aggregation by blocking ADP receptors on platelets, preventing clumping of platelets.

Indications
·        Treatment of patients at risk for ischemic events—history of MI, ischemic stroke, peripheral artery disease
·        Treatment of patients with acute coronary syndrome

Contraindications and cautions
·        Contraindicated with allergy to clopidogrel, active pathological bleeding such as peptic ulcer or intracranial hemorrhage, lactation.
·        Use cautiously with bleeding disorders, recent surgery, hepatic impairment, pregnancy.

Available forms
Tablets—75 mg

Dosages
ADULTS
Recent MI, stroke, or established peripheral arterial disease: 75 mg PO daily.
Acute coronary syndrome: 300 mg PO loading dose, then 75 mg/day PO with aspirin, given at a dose from 75–325 mg once daily.

Pharmacokinetics
Route
Onset
Peak
Duration
Oral
Varies
1 hr
2 hr

Metabolism: Hepatic; T1/2: 8 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Bile, feces, urine

Adverse effects
·        CNS: Headache, dizziness, weakness, syncope, flushing
·        CV: Hypertension, edema
·        Dermatologic: Rash, pruritus
·        GI: Nausea, GI distress, constipation, diarrhea, GI bleed
·        Other: Increased bleeding risk

Interactions
·        Increased risk of GI bleeding with NSAIDs, monitor patient carefully
·        Increased bleeding with warfarin; monitor carefully

Nursing considerations
Assessment
·        History: Allergy to clopidogrel, pregnancy, lactation, bleeding disorders, recent surgery, hepatic impairment, peptic ulcer
·        Physical: Skin color, T, lesions; orientation, reflexes, affect; P, BP, orthostatic BP, baseline ECG, peripheral perfusion; R, adventitious sounds

Interventions
·        Provide small, frequent meals if GI upset occurs (not as common as with aspirin).
·        Provide comfort measures and arrange for analgesics if headache occurs.

Teaching points
·        Take daily as prescribed. May be taken with meals.
·        You may experience these side effects: Dizziness, light-headedness (this may pass as you adjust to the drug); headache (lie down in a cool environment and rest; over-the-counter preparations may help); nausea, gastric distress (eat frequent small meals); prolonged bleeding (alert dentists and health care providers of this drug use).
·        Report skin rash, chest pain, fainting, severe headache, abnormal bleeding.

Adverse effects in Italic are most common; those in Bold are life-threatening.

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