Clinical Medications WorksheetsGeneric Nameclopidogrel

Trade NamePlavix

Classificationantiplatelet agents

Dose75 mg tab

RoutePO

Time/frequencyQd

Peak3-7 days 

OnsetWithin 24 hr 

Duration5 days

Normal dosage range75mg once daily

Why is your patient getting this medicationReduction of atherosclerotic events (MI, stroke, vascular death)

For IV meds, compatibility with IV drips and/or solutionsN/A

Mechanism of action and indications(Why med ordered)Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. The active metabolite of clopidogrel prevents binding of adenosine diphosphate (ADP) to its platelet receptor, impairing the ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. It is proposed that the inhibition involves a defect in the mobilization from the storage sites of the platelet granules to the outer membrane. No direct interference occurs with the GPIIb/IIIa receptor. As the glycoprotein GPIIb/IIIa complex is the major receptor for fibrinogen, its impaired activation prevents fibrinogen binding to platelets and inhibits platelet aggregation. By blocking the amplification of platelet activation by released ADP, platelet aggregation induced by agonists other than ADP is also inhibited by the active metabolite of clopidogrel.

Nursing Implications (what to focus on) Contraindications/warnings/interactionsHypersensitivity, pathologic bleeding (peptic ulcer, intracranial hemorrhage), patients at risk for bleeding (trauma, surgery, or other pathologic conditions), history of GI bleeding/ulcer disease.Common side effectsNo common side effectsPotential life threatening side effects: GI BLEEDING, BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTPENIC PURPURA

Interactions with other patient drugs, OTC or herbal medicines (ask patient specifically)Lovenox: Drugs that can affect hemostasis such as dextran, platelet inhibitors, thrombin inhibitors, thrombolytic agents, or other anticoagulants may potentiate the risk of bleeding complications associated with the use of a low molecular weight heparin (LMWH), heparinoid, or fondaparinux. In patients receiving neuraxial anesthesia or spinal puncture, the risk of developing an epidural or spinal hematoma during LMWH, heparinoid, or fondaparinux therapy may also be increased by the concomitant use of other drugs that affect coagulation. The development of epidural and spinal hematoma can lead to long-term or permanent paralysis.ASA: Clopidogrel has been shown to potentiate the inhibition of platelet aggregation due to aspirin. Single-dose studies have not shown a prolongation of bleeding time when aspirin was added to clopidogrel; however, the risk of gastrointestinal (GI) bleeding may be increased.

Lab value alterations caused by medicineMonitor bleeding time during therapy. Prolonged bleeding time, which is time- and dose-dependent, is expectedMonitor CBC with differential and platelet count periodically during therapy. Neutropenia and thrombocytopenia may rarely occur. May cause ↑ serum bilirubin, hepatic enzymes, total cholesterol, nonprotein nitrogen (NPN), and uric acid concentrations.Be sure to teach the patient the following about this medicationAvoid taking OTC medications containing aspirin or NSAIDs without consulting health care professional.

Nursing Process- Assessment(Pre-administration assessment)History and physical, assess risk for blood clots.

AssessmentWhy would you hold or not give this med?Fever, chills, sore throat, or unusual bleeding or bruising occurs.

EvaluationCheck after givingSuccessful prevention of TIA, MI.