Mosby's 2014 Nursing Drug Reference (104 page)
Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
(klo-pid′oh-grel)
Plavix
Func. class.:
Platelet aggregation inhibitor
Chem. class.:
Thienopyridine derivative
Do not confuse:
Plavix
/Paxil/Elavil
Inhibits ADP-induced platelet aggregation
Reducing the risk of stroke, MI, vascular death, peripheral arterial disease in high-risk patients, acute coronary syndrome, transient ischemic attack (TIA), unstable angina
Unlabeled uses:
Cardiac surgery (infant and child), Kawasaki disease
Hypersensitivity, active bleeding
Precautions:
Pregnancy (B), breastfeeding, children, previous hepatic disease, increased bleeding risk, neutropenia, agranulocytosis, renal disease, Asian/Black/Caucasian patients
Black Box Warning:
CYP2C19 allele (poor metabolizers)
Calculator
• Adult:
PO
75 mg/day with/without aspirin
• Adult:
PO
loading dose 300 mg then 75 mg/day with aspirin
• Child ≤2 yr, infant, neonate:
PO
0.2 mg/kg/day for platelet inhibition
Available forms:
Tabs 75, 300 mg
•
Without regard to food
•
Should be discontinued 5 days before elective surgery if an antiplatelet action is not desired
CNS:
Headache, dizziness, depression, syncope, hypesthesia, neuralgia
CV:
Edema, hypertension, chest pain
GI:
Nausea, vomiting, diarrhea, constipation, GI discomfort,
GI bleeding, pancreatitis, hepatic failure
GU:
Glomerulonephritis
HEMA:
Epistaxis, purpura,
bleeding, neutropenia, aplastic anemia, agranulocytosis, thrombotic thrombocytopenic purpura
INTEG:
Rash, pruritus,
anaphylaxis
MISC:
UTI, hypercholesterolemia, chest pain, fatigue,
intracranial hemorrhage, toxic epidermal necrolysis, Stevens-Johnson syndrome,
flulike syndrome
MS:
Arthralgia, back pain
RESP:
Upper respiratory tract infection, dyspnea, rhinitis, bronchitis, cough,
bronchospasm
Rapidly absorbed; peak 1-3 hr; metabolized by liver (CYP3A4); excreted in urine, feces; half-life 8 hr; plasma protein binding 95%; effect on platelets after 3-7 days
Black Box Warning:
Avoid use with CYP2C19 inhibitors (omeprazole, esomeprazole)
Increase:
bleeding risk—anticoagulants, aspirin, NSAIDs, abciximab, eptifibatide, tirofiban, thrombolytics, ticlopidine, SSRIs, treprostinil, rifampin
Increase:
action of some NSAIDs, phenytoin, TOLBUTamide, tamoxifen, torsemide, fluvastatin, warfarin
Decrease:
clopidogrel effect—proton pump inhibitor (PPIs)
Decrease:
CYP3A4 inhibitors/substrates —atorvastatin, simvastatin, cerivastatin
Increase:
clopidogrel effect—feverfew, fish oil, omega-3 fatty acid, garlic, ginger, ginkgo biloba, green tea, horse chestnut
Decrease:
clopidogrel effect—bilberry, saw palmetto
Increase:
AST, ALT, bilirubin, uric acid, total cholesterol, nonprotein nitrogen (NPN)
Thrombotic/thrombocytic purpura,
fever, thrombocytopenia, neurolytic anemia
Black Box Warning:
CYP2C19 Allele (poor metabolizers): Consider using another antiplatelet product, higher CV reaction occurs after acute coronary syndrome or PCI, tests are available to determine CYP2C19 allele
•
Symptoms of stroke, MI during treatment
•
Hepatic studies: AST, ALT, bilirubin, creatinine (long-term therapy)
•
Blood studies: CBC, differential, Hct, Hgb, PT, cholesterol (long-term therapy)
•
Therapeutic response: absence of stroke, MI
•
That blood work will be necessary during treatment
•
To report any unusual bruising, bleeding to prescriber; that it may take longer to stop bleeding
•
To take without regard to food
•
To report diarrhea, skin rashes, subcutaneous bleeding, chills, fever, sore throat
•
To tell all health care providers that clopidogrel is being used; may be held for 5 days before surgery
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert
(kloe-trim′a-zole)
Cruex, Gyne-Lotrimin, Lotrimin, Lotrimin AF, MyCelex, MyCelex-7, Trivagizole 3, Desenex
Func. class.:
Topical antifungal
Chem. class.:
Imidazole derivative
Do not confuse:
clotrimazole
/miconazole/clobetasol
Antifungal activity results from altering cell wall permeability
Vulvovaginal, oropharyngeal candidiasis; topical fungal infections
Hypersensitivity, ophthalmic use
Precautions:
Hepatic impairment (oral)
Calculator
• Adult/child ≥2 yr:
Apply to affected area and rub into area
AM
/
PM
× 2-4 wk
• Adult/child
≥
12 yr:
Vag cream
1 applicator at bedtime × 3 days (2%) or 7 days (1%)
• Adult/child
≥
3 yr:
Lozenge
1 PO dissolved 5 × /day × 2 wk or adults 1 lozenge dissolved tid (prevention)
Available forms:
Topical cream, solution, 1%; vaginal cream 1%, 2%; Lozenges, troches 10 mg
•
Topical skin products are not for intravaginal therapy and are for external use only; do not use skin products near the eyes, nose, or mouth
•
Wash hands before and after use; wash affected area and gently pat dry
•
Cream/solution:
Apply to the cleansed affected area; massage gently into affected areas
•
Troches:
Allow to dissolve, do not chew or swallow whole
•
Only use dosage formulations specified for intravaginal use; intravaginal dosage forms are not for topical therapy; do not ingest
•
Cream:
Use applicator(s) supplied by the manufacturer
GI:
Nausea, vomiting
GU:
Vaginal burning, irritation
INTEG:
Burning, peeling, rash, pruritus
PO duration 3 hr
Increase:
LFTs
•
Allergic reaction:
Assess for hypersensitivity, product might need to be discontinued
•
Infection:
Assess for severity of infection, itching
•
Decreased infection, itching
•
That topical skin products are not for intravaginal therapy and are for external use only; do not use skin products near the eyes, nose, or mouth
•
To wash hands before and after use; wash affected area and gently pat dry
•
Cream:
To shake well before use, apply a thin film to the cleansed affected area, massage gently into affected areas
•
Troches
: Allow to dissolve, do not chew or swallow whole
Intravaginal route:
To use only dosage formulations specified for intravaginal use; intravaginal dosage forms are not for topical therapy; do not ingest
•
Cream:
To use applicator(s) supplied by the manufacturer
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert