Lardizabal, Rafael Joseph P.
11/21/20
NDA4
CVA
DRUG MECHANISM OF ACTION INDICATIONS/
CONTRAINDICATIONS
Generic name Interferes with hepatic -Treatment of:
Warfarin synthesis of vitamin K- Venous Thrombosis,
dependent clotting factors (II, Pulmonary embolism, Atrial
Trade name VII, IX, and X). fibrillation with embolization
Coumadin -Management of MI
-Prevention of Thrombus
Classification formation and embolization
Anticoagulant after prosthetic valve
placement
Dose
2–5 mg/day for 2–4 days CONTRAINDICATIONS
Uncontrolled bleeding
Route Open wounds
PO Active ulcer disease
Recent brain, eye, or spinal
cord injury or surgery
Severe liver or kidney disease
Uncontrolled hypertension
SIFE EFFECT/ ADVERSE NURSING
EFFECT CONSIDERATION
Dermal necrosis -Monitor PT ratio or INR
Cramps, nausea regularly to adjust dosage.
Calciphylaxis -Administer IV form to
Bleeding patients stabilized on
Fever Coumadin who are not able
to take oral drug. Dosages
are the same. Return to oral
form as soon as feasible.
-Do not give patient any IM
injections.
-Double check all drugs
ordered for potential drug
interactions; dosage of both
drugs may need to be
adjusted.
-Arrange for frequent follow-
up, including blood tests to
evaluate drug effects.
-Many factors may change
your body’s response to this
drug, fever, change of diet,
change of environment, other
medications.
-Do not start or stop taking
any medication without
consulting your health care
provider.
 -Avoid situations in which you
could be easily injured
-Use contraception; do not
become pregnant while
taking this drug.

DRUG MECHANISM OF ACTION INDICATIONS/ SIFE EFFECT/ ADVERSE NURSING

CONTRAINDICATIONS EFFECT CONSIDERATION
Generic name Acts as a selective, reversible -Decreases risk of Hemat: Bleedeing -Instruct patient to take
Apixaban site inhibitor of factor Xa, Misc: Hypersensitivty
stroke/systemic embolism apixaban as directed.
inhibiting both free and bound reactions including
Trade name factor. Does not affect platelet associated with nonvalvular anaphylaxis -Take missed doses as soon
Eliquis aggregation directly, but does atrial fibrillation. as remembered on the same
inhibit thrombin-induced -Prevention of deep vein day and resume twice daily
Classification platelet aggregation. thrombosis that may lead to administration; do not double
Anticoagulant Decreases thrombin
generation and thrombus pulmonary embolism following doses.
Dose development. knee or hip replacement -Inform patient that they may
 5 mg twice daily surgery. bruise and bleed more easily
 -Treatment of and reduction in
Route
risk of recurrence of deep vein
PO
thrombosis (DVT) or
pulmonary embolism (PE).
Contraindications
-Previous severe
hypersensitivity reactions;
-Active pathological bleeding;
-Severe hepatic impairment;
-Not recommended for use in
patients with prosthetic heart
valves;
-Concurrent use of strong dual
inducers of CYP3A4 and P-gp;
-PE with hemodynamic
instability or requiring
thrombolysis or pulmonary
embolectomy;
-Lactation: Lactation.
or longer than usual.
-Advise patient to notify health
care professional immediately
if signs of bleeding occurs or if
injury occurs, especially head
injury.
-Caution patient to notify health
care professional if skin rash or
signs of severe allergic
reaction (chest pain or
tightness, swelling of face or
tongue, trouble breathing or
wheezing, feeling dizzy or
faint) occur.
-Advise patient to notify health
care professional of medication
regimen prior to treatment or
surgery.
-Inform patient having had
neuraxial anesthesia or spinal
puncture to watch for signs and
symptoms of spinal or epidural
hematomas (numbness or
weakness of legs, bowel or
bladder dysfunction). Notify
health care professional
immediately if symptoms
occur.
-Advise female patient to notify

DRUG MECHANISM OF ACTION
Generic name Clopidogrel is a thienopyridine
compound which acts to
clopidogrel antagonize adenosine
diphosphate (ADP).
Trade name Clopidogrel is inactive in vitro
and requires hepatic activation
Plavix to exert its antiplatelet effect.
The active metabolite
Classification selectively and irreversibly
Antiplatelets inhibits ADP-induced platelet
aggregation. It prevents
Dose binding of adenosine
75 mg once daily diphosphate (ADP) to its
platelet P2Y12 receptor. Thus,
Route ADP-mediated activation of
INDICATIONS/
CONTRAINDICATIONS
-For arterial thromboembolism
prophylaxis
-For patients with established
peripheral arterial disease or
coronary artery disease.
- For patients with unstable
angina or acute myocardial
infarction, NSTEMI  aplastic anemia
-For patients with unstable
angina or acute myocardial
infarction, NSTEMI  pancreatitis
- For patients with acute
coronary syndrome (ACS)
undergoing PCI.
- For patients with minor
SIFE EFFECT/ ADVERSE
EFFECT
GI bleeding
peptic ulcer
intracranial bleeding
thrombotic thrombocytopenic
purpura (TTP)
ocular hemorrhage
pancytopenia
agranulocytosis
hepatic failure
Drug Reaction with
Eosinophilia and Systemic
Symptoms (DRESS)
erythema multiforme
health care professional if
pregnancy is planned or
suspected or if breast feeding.
NURSING
CONSIDERATION
-Discontinue medication seven
days before elective surgery if
antiplatelet effect is not
desirable.
-The combination of low-dose
aspirin and clopidogrel in
acute coronary syndrome
without ST elevation is given
for at least one month but no
longer than 9-12 months. The
routine long-term use of this
combination increases the risk
of bleeding without clear
evidence of benefits.
- Ensure that patients are
PO the glycoprotein GPIIb/IIIa
complex is impaired. Because
the glycoprotein GPIIb/IIIa
complex is the major receptor
for fibrinogen, impaired
activation of the GPIIb/IIIa
complex prevents fibrinogen
binding to platelets which
ultimately inhibits platelet
aggregation. Because the
active metabolite of
clopidogrel irreversibly
modifies the platelet ADP
receptor, platelets exposed to
the drug are affected for the
remainder of their lifespan (7
to 10 days). In platelet
aggregation studies,
clopidogrel 75 mg once daily
produced inhibition of ADP-
induced platelet aggregation
equivalent to that of ticlopidine
250 mg twice daily. The active
metabolite of clopidogrel also
inhibits platelet aggregation
induced by agonists other
than ADP by blocking the
amplification of platelet
activation by released ADP;
the active metabolite does not
inhibit phosphodiesterase.
noncardioembolic stroke who
did not receive IV alteplase.
CONTRAINDICATIONS
-Clopidogrel is contraindicated
in patients with a known
hypersensitivity to clopidogrel
or any component of the
product.
-Bleeding, GI bleeding,
intracranial bleeding, peptic
ulcer disease, surgery, trauma
- Hepatic disease
- Renal disease, renal failure,
renal impairment
- Poor metabolizers
- Epidural anesthesia, labor,
obstetric delivery, pregnancy,
spinal anesthesia
- Geriatric
- Breast-feeding
- Children, infants, neonates
- Abrupt discontinuation
- Thienopyridine
hypersensitivity
acute generalized
exanthematous pustulosis
(AGEP)
toxic epidermal necrolysis
anaphylactoid reactions
Stevens-Johnson syndrome
exfoliative dermatitis
angioedema
serum sickness
bronchospasm
eosinophilic pneumonia
glomerulonephritis
vasculitis
insulin autoimmune syndrome
aware of the importance of
informing health care
professionals, including
doctors and dentists, that they
are taking clopidogrel before
starting any other treatment.
-Advise patients that
excessive intake of alcohol
should be avoided with this
medication.
-Ensure that patients know
they should report any signs of
increased bleeding and
bruising.
-Nurses should refer to
manufacturer’s summary of
product characteristics and to
appropriate local guidelines