Larry Case Study Questions(10 points/question) Answer each question in paragraph
ID: 137646 • Letter: L
Question
Larry Case Study Questions(10 points/question)
Answer each question in paragraph format, using complete sentences and proper grammar. You should have 2-3 paragraphs per question.
Include a title page, then pedigree, then questions/answers, then reference page, all in APA format.
Use more than the FDA package insert to research your answers.
Explain mechanism of action, general indications, contraindications, and risk factors/side effects of clopidogrel.
How is clopidogrel metabolized? How does CYP2C19 affect metabolism? Explain why a patient taking clopidogrel should avoid CYP2C19 inhibitors. How do CYP2C19 inhibitors affect the metabolism of clopidogrel? If a patient taking clopidogrel also takes a CYP2C19 inhibitor, what are the risks to the patient? Give some examples of strong, moderate, and weak CYP2C19 inhibitors.
Discuss the use of CYP2C19 testing related to clopidogrel dosage/response. What are the possible different genotypes (alleles) and how do they affect response?
Explain how race/ethnicity can influence drug metabolism. Provide the frequency (percentage) of poor metabolizers of clopidogrel in different ethnicities.
Describe the current status of the FDA boxed warning for clopidogrel regarding drug response in poor metabolizers. Does the FDA recommend or require testing before starting clopidogrel?
What are the nursing implications? What should Larry’s nurse do next? What teaching should Larry’s nurse provide?
Explanation / Answer
Ans: Clopidogrel is an antiplatelet medication and sometimes called a ''blood thinner'' and it is used to prevent strokes, heart attacks, and other heart problems.
* Mechanism of action: The mechanism of action includes the action of preventing platelets, which is a type of blood cell, from forming clots. A blood clot which forms inside a blood vessel, can cut off blood supply to the heart or brain which would cause a heart attack or stroke.
* Side effects: headache, dizziness, nausea, vomiting, excessive tiredness, nosebleed etc.
* Drug interaction: aspirin, heparin, non steroidal anti-inflammatory drugs such as ibuprofen or naproxen, warfarin, antidepressants such as fluoxetine, paroxetine.
Metabolism of Clopidogrel: The majority of the clopidogrel dose (>85%) is metabolized to inactive clopidogrel-carboxylic acid by human carboxylesterase. The remainder is metabolized to 2-oxo-clopidogrel, which is then converted either to inactive 2-oxo-clopidogrel-carboxylic acid via ester hydrolysis or to the active thiol metabolite, the moiety that irreversibly inhibits the binding of adenosine disphosphate to platelet P2Y12 receptors . The effectiveness of clopidogrel tablets results from its antiplatelet activity, which is dependent on its conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19. Clopidogrel tablets at recommended doses form less of the active metabolite and so has a reduced effect on platelet activity in patients who are homozygous for nonfunctional alleles of the CYP2C19 gene
The race and ethnicity effect the drug metabolism and sometimes cause toxicity also. In mediterrian region, it has been associated with a high risk for hemolysis with potentially significant consequences when these individuals are exposed to any of dozens of specific medications, including many antimalarial medications, sulfa drugs, and other medications, including possibly aspirin. The reduced response to ACE inhibitors, angiotensin II receptor antagonists, and beta-blockers in African Americans. These are things which occurs due to unfavorable conditon and the environment.
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