Clopidogrel

INTRODUCTION

Indications

Reduction of atherosclerotic events (MI, stroke, vascular death) in patients at risk for such events, including recent MI, acute coronary syndrome (unstable angina/non–Q-wave MI), stroke, or peripheral vascular disease.

Action

Inhibits platelet aggregation by irreversibly inhibiting the binding of ATP to platelet receptors. Therapeutic Effects: Decreased occurrence of atherosclerotic events in patients at risk.

Adverse Reactions/Side Effects

Incidence of adverse reactions similar to that of aspirin

CNS: depression, dizziness, fatigue, headache. EENT: epistaxis. Resp: cough, dyspnea. CV: chest pain, edema, hypertension. GI: GI BLEEDING, abdominal pain, diarrhea, dyspepsia, gastritis. Derm: pruritus, purpura, rash. Hemat: BLEEDING, NEUTROPENIA, THROMBOTIC THROMBOCYTOPENIC PURPURA. Metab: hypercholes-terolemia. MS: arthralgia, back pain. Misc: fever, hypersensitivity reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of GI bleeding signs (abdominal pain, vomiting blood, blood in stools, black/tarry stools) or other signs of bleeds (bleeding gums, nosebleeds, unusual bruising, hematuria; fall in hematocrit or blood pressure). Notify physician or nursing staff immediately if these signs occur.

• Monitor signs of thrombotic thrombocytopenic purpura, such as purplish spots on the skin, decreased consciousness, fatigue, weakness, shortness of breath on exertion, and tachycardia. Report these signs to the physician or nursing staff immediately.

• Assess blood pressure periodically and compare to normal values (See Appendix F). Report a sustained increase in blood pressure (hypertension) to the physician.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor excessive coughing, chest pain, or difficult, labored breathing. Report severe or prolonged respiratory symptoms.

• Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• Monitor and report signs of neutropenia including fever, sore throat, and other signs of infection.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any back pain or joint pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

Interventions

• Use caution with any physical interventions that could increase bleeding, including wound débridement, chest percussion, joint mobilization, and application of local heat.

• Use caution during aerobic exercise in patients at risk for MI, stroke, or other cardiovascular ...