Explain mechanism of action, general indications, contraindications, and risk factors/side effects of clopidogrel. How is clopidogrel metabolized?

Larry Case Study Questions(10 points/question)

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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?