Drug study no.

1 (Clopidogrel)

Drug Order Mechanism Of Action Indication Contraindication Drug Effects Nursing Responsibilities

Generic Name: Clopidogrel is Clopidogrel is an  Hypersensitivity to Serious side effects: Monitor for signs and
metabolized by CYP450 antiplatelet agent. It clopidogrel or any symptoms of bleeding
Clopidogrel enzymes to produce the works by preventing component of the (hematuria, hematochezia,
active metabolite that platelet or blood clot to product. melena, hematoma,
 Pallor,
inhibits platelet form inside a blood epistaxis, petechiae).
 Easy bruising
aggregation. The vessel which can cut off  Purple spots under
metabolite selectively blood supply to the
 Bleeding, GI skin or in mouth,
Brand Name: inhibits the binding of heart or brain that
bleeding, intracranial  Jaundice, Monitor patient for signs of
adenosine diphosphate causes heart attack,
Duoplavin, Plavix, bleeding, peptic  Fast heartbeats, thrombotic thrombocytopenic
(ADP) to its platelet stroke, and other heart
Zyllt ulcer disease,  Shortness of breath, purpura (low platelet count,
P2Y12 receptor and the problems.
surgery, trauma  Fever, neuro symptoms, renal
subsequent ADP-  Weakness, dysfunction, fever).
mediated activation of  Feeling tired,
the glycoprotein Clopidogrel is indicated  Little or no urination,
GPIIb/IIIa complex,  Liver impairment
Classification: to reduce the risk of  Seizure
thereby inhibiting and cholestatic Instruct to take the drug same
myocardial infarction for (convulsions),
platelet aggregation. jaundice time each day, with or without
Antiplatelet patients with non-ST  Sudden numbness or food.
elevated acute coronary Weakness,
syndrome (ACS),  Headache
patients with ST-  Confusion, and
elevated myocardial  Problems with vision Instruct that clopidogrel
Dosage: infarction, and in recent or speech should be stopped about 5–7
MI, stroke, or days before any procedure
75mg that may increase risk of
established peripheral
arterial disease. The most common side
 effects include: bleeding such as surgery.

 Increased bleeding,
 Nosebleeds,
Route:  Headaches, Monitor serum liver enzymes.
 Itching, and Clopidogrel may cause
Oral hepatotoxicity.
 Bruising

Instruct not to double dose. If

a dose is missed take as
Frequency:
soon as possible however, if
OD close to the time of the next
dose, disregard the missed
dose and return to the regular
dosing schedule.

Emphasize that overdosage

may lead to prolonged
bleeding time or bleeding
complications.

Drug Interactions: 1)
increased risk of bleeding
with aspirin, NSAIDS,
heparin, and other anti-
clotting drugs; 2) Omeprazole
and other proton pump
inhibitors may decrease
 efficacy of clopidogrel

Take note that platelet

function and bleeding time
return to baseline in 7 – 10
days.

Drug study no. 2 (Metformin)

Drug Order Mechanism Of Action Indication Contraindication Drug Effects Nursing Responsibilities
Generic Name:

Metformin ✓ Metformin decreases Metformin is indicated Hypersensitivity, type 1  Physical weakness Monitor blood sugar levels
blood glucose levels by as an adjunct to diet diabetes, chronic heart (asthenia) regularly. Educate the patient
decreasing hepatic and exercise to failure, metabolic  Diarrhea about fasting blood glucose,
glucose production improve glycemic acidosis with or without  Gas (flatulence) postprandial blood glucose,
(gluconeogenesis), control in adults and coma, diabetic  Symptoms of hemoglobin A1C (HbA1c),
Brand Name: decreasing the pediatric patients ≥10 ketoacidosis (DKA), weakness, muscle renal function monitoring
intestinal absorption of years old with type 2 severe renal disease, pain (myalgia) every 3 to 6 months, and
Actoplus Met, diabetes mellitus. abnormal creatinine  Upper respiratory checking of vitamin B12
glucose, and increasing
Avandamet, Fortamet, clearance resulting from tract infection levels.
insulin sensitivity by
Glucophage, shock, septicemia, or  Low blood sugar
increasing peripheral
Glucovance, myocardial infarction and (hypoglycemia)
glucose uptake and
Glumetza, Glycon, etc. lactation.  Abdominal pain (GI
utilization. Instruct the patient to avoid
complaints), lactic chewing, crushing, or
acidosis (rare) breaking an extended-release
 Low blood levels of
• Metformin inhibits tablet.
vitamin B-12
Classification: mitochondrial complex I
 Nausea
and activate AMP-
 Vomiting
anti-diabetic activated protein kinase Administer metformin with a
 Chest discomfort
(AMPK), an enzyme meal at the same time every
biguanide class  Chills, dizziness
that regulates glucose day with a full glass of water
 Bloating/abdominal
metabolism. It also to prevent stomach upset.
distention
inhibits fructose-1,6-
 Constipation
bisphosphatase
 Heartburn
enzyme, resulting in the
Dosage: Educate the patient that
inhibition of
blood glucose improvement
gluconeogenesis.
500 mg may take about 1 to 2 weeks
and the full blood glucose
control effect may take up to
 • Activated AMPK 2 to 3 months.
phosphorylates two
Route: isoforms of acetyl-CoA
carboxylase enzyme,
Oral Encourage patients to eat
thereby inhibiting fat nutritious foods, have regular
synthesis and leading to exercise, and avoid smoking.
fat oxidation, reducing
hepatic lipid stores and
increasing liver
Frequency: Instruct to take vitamin B12
sensitivity to insulin.
supplements to prevent
BID
deficiency.

Instruct the patient to limit

alcohol intake while using this
medication to decrease the
risk of developing
hypoglycemia and lactic
acidosis.

Instruct the patient to inform

the primary care provider
before any type of imaging
studies requiring a dye

Should withhold before any

surgery that might cause
oliguria. The usual dose may
 be resumed 48 hours after
the procedure if the kidney
function is tested and found
to be normal.

In case of a missed dose,

take it as soon as possible
and go back to the regular
dosing schedule. Do not
double dose and abruptly
stop this medication.

Caution should be given in

patients with severe renal
dysfunction

https://go.drugbank.com/drugs/DB00758

https://www.rxlist.com/plavix-drug.htm

https://shadwige.sites.truman.edu/cardiac-medications/33-2/clopidogrel/

https://go.drugbank.com/drugs/DB00331

https://www.rxlist.com/metformin/generic-drug.htm

https://nursestudy.net/metformin-nursing-considerations/