CC March 2017 Clopidogrel and Omeprazole

echoecho's version from 2018-04-10 04:14


Question Answer
What is Clopidogrel?Plavix is a P2Y12 inhibitor that decreases platelet aggregation
When is it recommended as treatment?1) acute coronary syndrome 2) acute stroke 3) after placement of coronary artery stents often in conjunction with aspirin
Due to the risk of GI bleeding with dual antiplatelet therapy, what do guidelines recommend?use of gastric protective agent such as PPI Omeprazole (Prilosec)
Why can the concomitant use of both Clopidogrel and Omeprazole decrease the effectiveness of Clopidogrel?because Clopidogrel and Omeprazole are metablised by the same hepatic cytochrome (P450 2C19)
PPIs may reduce the absorption of Clopidogrel due to reduced _____ ___?gastric pH
Initial studies failed to show any decrease of effectiveness of Clopidogrel when PPI was administered after percutaneous coronary interventions, however in 2017, a meta-analysis showed what/1) Patients in the non-PPI group had LOWER short-term mortality, myocardial infarction, stent thrombosis and revascularization 2) there was no significant difference in long-term mortality between the 2 groups
What is the consensus with the American College of Cardiology for use of PPIs Omeprazole or esomeprazole (Nexium) in pts taking Clopidogrel?it decreases Clopidogrel efectiveness (but do not specifically recommend against its use)
Other PPIS such as _________do not interfere with the efficacy of Clopidogrel? What other options?1) Pantoprazole (Protonix) 2) H2 blocker (Famotidine (Pepcid)) instead of a PPI for gastric ulcer prevention in patients on anti-platelet therapy
*** SUMMARY = Why is concomitant use of Clopidogrel and Omeprazole result in decreased effectiveness of Clopidogrel?both are metabolized by the same enzyme
*** SUMMARY = True or false? The American College of Cardiology notes that use of PPIs in patients taking Clopidogrel decreases its effectiveness, but they do not specifically recommend against its use? true
*** SUMMARY = In a large meta-analysis, patients taking Clopidogrel WITHOUT a PPI had what sequelae when compared to those taking both Clopidogrel and Omeprazole?1) lower short-term mortality 2) lower MI 3) lower stent thrombosis and revascularization
*** SUMMARY = Other proton pump inhibitors or what other medications may be used for gastric prophylaxis in patients on antiplatelet therapy?Histamine - 2 - blockers (Famotidine (Pepcid))