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Assessment & Drug Effects

Carefully monitor for and immediately report S&S of GI bleeding, especially when coadministered with NSAIDs, aspirin, heparin, or warfarin.

Lab tests: Periodic platelet count and lipid profile.

Evaluate patients with unexplained fever or infection for myelotoxicity.

Patient & Family Education

Report promptly any unusual bleeding (e.g., black, tarry stools).

Avoid chronic aspirin or NSAID use unless approved by physician.

Do not breast feed while taking this drug.

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Side Effects

1. Collection of blood under the skin

2. deep, dark purple bruise

3. itching, pain, redness, or swelling

Adverse Effects

Body as a Whole: Flu-like syndrome, fatigue, pain, arthralgia, back pain. CV: Chest pain, edema, hypertension, thrombocytic purpura. GI: Abdominal pain, dyspepsia, diarrhea, nausea, hypercholesterolemia. Hematologic: Thrombotic thrombocytopenic purpura, epistaxis. CNS: Headache, dizziness, depression. Respiratory: URI, dyspnea, rhinitis, bronchitis, cough. Skin: Rash, pruritus.

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Hypersensitivity to clopidogrel; intracranial hemorrhage, peptic ulcer, or any other active pathologic bleeding; pregnancy (category B). Discontinue clopidogrel 7 d before surgery and during lactation. Safety and efficacy not established in children.

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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.

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Inhibits platelet aggregation by selectively preventing the binding of adenosine diphosphate to its platelet receptor. It is an analog of ticlopidine. The drug's effect on the adenosine diphosphate receptor of a platelet is irreversible.

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BLOOD FORMERS, COAGULATORS, AND ANTICOAGULANTS; ANTIPLATELET AGENT

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Secondary Prevention

Adult: PO 75 mg q.d.

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Plavix

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Clopidogrel

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Assessment & Drug Effects
- Neonates born to mothers who are receiving atenolol at parturition or breastfeeding may be at risk for hypoglycemia.

Check apical pulse before giving oral drugs, especially in patients receiving digitalis (both drugs slow AV conduction). If below 60 bpm (or other ordered parameters), withhold dose and consult a physician.

Monitor apical pulse, BP, respirations, and peripheral circulation throughout the dosage adjustment period. Consult a physician for acceptable parameters.

Patient & Family Education

Adhere rigidly to the dose regimen. Sudden discontinuation of drugs can exacerbate angina and precipitate tachycardia or MI in patients with coronary artery disease, and thyroid storm in patients with hyperthyroidism.

Make position changes slowly and in stages, particularly from recumbent to upright posture.

Do not breastfeed while taking this drug.

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Side Effects

new or worsening chest pain;

slow or uneven heartbeats;

a light-headed feeling, like you, might pass out;

shortness of breath (even with mild exertion), swelling, rapid weight gain; or a cold feeling in your hand and feet.

Adverse Effects

CNS: Dizziness, vertigo, light-headedness, syncope, fatigue or weakness, lethargy, drowsiness, insomnia, mental changes, depression. CV: Bradycardia, hypotension, CHF, cold extremities, leg pains, dysrhythmias. GI: Nausea, vomiting, diarrhea. Respiratory: Pulmonary edema, dyspnea, bronchospasm. Other: May mask symptoms of hypoglycemia; decreased sexual ability.

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Sinus bradycardia, greater than first-degree AV heart block, uncompensated heart failure, cardiogenic shock, peripheral vascular disease, Raynaud's disease, hypotension; abrupt discontinuation, pulmonary edema. Safety during pregnancy (category D), or lactation is not established.

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Treatment of angina pectoris due to coronary atherosclerosis.

Hypertension, as a step 1 agent, alone or with other drugs, especially diuretics.

Treatment of MI.

Unlabeled uses: Prevention of migraine headaches; alcohol withdrawal syndrome, treatment of ventricular and supraventricular arrhythmias.

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Atenolol selectively blocks beta1-adrenergic receptors located chiefly in cardiac muscle. With large doses, the preferential effect is lost and inhibition of beta2-adrenergic receptors may lead to increased airway resistance, especially in patients with asthma or COPD. Mechanisms for antihypertensive action include central effect leading to decreased sympathetic outflow to the periphery, reduction in renin activity with consequent suppression of the renin-angiotensin-aldosterone system, and competitive inhibition of catecholamine binding at beta-adrenergic receptor sites.

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AUTONOMIC NERVOUS SYSTEM AGENT; BETA-ADRENERGIC ANTAGONIST (SYMPATHOLYTIC, BLOCKING AGENT); ANTIHYPERTENSIVE.

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Adult and Pediatric Dosage Forms and Strengths.

Tablet

25 mg

50 mg

100 mg

Dosage Considerations – Should be Given as Follows: Hypertension

Adult: 25-50 mg/day orally initially; may be increased to 100 mg/day orally.

Pediatric (Off-label): 0.5-1 mg/kg/day orally; not to exceed 2 mg/kg/day or 100 mg/day.

Geriatric: 25 mg/day orally initially; may be increased to 100 mg/day orally.

Angina Pectoris

Adult: 50 mg/day orally; after 1 week, may be increased to 100 mg/day orally; some patients may require 200 mg/day.

Geriatric: 25 mg/day orally; after 1 week, may be increased to 100 mg/day; some patients may require 200 mg/day.

Post Myocardial Infarction (MI)

Secondary prevention

Adult: 100 mg orally once daily or divided every 12 hours for 6-9 days after myocardial infarction (MI).

Geriatric: 100 mg orally once daily or divided every 12 hours for 6-9 days after MI.

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Tenormin

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Atenolol