The healthcare provider prescribes clopidogrel (Plavix) for a patient at risk for a myocardial infarction. While instructing the patient about the adverse effects and precautions associated with this drug, the nurse tells him that the following drugs should not be used while on clopidogrel unless the doctor is consulted. (Select all that apply.)

alteplase (Activase)

Diltiazem

Ibuprofen

Aspirin

Coumadin

Answer and Explanation

Correct Answer : A,B,C,D,E

A. Alteplase (Activase): Alteplase is a thrombolytic agent used to dissolve blood clots. Concurrent use with clopidogrel, an antiplatelet medication, can increase the risk of bleeding due to additive effects on clotting. Therefore, it's important to consult the doctor before using these medications together.

B. Diltiazem: Diltiazem is a calcium channel blocker used to treat hypertension and certain heart rhythm disorders. Diltiazem will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Therefore, it's advisable to consult the doctor before using these medications together.

C. Ibuprofen: Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used to relieve pain and inflammation. Like other NSAIDs, it can increase the risk of bleeding when taken with clopidogrel. Therefore, it's important to consult the doctor before using these medications together.

D. Aspirin: Aspirin is another antiplatelet medication commonly used to prevent heart attacks and strokes. Combining clopidogrel with aspirin can increase the risk of bleeding without significantly improving outcomes in most cases. However, in some situations, such as after certain cardiac procedures, dual antiplatelet therapy (clopidogrel plus aspirin) may be prescribed under close medical supervision. Therefore, it's crucial to consult the doctor before using these medications together.

E. Coumadin (warfarin): Coumadin is an anticoagulant medication used to prevent blood clots. Concurrent use with clopidogrel can increase the risk of bleeding. Therefore, it's essential to consult the doctor before using these medications together.

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Correct Answer is C

Explanation

A. Ferrous sulfate: This is an iron supplement and wouldn't be used to reverse warfarin's anticoagulant effect.

B. Prednisone: This is a steroid medication used for various inflammatory conditions and wouldn't be used to address excessive blood thinning.

C. Vitamin K: Vitamin K is the antidote for warfarin poisoning or excessive anticoagulation. By providing vitamin K, the body can resume producing clotting factors, counteracting warfarin's effect.

D. Heparin: This is another blood thinner medication. While it can be used in specific situations, it wouldn't be the first choice to reverse warfarin's effect because it adds another layer of anticoagulation, which could be risky.

A. Food, Drug and Cosmetic Act B. Joint Commission on the Accreditation of Healthcare Organizations C. Health and Human Services (HHS) D. Dietary Supplement Health and Education Act (DSHEA)

Correct Answer is D

Explanation

A. Food, Drug and Cosmetic Act (FD&C Act): This act sets the groundwork for food and drug regulations, but it's not the specific legislation governing dietary supplements. While FD&C Act applies to some aspects of supplements, DSHEA has more specific regulations.

B. Joint Commission on the Accreditation of Healthcare Organizations (JCAHO): This organization focuses on accrediting healthcare facilities, not regulating supplements.

C. Health and Human Services (HHS): HHS is a broad department encompassing various healthcare agencies, but DSHEA is the specific act within HHS that governs supplements.

D. Dietary Supplement Health and Education Act (DSHEA): This 1994 act specifically addresses dietary supplements, outlining regulations for labeling, manufacturing, and marketing. It places the responsibility for ensuring the safety and effectiveness of supplements on the manufacturers, unlike prescription drugs approved by the FDA.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has been taking warfarin and has a prothrombin time of 30 seconds and an INR of 7. Which of the following medications should the nurse anticipate the provider to prescribe?

Correct Answer is C

Explanation

When asked if there are any regulatory controls on herbal or dietary supplements, the nurse responds to the client by informing him that herbal and dietary supplements are regulated by the:

Correct Answer is D

Explanation

A client taking warfarin (Coumadin) should be instructed to avoid herbal supplements such as green tea, ginkgo, feverfew, garlic, and ginger because these could:

A nurse is reinforcing teaching with a client who is to start subcutaneous heparin. Which of the following information should the nurse include in the teaching?

The patient requests information on alternative treatments for her arthritis. The nurse provides the patient with information on which of the following supplements?

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Which of the following statements would most likely NOT be allowed on the label of a dietary supplement?

Patients often use herbal therapies for which of the following reasons?

A nurse is reviewing the laboratory report of a client and realizes the liver function tests are elevated, indicating liver damage. The client should be monitored for which potential complication?

When beginning herbal products, the nurse understands that the best way to identify allergic or other adverse reactions is to have the client: