Paper I
2017 August (Supplementary) (2010 Scheme) · 40 marks · 120 min

Question

Clopidogrel.

Q53 marksShort Notes

Answer

Clopidogrel is a thienopyridine antiplatelet drug.

Mechanism of action

  • A prodrug, activated by hepatic CYP450 enzymes
  • Irreversibly blocks the P2Y12 ADP receptor on platelets, preventing ADP-mediated platelet activation and aggregation (inhibits activation of GPIIb/IIIa receptor complex)

Uses

  • Secondary prevention of myocardial infarction/stroke
  • Acute coronary syndromes (dual antiplatelet therapy with aspirin)
  • Following coronary stent placement (prevention of stent thrombosis)
  • Peripheral arterial disease

Adverse effects

  • Bleeding
  • GI upset
  • Thrombotic thrombocytopenic purpura (rare)
  • Reduced efficacy in patients with CYP2C19 loss-of-function polymorphisms (poor metabolizers)

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