Protocol per Walker et al. Critical Pathways in Cardiology Vol. 6 March 2007
Initial Visit
1.
Review risks of benefits of desensitization
2.
hold clopidogrel until cutaneous symptoms resolve
3.
Hold steroids and antihistamines for 3 days prior to desensitization
4.
Hold Beta-blockers 4 days prior to desensitization
5.
Cardiologist to arrange CCU admit
6.
Call inpatient pharmacy to inform him that we are planning the desensitization, 1-2 days in advance – in order to compound oral dosages on day of desensitization
Day of Desensitization
1.
Obtain informed consent for desensitization
2.
Write orders for clopidogrel desensitization (see below)
3.
Write consultation with following chart (Time / Dose/ Signs and symptoms/ RR/ BP/ 02sat/ HR)
4.
Get Baseline Vitals, check IV sites
5.
Start desensitization, shake each dose suspension prior to administration
6.
After last dose, monitor vitals for 1 hour, may transfer to stepdown unit for overnight monitoring
7.
Write prescription for Epi-pen or twin-ject for patient, discuss effects of Beta-blockers
8.
Next AM patient is given Plavix 75mg, monitored for 1 hours and discharged by cardiology if not adverse reactions
9.
No skipped doses are allowed
10.
Delay percutaneous interventions for 2-4 weeks
11.
Allergy follow-up at physician’s discretion
ORDERS
Epinephrine 0.3mg 1:1000 IM at Bedside
Benadryl 50mg IM at Bedside
Ranitadine 50 mg IV at Bedside
Solumedrol 120 mg IV at bedside
Plavix 0.02 mg po x 1 proceed to next dose Q15 minutes, hold dose for SBP < __, HR<___ or signs of an adverse drug reaction
Plavix 0.05 mg po x 1
Plavix 0.15 mg po x 1
Plavix 0.5 mg po x 1
Plavix 1.5 mg po x 1
Plavix 5 mg po x 1
Plavix 15 mg po x 1
Plavix 45 mg po x 1