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Flashcards in 63. Stroke Deck (13):
1

Which of the following options are appropriate for secondary prevention of ischemic stroke in a patient without comorbidities? (Select ALL that apply.)

A. Aspirin
B. Clopidogrel
C. Aspirin + clopidogrel
D. Aspirin + dipyridamole ER
E. Clopidogrel + aspirin + dipyridamole ER

A, B, D. Aspirin, clopidogrel, and aspirin + dipyridamole ER are the three approved regimens for secondary prevention of stroke.

2

Jacob had a stroke and has been given a prescription for Aggrenox. Choose the correct statement concerning Aggrenox:

A. Aggrenox is more effective in preventing strokes than clopidogrel.
B. Aggrenox is less effective in preventing strokes than clopidogrel.
C. Aggrenox contains aspirin and dipyridamole extended-release.
D. Aggrenox is an expensive formulation of plain aspirin.
E. Aggrenox is not used for secondardy stroke prevention.

C. Aggrenox is used to reduce the risk of stroke in people who have TIAs or who have had a stroke. Use caution with any other agent that the patient may be using that will also increase bleeding risk.

3

Marco had a stroke and has been given a prescription for clopidogrel to prevent against another stroke. Select the correct statement concerning clopidogrel:

A. The brand name is Aggrenox.
B. The daily dose is 300 milligrams, taken once daily.
C. The most common adverse reaction is bleeding.
D. It can be used safely with ginkgo biloba and high doses of fish oils.
E. This agent has a very low risk of bleeding, particularly if used together with aspirin.

C. Clopidogrel will increase the risk of bleeding. The daily dose is 75 mg.

4

Which of the following is the most common cause of a stroke?

A. Smoking
B. High intake of saturated fat
C. Diabetes
D. Dyslipidemia
E. Hypertension

E. There are many risk factors for stroke (gender, ethnicity, age, cardiac disease, diabetes, history of TIAs, smoking, high lipids) but the number one cause is poorly controlled hypertension. The tragedy in this is that many patients could control their blood pressure if they took their medicines regularly, but as hypertension is asymptomatic this is a condition with overall poor adherence. If a patient has multiple risk factors, the risk of developing a stroke is higher.

5

Ann, a 77 year-old female, was cooking in the kitchen when she collapsed onto the floor. Her daughter called an ambulance and Ann was taken to the emergency room. The triage nurse did a brief physical exam and found the left side of her body was paralyzed. What is the most important step to take next?

A. The patient should receive a CT scan to determine the nature of the injury.
B. The patient should be given aspirin immediately.
C. The patient should be discharged to a nursing home.
D. A DEXA should be ordered to determine if the patient has suffered a fracture from the fall.
E. An EKG should be ordered to rule-out a myocardial infarction.

A. Every minute counts. The sooner the patient receives a CT scan, the sooner a proper diagnosis on the type of stroke can be made. Strokes can be either hemorrhagic or ischemic in nature.

6

A stroke is extremely debilitating to the patient and costly to everyone. The American Stroke Association has a public health awareness campaign to assist the public in identifying a stroke and acting quickly to prevent devastating consequences. What are the key components of this public health initiative called F.A.S.T? (Select ALL that apply.)

A. F is for FACT: Ask the person a simple fact. Do they know it?
B. A is for ARMS: Ask the person to raise both arms. Does one arm drift downward?
C. S is for SMILE: Ask the person to smile. Does one side of the face droop?
D. T is for TIME: If the person shows any of these symptoms, time is important.
E. Call 911 or get to the hospital fast. Brain cells are dying.

B, D, E. F.A.S.T stands for FACE, ARMS, SPEECH, and TIME. Act F.A.S.T to look for signs and symptoms of a stroke. If present, get to the ER stat! It is generally fastest to call 911 and patients in acute need of urgent care should not be driving a car.

7

Which of the following best describes the mechanism of action of mannitol?

A. Inhibits platelet aggregation
B. Increases osmotic pressure, thus reducing intracranial pressure
C. Lyses blood clots that have caused a stroke
D. Increases cardiac output
E. Lowers systolic blood pressure by dilating peripheral arterioles

B. Mannitol is as osmotic agent used to reduce intracranial pressure.

8

SG presents 2 hours after onset of symptoms of stroke. The provider has completed a CT scan to rule out a hemorrhage and diagnoses this patient with ischemic stroke. SG is 48 years old and weighs 250 lbs. Her CrCl is about 60 mL/min. The pharmacist receives an order for alteplase 0.9 mg/kg X 1. Which of the following represents the most appropriate course of action for the pharmacist?

A. Verify this order as written and dispense 100 mg of alteplase
B. Reject this order because SG did not present within the appropriate time window for the use of alteplase.
C. Verify this order as written and dispense 90 mg of alteplase
D. Institute a therapeutic interchange to reteplase and dispense
E. Reject this order because alteplase is only approved in hemorrhagic stroke

C. The maximum dose of alteplase for ischemic stroke is 90 mg. Patients should receive 0.9 mg/kg up to the maximum of 90 mg.

9

Which of the following are likely signs of a stroke? (Select ALL that apply.)

A. Extreme jaw pain that radiates down the neck to both hands.
B. Numbness or weakness of the face, arm or leg, especially on one side of the body.
C. Trouble walking, dizziness, loss of balance or coordination.
D. Neck stiffness and high fever.
E. Confusion, trouble speaking or understanding

B, C, E. Other possible signs of a stroke include trouble seeing in one or both eyes and a severe headache.

10

Which of the following statements are true regarding nimodipine? (Select ALL that apply.)

A. There is a boxed warning concerning inadvertent IV administration of this agent.
B. It is used in patients with a subarachnoid hemorrhage
C. Syringes dispensed from pharmacy should be labeled "for oral use only"
D. It is a dihydropyridine calcium channel blocker
E. It should be continued indefinitely in patients who have had a stroke

A, B, C, D. Nimodipine is a dihydropyridine calcium channel blocker useed in patients with SAH. It should only be given PO and continued for up to 21 days.

11

Ann is suffering from an ischemic stroke and has no contraindications to fibrinolytic therapy. Which fibrinolytic should be used to treat Ann's ischemic stroke?

A. Streptokinase
B. Reteplase
C. Urokinase
D. Tenecteplase
E. Alteplase

E. Only alteplase can be used in treating acute ischemic stroke.

12

Ann is suffering from an ischemic stroke and has no contraindications to fibrinolytic therapy. How long does Ann have to receive benefit from fibrinolytic therapy, counting from the time of symptom onset while standing in her kitchen?

A. 90 minutes
B. 2 hours
C. 3 hours
D. 6 hours
E. 12 hours

C. Treatment must be initiated within 3 hours (and possibly up to 4.5 hours per the stroke guidelines) of symptom onset. The use of alteplase between 3 and 4.5 hours has not been approved by the FDA.

13

Which of the following provides the best definition of a transient ischemic attack (TIA)?

A. A "warning stroke" or "mini-stroke" that produces stroke-like symptoms but no lasting damage.
B. A severe loss of blood supply to the brain that causes lasting damage; if occurring repeatedly, the cumulative damage can be equivalent to a major stroke.
C. Repeated loss of consciousness
D. A post-myocardial ischemic event.
E. TIAs indicate that a plaque has ruptured in a coronary artery.

A. It is important to recognize and treat TIAs in order to prevent strokes. A TIA produces stroke-like symptoms but no lasting damage. The short duration of these symptoms and lack of permanent brain injury is the main difference between TIA and stroke.

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