STROKE MEDS Flashcards
(45 cards)
What is the MOA of Labetalol (Trandate)?
- blocks stimulation of beta 1 and beta 2 adrenergic receptor sites
- blocking affect on alpha 1 receptor sites
What is the indication of Labetalol (Trandate)?
management of HTN
What is the therapeutic effect of Labetalol (Trandate)?
decreased BP
What are the adverse effects of Labetalol (Trandate)?
- fatigue, weakness
- bronchospasm
- arrhythmias, bradycardia
- CHF, pulmonary edema
- orthostatic hypotension
What are the CI and precautions for Labetalol (Trandate)?
- allergies/hypersensitivity
- HF
- pulmonary edema + pre-existing obstructive lung diseases
- bradycardia and heart blocks
Precautions:
- renal/liver dysfunction
- DM
What are the nursing considerations and assessments of Labetalol (Trandate)?
assess:
- apical pulse prior to admin (if <60 hold med and notify MD)
- BP and pulse
- orthostatic hypotension
- signs of fluid overload (lungs crackles, weight gain, edema, fatigue)
nursing considerations:
- IV (high alert med)
- pts must lay supine for 3hrs after admin
- vitals assessed q5-15 mins during and after administration
Why does blood pressure increase with stroke?
a protective response to maintain cerebral perfusion
When do we administer BP meds?
ischemic stroke –> if BP extremely high
What are the parameters to administer anti-HTN meds for ischemic stroke?
syst. BP (>220mmHg) and diast. BP (>120mmHg)
What are the parameters to administer anti-HTN meds for hemorrhagic stroke?
syst BP >160 mmHg
What key facts to educate a patient that is on Labetalol?
- abrupt withdrawal (life-threatening arrythmias, HTN, MI)
- slow position changes (CAUTION: exercising, alcohol, hot weather)
- DM pts –> monitor BG more closely d/t masked warning signs of hypoglycemia
What is the key factor in the stimulation of new platelets and platelet aggregation?
Thromboxane A2
How does Aspirin correlate with thromboxane A2?
inhibits the formation of thromboxane A2 by platelets –> preventing platelet adhesion and aggregation
Why does thromboxane A2 matters in stroke?
stroke results from aggregation at site of endothelial damage
What is the MOA of Acetylsalicylic acid (Aspirin - NSAIDs)?
suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase (enzyme) = reduces risk of arterial thrombosis
What is the indication for Aspirin?
prophylaxis for MI and stroke
What is the therapeutic effect of Aspirin?
decreased incidence of stroke and MI
What adverse effects of Aspirin?
- heart burn, nausea
- GI bleeds (anemia with chronic occult blood loss)
- gastric ulceration, perforation, bleeding, hemorrhage (use of PPI recommended)
- bleeding (d/c 1-2 weeks prior to surgical procedures)
- renal impairment (acute, reversible impairment in renal function)
- salicylism (syndrome d/t high lvls of Aspirin)
Which Cox is Aspirin blocking?
Cox 2 –> vasodilation
What are the CI and precautions of Aspirin?
- hypersensitivity/allergies
- asthma
- bleeding disorders or thrombocytopenia
precautions:
- renal dysfunction
- chronic alcohol abuse
- history of GI bleeds or ulcer disease
- liver disease
What are the nursing considerations and assessments of Aspirin?
assess:
- signs/symptoms of bleeding (hypotension, tachycardia, dizziness, weakness, pallor, bruising, bleeding gums, epistaxis, hematuria, melena)
- CBC
- renal function (weight, urea/creatinine lvls, UO)
nursing considerations:
- apply pressure to site to prevent bleeding and monitor site carefully
- d/c at least 1 week prior to surgery
- PO
What is the dose of Aspirin to prevent CAD?
81mg per day
When would you start Aspirin for a pt that experienced an ischemic stroke?
within 48hrs of stroke onset (once daily for prevention of future strokes)
What is the MOA of Tissue Plasminogen activator (tPa/alteplase - Thrombolytic)?
binds to fibrin in a blood clot and activates plasminogen –> forms plasmin and breaks down/dissolves the present clot
