CVA Medications

Antiplatelet Medications

• Clopidogrel (Plavix) is an antiplatelet medication that prevents platelet aggregation.
• Clopidogrel reduces the risk of clot formation in stroke patients.

Anticoagulants

• Warfarin and Dabigatran are anticoagulants.
• Enoxaparin is a low-molecular-weight heparin.
• Warfarin requires monitoring of the International Normalized Ratio (INR) to ensure therapeutic effectiveness and reduce the risk of bleeding.
• Rivaroxaban (Xarelto) is a direct oral anticoagulant (DOAC) that does not require routine INR monitoring.
• Patients taking anticoagulants should monitor for unusual bruising, black or tarry stools, hematuria, and bleeding gums.
• Anticoagulants increase bleeding risk, leading to bruising, GI bleeding (black stools), hematuria, and gum bleeding.

ACE Inhibitors

• Swelling of the lips or tongue (angioedema) is a serious adverse effect of ACE inhibitors and requires immediate discontinuation of the medication.
• A patient with a history of angioedema should not receive an ACE inhibitor, as they can cause or worsen angioedema, which is potentially life-threatening.
• Lisinopril, losartan, and enalapril (ACE inhibitors/ARBs) and spironolactone (potassium-sparing diuretic) can cause hyperkalemia.
• A dry, persistent cough is a common side effect of ACE inhibitors.

Beta-Blockers

• Beta-blockers lower heart rate and blood pressure, which causes dizziness, bradycardia, and fatigue.
• Beta-blockers can worsen asthma symptoms by causing bronchoconstriction.
• The priority nursing assessment before administering beta-blockers is monitoring blood pressure and heart rate.

Calcium Channel Blockers

• Calcium channel blockers relax blood vessels, which can lead to hypotension.
• Nimodipine is a calcium channel blocker that prevents cerebral vasospasm in patients with subarachnoid hemorrhage.
• Patients on calcium channel blockers should avoid grapefruit juice, as it can increase calcium channel blocker levels, leading to excessive hypotension.

Statins

• Grapefruit can interfere with the metabolism of statins, which increases the risk of side effects like muscle toxicity.
• Statins lower LDL cholesterol, reducing the risk of cardiovascular disease.
• Statins must be taken long-term to maintain cholesterol control; stopping them can increase cardiovascular risk.
• Lifestyle modifications (diet and exercise) are essential in managing cholesterol, even while taking statins.
• While taking Simvastatin, the patient must inform that lifestyle modification (diet and exercise) are essential

Diuretics

• Thiazide diuretics like hydrochlorothiazide can cause potassium loss, leading to hypokalemia, so potassium levels should be monitored.
• Furosemide is a loop diuretic that causes potassium loss, leading to hypokalemia.

Other Medications

• Hydralazine is an antihypertensive medication that lowers blood pressure, requiring close monitoring.
• Phenytoin can cause gum overgrowth (gingival hyperplasia), requiring good oral hygiene.
• Phenytoin is an anticonvulsant used to prevent seizures in patients at risk following a stroke.
• Aspirin should be taken with food to reduce the risk of gastrointestinal irritation.
• Metformin should be taken with meals to reduce gastrointestinal side effects.
• Dabigatran must be stored in its original bottle to protect it from moisture and maintain effectiveness.
• Enoxaparin should not be rubbed after injection, as it increases the risk of bruising and tissue damage.

Dietary Considerations

• Green leafy vegetables, such as broccoli, are high in vitamin K, which can interfere with warfarin's anticoagulant effects.
• Patients taking an ACE inhibitor who report a persistent cough should be switched to an ARB.
• ARBs are an alternative that does not cause this issue.