Pharmacy Stroke Management Quiz

Questions and Answers

What distinguishes a Transient Ischemic Attack (TIA) from a full-blown ischemic stroke?

TIA is characterized by permanent tissue damage.

TIA involves bleeding into the CNS.

TIA presents long-term neurologic deficits.

TIA occurs without evidence of infarct. (correct)

Which risk factor is considered non-modifiable for stroke?

Age (correct)

Diabetes

Cigarette smoking

Hypertension

What is the primary cause of a hemorrhagic stroke?

Reduced blood flow to brain tissue.

Bleeding into the brain or CNS. (correct)

Clot formation in the arteries.

Plaque buildup in blood vessels.

Which statement about ischemic stroke is correct?

Ischemic strokes result from clot formation and can cause local tissue damage. Signup and view all the answers

What percentage of strokes has a history of a prior TIA?

15% Signup and view all the answers

Which of the following is considered a modifiable risk factor for stroke?

Cardiovascular disease Signup and view all the answers

What is the term for the ischemic tissue surrounding an infarction that can be salvaged?

Penumbra Signup and view all the answers

Which condition is NOT typically associated with increased stroke risk?

Caffeine consumption Signup and view all the answers

Which of the following is a known risk factor for subarachnoid hemorrhage?

Blood clotting deficiencies Signup and view all the answers

What is a typical clinical presentation of subarachnoid hemorrhage?

Sudden onset severe headache with nausea/vomiting Signup and view all the answers

In the management of anticoagulant-related hemorrhage, which treatment is used for patients on warfarin?

Prothrombin complex concentrate and IV Vitamin K Signup and view all the answers

Which of the following is a management strategy for intracranial pressure (ICP) monitoring?

Regular assessment of blood sugar levels Signup and view all the answers

Which risk factor is associated with both intracerebral hemorrhage and subarachnoid hemorrhage?

Hypertension Signup and view all the answers

What is a common characteristic of a transient ischemic attack (TIA)?

It is a temporary interruption of blood flow to the brain. Signup and view all the answers

Which of the following is a modifiable risk factor for stroke?

Hypertension Signup and view all the answers

What is the first-line treatment indicated for appropriate patients with acute ischemic stroke?

Thrombolytic therapy with tPA Signup and view all the answers

Which of the following is recommended for secondary stroke prevention?

Statin therapy Signup and view all the answers

What is the main composition of 'white clots' associated with arterial thrombosis?

Fibrin and platelets Signup and view all the answers

Which of the following parameters is critical to monitor for efficacy in stroke medication management?

Blood pressure levels Signup and view all the answers

Which class of medication is primarily used in the management of ischemic stroke?

Antiplatelets Signup and view all the answers

What is a contraindication for the use of tPA in ischemic stroke treatment?

History of intracranial hemorrhage Signup and view all the answers

What is the recommended daily dose of John's wort for a patient with a creatinine clearance (CrCl) greater than 50 mL/min?

20 mg Signup and view all the answers

Which monitoring parameters are affected by the use of Factor Xa inhibitors?

All of the above Signup and view all the answers

What is the appropriate action for a patient with a CrCl less than 15 mL/min when considering John's wort?

Avoid use Signup and view all the answers

How should the dose of a Factor Xa inhibitor be adjusted for a patient who is ≥80 years old?

2.5 mg PO BID Signup and view all the answers

What is the mechanism of action for Andexanet alfa?

It is a reversal agent for Factor Xa inhibitors Signup and view all the answers

What should be avoided if a patient is already on a lower dose of Factor Xa inhibitors due to drug interactions?

Concomitant use with P-gp inducers Signup and view all the answers

What symptoms may indicate a stroke based on the area of the brain affected?

Falling and dysarthria Signup and view all the answers

Which of the following statements about monitoring with Factor Xa inhibitors is true?

Small variable changes in PT, INR, and aPTT occur Signup and view all the answers

What is a key recommendation for managing diabetes?

Refer to current guidelines for glycemic control Signup and view all the answers

Which dietary change is advised for patients with cardiovascular risks?

Consume a diet rich in fruits, vegetables, and low-fat dairy Signup and view all the answers

What effect does the combination of clopidogrel and aspirin have?

Considered in dual antiplatelet therapy for certain patients Signup and view all the answers

Which is a common side effect of ASA + extended-release dipyridamole?

Headaches Signup and view all the answers

What is recommended for patients who smoke?

Abstain or cease all smoking Signup and view all the answers

Which is true regarding aspirin dosage?

Efficacy is similar across a range of dosages Signup and view all the answers

In which situation might ticagrelor + aspirin be considered?

For minor stroke/high-risk TIA with specific criteria Signup and view all the answers

When considering antiplatelet therapy options, what factors should be taken into account?

Effectiveness, safety, cost, and patient factors Signup and view all the answers

What is the role of clopidogrel in antiplatelet therapy?

It must be metabolized to its active form Signup and view all the answers

What defines the main approach for stroke prevention in non-cardioembolic cases?

Antiplatelet therapy is recommended over oral anticoagulation Signup and view all the answers

Study Notes

Stroke Sub-Types

Ischemic Stroke: Results from arterial occlusion causing reduced blood flow, leads to CNS tissue damage.
Transient Ischemic Attack (TIA): Temporary neurological dysfunction without infarct; serves as a warning sign for future strokes.
Hemorrhagic Stroke: Involves bleeding into the brain or CNS, resulting in vascular leakage.

Stroke Statistics

Fifth leading cause of death in the US with approximately 795,000 strokes annually.
15% of strokes occur in individuals with prior TIA.
Over 7.2 million Americans have reported a history of stroke; it is the leading cause of disability in adults.

Risk Factors for Stroke

Non-Modifiable Risks: Age, sex (males more than females), race (African American > Hispanic > Caucasian), genetic factors, and family history.
Modifiable Risks: Hypertension, smoking, diabetes, dyslipidemia, cardiovascular diseases (AFib, CAD, HF, PAD), and lifestyle choices.
Associated factors: Hormonal contraceptives (estrogen), migraines with aura, substance abuse, hypercoagulable states, high homocysteine levels, and inflammation.

Stroke Classification and Management

In ischemic strokes, timing is critical as brain tissue needs immediate reperfusion (Time = Tissue).
Penumbra: Ischemic but salvageable brain tissue surrounding the infarct area.

Reperfusion Therapy

Eligibility for tPA (tissue Plasminogen Activator) is determined based on clinical guidelines to restore blood flow in cases of ischemic stroke.

Anticoagulants and Antiplatelets

Oral anticoagulants are tailored based on individual indications including risk assessment and contraindications.
Anticoagulation management includes factors such as renal function (CrCl) and potential drug interactions impacting dose and safety.

Primary and Secondary Stroke Prevention

Strategies include lifestyle modifications like diet, exercise, smoking cessation, and annual healthcare assessments.
Dual antiplatelet therapy may be considered for specific high-risk patients post-minor stroke or TIA events.

Acute Management and Monitoring

Treatment regimens differ based on stroke subtype; continuous monitoring of efficacy and safety parameters are critical.
Common medications include aspirin, clopidogrel, and newer anticoagulants with specific dosing adjustments based on kidney function.

Complications from Hemorrhagic Stroke

Risk factors include hypertension and trauma, with typical presentations involving sudden neurological deficits or severe headaches.
Management may involve correction of anticoagulant effects, hypertension control, and potential surgical intervention.

Clinical Presentation and Symptoms

Symptoms vary based on the affected brain region but may include hemiparesis, speech deficits, vertigo, and severe headaches.

Guidelines and References

Utilization of the 2019 updates and current guidelines for the early management of ischemic stroke, primary prevention, and hemorrhagic stroke management.

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Description

This quiz covers critical aspects of stroke management, including differentiation of stroke sub-types such as TIA, ischemic, and hemorrhagic strokes. It also examines risk factors and eligibility for reperfusion therapy. Test your knowledge on the appropriate use of oral anticoagulants in treating stroke patients.