lecture 25 - pharmaceutical care in patients with atrial fibrillation of stroke Flashcards

Question

what are counselling points of flecainide pill in the pocket ?

Answer 1

What is pill in the pocket – prone to get af symptoms from time to time and doesn’t want to be on regular medicine. Common in younger males. Beta blcokers can cause erectal dysfunction. They will vet 2 tablets with flecainide. If symptoms of palpitations, then they will take 2 flecainide and go from af to sinus rhythm. Counselling required. Needs to someone nearby to help if it goes wrong.

Answer 2

if haemodynamic is unstable systolic BP is less than 90mmHg chest pain/ heart failure symptoms reduced consciousness levels known onset of AF is less than 48 hours

Answer 3

stroke is a clinical syndrome characterised by sudden onset of rapidly developing focal or global neurological disturbance which alerts more than 24 hours or leads to death Transient ischaemic attack (TIA) — transient (less than 24 hours) neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia, without evidence of acute infarction

Answer 4

thrombotic stroke - blood clot blocks flow of blood in brain and so brain really deprived of blood embolic stroke - fatty plaque or blot clot (embolism) breaks away and flows to brain where it blocks an artery cerebral haemorrhage - break in blood vessels (aneurysm) in brain - area of bleeding in brain

Answer 5

small vessels, lacunar - small vessels Deep in the brain are affected large vessels (thrombotic) - hyperlipidaemia with unstable plaque cariogenic (embolic) - clot moves from the heart and lodges in a vessel in the brain

Answer 6

Haemorrhagic transformation of ischaemic stroke. Cerebral oedema. Seizures. Venous thromboembolism — pulmonary embolism has been associated with 13-25% of deaths in the early period following stroke. Cardiac complications — cardiac complications (myocardial ischemia, congestive heart failure, atrial fibrillation, and arrhythmias) are common due to shared aetiology. Infection — people with stroke are at increased risk of infection including aspiration pneumonia, urinary tract infection, and cellulitis from infected pressure sores.

Answer 7

Mobility problems Hemiparesis or hemiplegia (weakness on one side of the body) Ataxia (lack of co-ordination of movement) Falls — Spasticity and contractures. Spasticity is common following stroke and can lead to discomfort, pain, difficulties for carers and restriction of activities. Sensory problems It has been estimated that up to 80% of people have some loss or alteration in sensations such as touch, temperature, and pain. Continence problems Urinary and faecal continence problems are common following stroke and can persist long-term. They can have a negative impact on mood, self-image, confidence, and rehabilitation and increase carer stress. Urinary incontinence increases the risk of skin breakdown and can be exacerbated by constipation. Pain — pain is common following stroke and can be due to neuronal damage from stroke or a pre-existing condition (such as osteoarthritis): Dysphagia (difficulty in swallowing foods, fluids and saliva) occurs in 40–78% of people with stroke and is associated with aspiration pneumonia, disability and death. Visual problems

Answer 8

1. admit ti a stroke unit - patients more likely to survive stoke, have fewer disabilities and live independent life-styles if admitted to stroke unit 2. imaging initial CT scan will identify if haemorrhage or clot CT quicker than MRI 3. swallow dysphagia may occur and if not identified can cause poor nutrition, pneumonia and increased disability 4. assess medicines stop all anticoagulation's, thrombolytics, antipalteles and saids pending ct results withhold all swallowing medicines

Answer 9

Main Side Effects 1. Intra –cerebral haemorrhage 4.2% of these 4.2 %, 1 in 100 will die as a result. 2. Angioedema 0.7% Bleeding-minor bleeding is common (IV site) Anaphylaxis Stats show the quicker the stroke is treated the better the outcome (4.5 hours window from start of symptoms)

Answer 10

Aspirin given on the day of admission or the following day for all patients in whom a haemorrhagic stroke, or other contraindication has been excluded one state dose of aspirin by moth or suppository aspirin should be avoided for 24 hours post thrombolysis as it would increase risk of bleeding

Answer 11

After stat dose: a)Patients in Sinus Rhythm 14 days aspirin 300 mg then clopidogrel 75 mg daily and then: Clopidogrel 75mg (unlicensed in TIAs) b) Patients in AF Remember: x5 increased stroke risk 14 days aspirin 300 mg depending on impact of stroke and then: Anticoagulation is usually initiated 10-14 days after stroke Remember also to alleviate symptoms of AF – rate control

Answer 12

All patients with previous stroke or TIA should be considered for treatment regardless of BP as it reduces risk of stroke by 37% If under 55 years old –an ACE inhibitor or an angiotensin receptor blocker (ARB). If 55 or older or African – Caribbean origin of any age – a calcium channel blocker or thiazide

Answer 13

Atorvastatin 40 mg – 80 mg is used 1ST line Statins should NOT be used in patients with haemorrhagic stroke unless risk of vascular event outweighs risk of haemorrhagic event.

Answer 14

High incidence of stroke in patients with diabetes Risk factor for stroke Sliding scale insulin may be indicated if glucose high on admission

Answer 15

Overweight / obese increases risk of stroke Smoking Increased Risk of stroke by ~50% Smoking cessation – risk returns to that of non-smoker after 5 years Alcohol -Effect on stroke risk controversial -Protective effect in light/moderate drinkers -Elevated risk in heavy alcohol consumption