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NURS 2514 > Pharmacology for Stroke > Flashcards

Pharmacology for Stroke Flashcards

1
Q

Drug example of beta-blocker for stroke

A

Labetalol (Trandate)

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2
Q

Labetalol (Trandate) MOA

A

Blocks stimulation of beta 1 and beta 2 adrenergic receptor sites. Also has blocking effect on alpha 1 receptor sites.

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3
Q

Indication for Labetalol (Trandate)

A

Management of hypertension

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4
Q

Therapeutic effect of labetalol (Trandate)

A

Decreased blood pressure

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5
Q

Adverse effects of labetalol (Trandate)

A

Fatigue, weakness
Bronchospasm
Arrhythmias, bradycardia
Congestive heart failure, pulmonary edema
Orthostatic hypotension

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6
Q

Precautions for labetalol (Trandate)

A

Allergies/ hypersensitivity
Heart failure
Pulmonary edema and pre-existing obstructive lung diseases
Bradycardia and heart blocks
Use cautiously in renal and liver dysfunction

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7
Q

Nursing considerations for labetalol (Trandate)

A

Administer with meals to increase absorption
Frequent monitoring of BP and pulse
Take apical pulse prior to admin, if <50bpm, hold and notify physician
Assess for orthostatic hypotension
Monitor intake/ output
Daily weights
Assess for signs of fluid overload (lung crackles, weight gain, edema, fatigue)

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8
Q

When receiving intravenous labetalol…

A

High alert medication → can be very dangerous
Patient must lay supine for 3 hours after admin
Vitals assessed q5-15 minutes during and after admin

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9
Q

Stroke specific info: labetalol

A

Commonly used in acute phase of stroke
Blood pressure usually rises following a stroke → thought to be a protective response to maintain cerebral perfusion
We only administer BP meds in ischemic stroke if the BP is extremely high

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10
Q

In order to administer thrombolytic therapy

A

Systolic BP must be less than 185 mmHg and diastolic BP must be less than 110 mmHg

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11
Q

If patient is not receiving thrombolytics for an ischemic stroke, then patient only requires antihypertensive if…

A

Systolic BP > 220 mmHg and diastolic > 120 mmHg

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12
Q

For hemorrhagic stroke, administer antihypertensive if…

A

Systolic > 160 mmHg

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13
Q

Patient education for labetalol (Trandate)

A

Abrupt withdrawal of labetalol can cause life threatening arrhythmias, hypertension, or myocardial infarction
Direct patient to make slow position changes → special caution when exercising, drinking alcohol, and in hot weather
Diabetic patients should have sugars monitored more closely → medication will mask warning signs of hypoglycemia (such as tachycardia)

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14
Q

What is cyclooxygenase?

A

Cyclooxygenase is an enzyme found in all tissues. It converts arachidonic acid into prostaglandins and other related compounds like thromboxane A2, also called TXA 2

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15
Q

What is COX 1?

A

COX 1 is found in almost all tissues and it is considered the “good cox”. It is like the housekeeper that protects many parts of the body.

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16
Q

How does COX 1 work?

A

It works in the stomach and protects the gastric mucosa by reducing gastric acid secretion and maintaining blood flow. It supports the kidneys by supporting renal blood flow. It promotes platelet aggregation by synthesizing thromboxane A2.

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17
Q

What is COX 2?

A

COX 2 comes into action during tissue injury. It mediates inflammation and sensitizes pain receptors. It also affects the brain where it facilitates fever and contributes to pain reception. It improves renal flow and dilate our blood vessels

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18
Q

What is the name for aspirin?

A

Acetylsalicylic acid

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19
Q

Acetylsalicylic acid MOA

A

Suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase

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20
Q

Indications for acetylsalicylic acid

A

Inflammatory disorders
Fever
Prophylaxis for myocardial infarction and stroke
Non-opioid analgesic

21
Q

Therapeutic effect of acetylsalicylic acid

A

Decreased pain
Decreased inflammation
Decreased incidence of stroke and MI

22
Q

Adverse effects of acetylsalicylic acid

A

Heart burn, nausea → take with food or full glass of water
GI bleeds → may cause anemia with chronic occult blood loss
Gastric ulceration, perforation, bleeding, hemorrhage → prophylaxis with a PPI is recommended
Bleeding → discontinue 1-2 weeks prior to surgical procedures
Renal impairment → acute, reversible impairment in renal function
Salicylism → syndrome resulting from high levels of aspirin

23
Q

Precautions of acetylsalicylic acid

A

Allergies/ hypersensitivity/ asthma
Bleeding disorders or thrombocytopenia
Use cautiously in renal dysfunction, chronic alcohol abuse, history of GI bleeds or ulcer disease, liver disease

24
Q

Nursing considerations for acetylsalicylic acid

A

Monitor for signs and symptoms of bleeding → hypotension, tachycardia, dizziness, weakness, pallor, bruising, bleeding gums, epitaxis, hematuria, melena, labs (CBC)
After procedures and injections → apply pressure to site to prevent bleeding and monitor the site carefully
Take aspirin with food or glass of water
Discontinue at least one week prior to surgery
Monitor renal function → weigh patient, urea and creatinine levels, urine output

25
Q

Aspirin - prevention of stroke

A

Thromboxane A2 → stimulates activation of new platelets and increases platelet aggregation
Often stroke result from platelet aggregation at site of endothelial damage
Aspirin prevents platelet adhesion and aggregation → inhibits the formation of thromboxane A2 by platelets

26
Q

Dose of aspirin for prevention of cardiovascular disease

A

81mg per day

27
Q

Treatment of aspirin after ischemic stroke

A

Initiate within 48 hours of stroke onset

28
Q

Most common sites for bleeding

A

Recent wounds
Sites of needle puncture
Sites of invasive procedures/ surgery

29
Q

Exemplar of thrombolytic

A

Tissue plasminogen activator (Alteplase)

30
Q

Tissue Plasminogen Activator (Alteplase) MOA

A

Binds to fibrin in a blood clot and activates plasminogen, forming plasmin (fibrinolytic enzyme) which breaks down and dissolves the clot

31
Q

Indications for Tissue Plasminogen Activator (Alteplase)

A

Acute MI
Ischemic stroke
Pulmonary embolus

32
Q

Therapeutic effect of Tissue Plasminogen Activator (Alteplase)

A

Break down clot and restore blood flow through the vessel

33
Q

Adverse effects for Tissue Plasminogen Activator (Alteplase)

A

There are two main reasons for bleeding:
1. Plasmin destroys preexisting clots and can promote bleeding at sites that have recently healed
2. Degradation of clotting factors which disrupts the ability for the body to coagulate when trauma or injury does occur

34
Q

Nursing considerations for Tissue Plasminogen Activator (Alteplase)

A

Patients are screened carefully admin - ischemic stroke must be confirmed on CT scan
Must be administered within 3-4.5 hrs of symptoms onset - “door to needle” < 60 min
Patient history taken to determine contraindications
Baseline coagulation blood work sent (INR, aPTT, platelets, hgb)
Frequent monitoring of vital signs and EKG monitoring
Glasgow Coma Scale and neurochecks - high risk for intracranial bleeding
Monitor for bleeding - major risk
Hold all anticoagulants and antiplatelets for 24hr
To reduce risk of bleeding → avoid subcut and IM injections, minimize invasive procedures, do not administer with anticoagulants, do not administer with antiplatelets

35
Q

Absolute contraindications for Tissue Plasminogen Activator (Alteplase)

A

Previous intracranial bleeding
Known intracranial lesions/ tumours
Active internal bleeding (with the exception of menses)
Suspected aortic dissection

36
Q

Relative contraindications for Tissue Plasminogen Activator (Alteplase)

A

Severe uncontrolled hypertension >180/110 mmHg
Current anticoagulant use
Traumatic/ prolonged CPR/ surgery <3 weeks ago
Recent internal bleeding (within 2-4 weeks)
Pregnancy
Active peptic ulcer

37
Q

TPA and stroke

A

Only use for ischemic stroke - must be confirmed with CT scan
Must be administered within 4.5 hours of symptom onset
Administered to reestablish blood flow through a blocked artery
Increases risk of intracranial hemorrhage

38
Q

Drug example of an anticoagulant

A

Unfractionated heparin

39
Q

Unfractionated heparin MOA

A

Enhance activity of antithrombin which is a protein that inactivates clotting factors (thrombin and factor Xa). Without these two clotting factors, there is reduced production of fibrin and clotting is suppressed

40
Q

Indications for unfractionated heparin

A

Pulmonary embolism
Deep vein thrombosis
Dialysis and open-heart surgery
Post-operative, spinal cord injury, stroke DVT prophylaxis → to be initiated within 48-72 hrs of ischemic stroke
Acute myocardial infarction

41
Q

Therapeutic effect of unfractionated heparin

A

Prevention of new clots

42
Q

Adverse effects of unfractionated heparin

A

Bleeding/ hemorrhage → develops in about 10% of patients
Epidural hematoma → can develop in patients with epidural/ spinal anaesthesia
Heparin Induced Thrombocytopenia (HIT) → immune mediated disorder causing reduced platelet count and increase in thrombotic events. Antibodies develop against heparin-platelet complexes
Antidote → Protamine Sulfate

43
Q

Nursing considerations for unfractionated heparin

A

Monitor vital signs
Labs → monitor aPTT (activated partial thromboplastin time), should be checked every 4-6 hrs when on a heparin infusion, monitor platelets and hgb
Monitor for signs and symptoms of bleeding → pallor, bruising, bleeding gums, epistaxis, melon, hematuria
Monitor hands and feet for colour, warmth, circulation, movement → signs of clots from heparin induced thrombocytopenia

44
Q

Drug example of HMG-CoA reductase inhibitor “statins”

A

Atorvastatin (Lipitor)

45
Q

HMG-CoA reductase inhibitor “statins” MOA

A

Lower the rate of cholesterol production
HMG-CoA reductase synthesizes cholesterol → statins block the enzyme which decreases cholesterol production
Liver increases LDL receptors and hepatocytes remove LDL from blood

46
Q

Indications for HMG-CoA reductase inhibitor “statins”

A

Hypercholesterolemia
Risk reduction for stroke, myocardial infarction, and angina
Diabetes

47
Q

Therapeutic effect of HMG-CoA reductase inhibitor “statins”

A

Lower LDL cholesterol
Elevate HDL cholesterol
Reduce triglycerides

48
Q

Nursing considerations for HMG-CoA reductase inhibitor “statins”

A

Check serum lipid levels and triglycerides
Should assess liver function (LFTs)
Administer in evening

49
Q

Additional info for HMG-CoA reductase inhibitor “statins”

A

Well tolerated overall, minimal side effects
Teratogenic
Should not have grapefruit juice

NURS 2514 (14 decks)

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