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NURS 2514 > STROKE MEDS > Flashcards

STROKE MEDS Flashcards

1
Q

What is the MOA of Labetalol (Trandate)?

A
  • blocks stimulation of beta 1 and beta 2 adrenergic receptor sites
  • blocking affect on alpha 1 receptor sites
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2
Q

What is the indication of Labetalol (Trandate)?

A

management of HTN

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3
Q

What is the therapeutic effect of Labetalol (Trandate)?

A

decreased BP

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4
Q

What are the adverse effects of Labetalol (Trandate)?

A
  • fatigue, weakness
  • bronchospasm
  • arrhythmias, bradycardia
  • CHF, pulmonary edema
  • orthostatic hypotension
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5
Q

What are the CI and precautions for Labetalol (Trandate)?

A
  • allergies/hypersensitivity
  • HF
  • pulmonary edema + pre-existing obstructive lung diseases
  • bradycardia and heart blocks

Precautions:
- renal/liver dysfunction
- DM

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6
Q

What are the nursing considerations and assessments of Labetalol (Trandate)?

A

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

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7
Q

Why does blood pressure increase with stroke?

A

a protective response to maintain cerebral perfusion

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8
Q

When do we administer BP meds?

A

ischemic stroke –> if BP extremely high

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9
Q

What are the parameters to administer anti-HTN meds for ischemic stroke?

A

syst. BP (>220mmHg) and diast. BP (>120mmHg)

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10
Q

What are the parameters to administer anti-HTN meds for hemorrhagic stroke?

A

syst BP >160 mmHg

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11
Q

What key facts to educate a patient that is on Labetalol?

A
  • 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
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12
Q

What is the key factor in the stimulation of new platelets and platelet aggregation?

A

Thromboxane A2

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13
Q

How does Aspirin correlate with thromboxane A2?

A

inhibits the formation of thromboxane A2 by platelets –> preventing platelet adhesion and aggregation

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14
Q

Why does thromboxane A2 matters in stroke?

A

stroke results from aggregation at site of endothelial damage

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15
Q

What is the MOA of Acetylsalicylic acid (Aspirin - NSAIDs)?

A

suppresses platelet aggregation by causing irreversible inhibition of cyclooxygenase (enzyme) = reduces risk of arterial thrombosis

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16
Q

What is the indication for Aspirin?

A

prophylaxis for MI and stroke

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17
Q

What is the therapeutic effect of Aspirin?

A

decreased incidence of stroke and MI

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18
Q

What adverse effects of Aspirin?

A
  • 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)
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19
Q

Which Cox is Aspirin blocking?

A

Cox 2 –> vasodilation

20
Q

What are the CI and precautions of Aspirin?

A
  • hypersensitivity/allergies
  • asthma
  • bleeding disorders or thrombocytopenia

precautions:
- renal dysfunction
- chronic alcohol abuse
- history of GI bleeds or ulcer disease
- liver disease

21
Q

What are the nursing considerations and assessments of Aspirin?

A

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

22
Q

What is the dose of Aspirin to prevent CAD?

A

81mg per day

23
Q

When would you start Aspirin for a pt that experienced an ischemic stroke?

A

within 48hrs of stroke onset (once daily for prevention of future strokes)

24
Q

What is the MOA of Tissue Plasminogen activator (tPa/alteplase - Thrombolytic)?

A

binds to fibrin in a blood clot and activates plasminogen –> forms plasmin and breaks down/dissolves the present clot

25
Q

What is the indication for tPA?

A

ischemic stroke

26
Q

What is the therapeutic effect of tPA?

A

break down clot and restore blood flow through the vessel

27
Q

What is the adverse effect of tPA?

A
  • bleeding
28
Q

Why does tPA cause bleeding?

A
  • plasmin destroys preexisting clots and can promote bleeding at sites that have recently healed
  • degradation of clotting factors which disrupts the ability for the body to coagulate when trauma or injury does occur
29
Q

What are the common sites for bleeding?

A

recent wounds, needle puncture sites, invasive procedures/surgery sites

30
Q

What are the ABSOLUTE CI of tPA?

A
  • previous intracranial bleeding
  • known intracranial lesions/tumors
  • active internal bleeding
  • suspected aortic dissection
31
Q

What are the RELATIVE CI of tPA?

A
  • severe uncontrolled HTN (>180/110 mmHg)
  • current anticoagulant use
  • traumatic/prolonged CPR/surgery (<3weeks ago)
  • recent internal bleeding (within 2-4 weeks)
  • pregnancy
  • active peptic ulcer
32
Q

What are the nursing considerations and assessments of tPA?

A

assess:
- screened carefully for ischemic stroke (confirmed by CT scan)
- pt history (contraindications)
- baseline coagulation blood work (INR, aPTT, platelets, hgb)
- VS and EKG
- GCS/neurocheks (d/t intracranial bleeding)
- bleeding (HIGH RISK)

nursing considerations:
- must be administered within 3-4.5 hrs of symptoms of onset
- hold all anticoagulants/antiplatelets for 24hrs
- avoid SC/IM injections (reduce risk of bleeding, minimize invasive procedures)
- given IV (fast onset)
- administered to re-establish blood flow through a blocked artery

33
Q

What are the parameters to administer tPA in a ischemic stroke?

A

syst. BP <185 mmHg, diast BP <110 mmHg

34
Q

What is the MOA of unfractionated heparin (anticoagulant)?

A

enhances the activity of antithrombin (protein - inactivates thrombin/factor Xa) = reduced fibrin production and clotting is suppressed

35
Q

What are the indications for unfractionated heparin?

A
  • DVT
  • post-op, SCI, stroke = DVT prophylaxis
36
Q

What is the therapeutic effect of unfractionated heparin?

A

prevention of new clots

37
Q

What are the adverse effects of unfractionated heparin?

A
  • bleeding/hemorrhage (10% of pts)
  • epidural hematoma (epidural/spinal anesthesia)
38
Q

What is HIT?

A

heparin-induced thrombocytopenia = immune-mediated disorder causing reduced platelet count and increase in thrombotic events (Ab develop against heparin-platelet complexes)

39
Q

What is the antidote for unfractionated heparin?

A

protamine sulfate

40
Q

What are the nursing considerations and assessment of unfractionated heparin?

A

assess:
- VS
-aPTT (activated partial thromboplastin time)
- platelets/HgB
- s/s of bleeding (pallor, bruising, bleeding gums, epistaxis, melena, hematuria)
- hands/feets CWCM –> signs of clots from HIT

nursing considerations:
- initiated within 48-72hrs of ischemic stroke
- SC or IV (hospital setting)
- monitor aPTT q4-6hrs on IV
- rapid acting

41
Q

What is the MOA of Atorvastatin (Lipitor - HMG-CoA reductase inhibitor)?

A
  • lower the rate of cholesterol production
  • HMG-CoA reductase synthesizes cholesterol = statins blocks the enzyme which decreases cholesterol production –> liver increases LDL receptors and hepatocytes remove LDL from blood
42
Q

What are the indications for Atorvastatin?

A
  • risk reduction for stroke, MI, angina
43
Q

What are the therapeutic effects of Atorvastatin?

A
  • lower LDL cholesterol
  • elevate HDL cholesterol
  • reduce triglycerides
44
Q

What are the adverse effects of Atorvastatin?

A

generally, well tolerated
- headaches, rash, memory loss, GI upset
- myopathy/rhabdomyolysis (mild 5-10%, rare myositis –> rhabdo)
- hepatotoxicity (05.-2%)
- muscle aches/cramps

45
Q

What are the nursing considerations and assessments for Atovastatin?

A

assess:
- serum lipid lvls and triglycerides
- LFTs

nursing considerations:
- administer in evening
- TERATOGENIC
- should not have grapefruit juice

NURS 2514 (4 decks)

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