Stroke: Pharmacological Management

Question 1

Thrombolytic Therapy - Recombinant t-PA

Answer 1

It works by biding to plasmin, which stimulates fibrinolysis (breakdown of clots) of the atherosclerotic lesion

Question 2

Thrombolytic Therapy - Recombinant t-PA

Minimum dose

Answer 2

0.9mg/kg

Question 2

Thrombolytic Therapy - Recombinant t-PA

Maximum dose

Answer 2

90mg

Question 3

Thrombolytic Therapy - Recombinant t-PA

Loading dose

Answer 3

10% of the calculated dose and is administered over 1 minute

The remaining dose is administered over 1hr via infusion pump

Question 4

Thrombolytic Therapy - Recombinant t-PA

After the infusion is completed, the line is flushed with ____________

Provide rationale

Answer 4

20ml NS to ensure that all the medication is administered

Question 5

Thrombolytic Therapy - Recombinant t-PA

Side effects

Answer 5

Bleeding - most common for t-PA

*TPA is only for ischemic stroke; strictly not for hemorrhagic stroke

Question 6

Thrombolytic Therapy - Recombinant t-PA

Nursing responsibilities

Answer 6

1. Cardiac monitoring
2. V/S monitoring; are obtained every
   
   • 15mins for the first 2hrs
   • 30mins for the next 6hrs
   • every hr for 16hrs
3. BP should be maintained with the
   
   • Systolic pressure < 180mmHg
   • Diastolic pressure < 100mmHg
4. Airway management is instituted based on the patient’s clinical condition and arterial blood values

Question 7

IV heparin or low-molecular weight heparin
For ischemic stroke

Answer 7

Anticoagulant

Question 8

Stroke: Pharmacological Management

Answer 8

1. Thrombolytic Therapy - Recombinant t-PA
2. Anticoagulant
3. Careful maintenance of cerebral hemodynamics to maintain cerebral perfusion
4. Reduce ICP by:
   
   • Administering an osmotic diuretics (mannitol)
   • Maintaining PaCO2 within the range of 35-45mmHg
   • Positioning to avoid hypoxia

Question 9

Other Tx measures

Answer 9

1. Elevation of head of the bed to promote venous drainage and to lower increased ICP
2. Intubation with an endotracheal tube to establish patent airway, if necessary
3. Continuous hemodynamic monitoring
4. Systolic pressure should be maintained < 180mmHg, diastolic pressure < 100mmHg - to reduce the potential for additional bleeding or further ischemic damage
5. Neurologic assessment