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BCPS study guide
Stroke
Question | Answer |
---|---|
MOA of dabigatran | direct thrombin inhibitor |
MOA of apixaban | Factor Xa inhibitor |
MOA of rivaroxaban | Factor Xa inhibitor |
time frame for administration of TPA | 4.5 hours since last known normal |
dose of TPA for stroke | 0.9 mg/kg total dose max of 90 mg. give 10% as bolus f/b the rest as an infusion over 1 hour. |
exclusion criteria for TPA other than timing | preggers, improvement in s/sx, hx of SAH or ICH, internal bleeding, head trauma/surgery/stroke in last 3 months, major surgery/serious trauma in last 2 wks, GI/UT bleeding in last month, BP >185/110, warfarin trt with INR >1.7 or heparin or plt < 100,000. |
if pt not a candidate for TPA you give ASA. when and how much | give 325 mg initially within 48 hours of stroke onset f/b 81 mg daily as maintenance |
secondary prevention of stroke, medication options | ASA, Aggrenox (ASA + dipyrimadole), clopidogrel, cilostazol, warfarin [if pt also has afib, rheumatic mitral valve dz, mechanical heart valve, bioprosthetic valve, or left ventricular mural thrombus formation.] |
drug therapy recommendation for a pt with afib and a CHADS2 score of 0 | no therapy or ASA 81 mg |
drug therapy recommendation for pt with afib and a CHADS2 score of 1 | oral anticoagulant or if unsuitable for oral anticoag or per pt preference use ASA 81 mg AND clopidogrel 75 mg. exception if pt has high risk of major bleed |
drug therapy recommendation for pt with afib and a CHADS2 score of 2+ | oral anticoagulant or if unsuitable for oral anticoag or per pt preference use ASA 81 mg AND clopidogrel 75 mg. exception if pt has high risk of major bleed |