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BCPS study guide

Stroke

QuestionAnswer
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
Created by: mjuhlin