Acting with Expediency: Medication as the Cornerstone of ...



Acting with Expediency: Medication as the Cornerstone of Stroke Prevention and TreatmentPharmacist Post-testPharmacist Learning Objectives:DISTINGUISH types of stroke by presentation to determine appropriate treatment LIST proper dosage, administration, and monitoring knowledge for the healthcare teamGIVE providers and patients the most up to date evidence-based medicine DEMONSTRATE ability to manage community-based post-stroke patients safely and effectively 1. Which patient is most likely experiencing a transient ischemic attack (TIA)? A. 55 year old female describes a sudden onset of the worst headache of her lifeB. 36 year old male describes difficulty walking and visual disturbances in one eyeC. 20 year old female describes one-sided facial weakness that resolved rapidly2. According to the AHA/ASA quality initiative to reduce door-to-needle (DTN) times for patients eligible for tPA, what is the optimal DTN?A. 30 minutes or fewer B. 60 minutes or fewerC. 100 minutes or fewer 3. The medical team is about to administer IV alteplase to an AIS patient. Right before treatment initiation, you check the patient’s blood pressure and it is 195/120 mmHg. How should you proceed? A. Do not administer IV alteplase until BP is below 185/110B. Administer IV alteplase, but monitor BP closely C. Do not administer IV alteplase until BP is below 130/1054. Sally notices her husband John is “acting funny” when he arrives home from work. During dinner, he becomes progressively worse, still able to talk, but not making much sense. After dinner, Sally drives him to the nearest emergency room. Upon neurologic exam, the patient understands questions and responds appropriately, but he articulates his words poorly. The patient nearly falls when walking across the room. How should the medical team proceed? A. Administer unfractionated heparinB. Perform emergency brain imagingC. Administer recombinant alteplase 5. Which patient is most eligible for secondary stroke prevention with clopidogrel and aspirin Dual Antiplatelet Therapy (DAPT)? A. A 5 month post-AIS patient with PMH significant for atherosclerotic cardiovascular diseaseB. A 24 hour post-AIS patient with CYP2CC19 loss of function allele C. A 12 hour post-AIS patient with PMH significant for uncontrolled hypertension6. View this sample prescription order and identify the source of error.John Smith 85 year old male, 55kg. IV TPA 5 mg bolus over one minute, followed by 45 mg infused over 60 minutes Dr. Joe Shmo A. Dose B. Medication name C. Administration route7. Which of the following contains the two possible routes of administration for alteplase? A. Intramuscular and intravenous B. Subcutaneous and intravenous C. Intra-arterial and intravenous8. Identify the WHO global health improvement priority for stroke.A. 25% reduction in overall mortality from select noncommunicable diseases B. 20% decline in the stroke death rate over the next decadeC. 75% of stroke patients access EMS service annually over five years9. A customer just discharged from the local hospital after having a stroke comes to the pharmacy for prescriptions. The technician tells the customer there is nothing here and to check back later. You hear this interaction and ask the customer his name, so you can follow up. You go about your day and remember that this patient is waiting for secondary prevention prescriptions right before closing. You find the patient’s profile and still nothing. What would be the best way to proceed? A. It is right before closing, so even if the hospital sent in the prescriptions, there wouldn’t be enough time to fill and dispense them. Therefore, you make a note to follow up tomorrow.B. Call the local hospital and tell them you never received the prescriptions, so you would appreciate if they resent them. Provide your pharmacy phone number and fax number.C. Call the patient to let him know you never received the prescriptions. Call the hospital and suggest the administrator send the prescriptions to the 24-hour pharmacy down the street. 10. What is the MOST SIGNIFICANT risk factor for stroke?A. HypertensionB. SmokingC. Diabetes11. Which of the following is one of the five common symptoms of stroke?Severe headacheNausea and vomitingSevere arm pain on one side of the body12. A patient had an embolic stroke from atrial fibrillation and you see her in the community pharmacy 60 days later for a refill. You see her medication profile includes atorvastatin 80 mg daily, aspirin 650 mg twice daily, ibuprofen 400 mg daily. Which of the following two issues you should notice?The atorvastatin dose is too high and the patient needs an anticoagulantThe aspirin dose is too low and the patient’s atorvastatin dose is too highThe patient needs an anticoagulant and the aspirin dose is too high ................
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