AANN Comprehensive Review for Stroke Nursing, 2nd Edition, Ch. 6 Medications: Digital Version-Stroke Chapter 6

Stroke Chapter 6

Pdf Summary

This chapter reviews medications used in acute stroke care, prevention, and recovery, emphasizing the stroke nurse’s role in understanding indications, dosing, administration, monitoring, adverse effects, interactions, and patient education.<br /><br />For ischemic stroke prevention, antiplatelet therapy is selected individually; aspirin is commonly used, while clopidogrel or aspirin–dipyridamole are alternatives. Long-term dual antiplatelet therapy generally increases bleeding risk, though short courses may be appropriate after selected minor strokes or TIAs. Anticoagulants are used for cardioembolic risk, including atrial fibrillation; warfarin requires INR and interaction monitoring, while direct oral anticoagulants require attention to renal function and interactions. Bleeding is a major risk, and specific reversal agents are available. Anticoagulation is often delayed after acute ischemic stroke because of hemorrhagic transformation risk.<br /><br />Alteplase is the approved thrombolytic for eligible acute ischemic stroke patients within 4.5 hours; tenecteplase is a potential alternative in selected cases. Careful eligibility screening and frequent neurologic and blood-pressure monitoring are essential. Antiplatelets and DVT prophylaxis are generally withheld for 24 hours after thrombolysis pending assessment for bleeding.<br /><br />Other key treatments include individualized blood-pressure management; statins for atherosclerotic risk reduction; nimodipine after aneurysmal subarachnoid hemorrhage; and mannitol or hypertonic saline for cerebral edema or raised intracranial pressure. Routine seizure prophylaxis is generally not recommended after ischemic or intracerebral hemorrhagic stroke, but seizures should be treated. Glucose and temperature should be monitored and managed to avoid harmful extremes.<br /><br />The chapter also covers medications for post-stroke spasticity, depression, agitation, pain, sedation, cognitive or motor stimulation, and smoking cessation. Across drug classes, nurses should monitor for bleeding, hypotension, organ toxicity, metabolic changes, sedation, and drug interactions; use the lowest effective doses when appropriate; and explain medication schedules, expected effects, warning signs, and follow-up needs to patients and families.

Keywords

acute stroke care

ischemic stroke prevention

antiplatelet therapy

anticoagulants

alteplase

thrombolysis

blood pressure management

statins

nimodipine

patient education