CVA
Common Drugs given to prevent another CVA
Those that have had have had an ischemic stroke, may need medicines to help lower the risk of having another CVA.
Anti-platelet drugs. Platelets are cells in the blood that form clots. Anti-platelet medicines make these cells less sticky and less likely to clot. The most commonly used anti-platelet medicine is aspirin. Your healthcare professional can recommend the right dose of aspirin for you.
Examples: Aspirin, Plavix, Brilinta
Sometimes both an aspirin and an anti-platelet medicine such as clopidogrel (Plavix) are taken together, or other times just one. These medicines may be prescribed for a period of time to reduce the risk of another stroke. Ticagrelor (Brilinta) is another anti-platelet medicine that can be used for stroke prevention.
Side Effects and Black Box warnings:
Bleeding – Hemorrhaging : CMAs must be on the watch for cues that a resident may be experiencing these and must report with documentation immediately. Excessive bleeding, nosebleeds, kicks from shaving, or internal bleeding as in the GI system, blood in the urine or stool. Be vigilant with falls or hits of any kind especially involving the head as subdural hematoma (bleeding in the brain) may occur and is life threatening!
Bruising: Easy bruising or unusual bruising
Gastrointestinal issues: Upset stomach, heartburn, or abdominal pain
Other side effects: Shortness of breath, dizziness, difficulty swallowing, chest pain, swelling in the face or hands, itching, hives, or tingling in the face or hands, wheezing, or skin rash
Blooding-thinning medicines, known as anticoagulants. These medicines reduce blood clotting.
Slower acting warfarin (Jantoven) may be used over a longer term. Warfarin (Coumadin) is a powerful blood-thinning medicine, and needs to be taken exactly as directed and watch for side effects. There absolutely must be regular blood tests to monitor warfarin's effects as it has a narrow therapeutic dose range.
Side Effects and Black Box warnings:
The black box warning of anticoagulants is excessive bleeding (hemorrhage), because these medicines increase the time it takes for blood clots to form, therefore the blood flows longer before clotting. Serious hemorrhage, including internal bleeding, is most commonly caused by incorrect dosing, or a fall or injury. Drugs such as warfarin have requirements for frequent labs to monitor the time it takes the blood to clot. It can change drastically in just a couple days resulting in frequent dosage changes. When a dosage change (or a lab) is missed and therefore the incorrect dosage is administered, the result can be a tragic hemorrhage. The CMA absolutely most be on top of warfarin and other anticoagulant lab orders, results and new orders as they change frequently. Do not be in a hurry on these, if you feel there is an issue, absolutely go ask the nurse!
Several newer blood-thinning medicines are available to prevent strokes in people who have a high risk. These medicines include dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis) and edoxaban (Savaysa). They work faster than warfarin and usually don't require regular blood tests or monitoring by your healthcare professional. These medicines also are associated with a lower risk of bleeding complications compared to warfarin.
Statins:
Statins help lower high cholesterol levels, and are commonly called the statin sisters, and are in the class of antilipemics. When your cholesterol levels are too high, cholesterol can start to build up along the walls of your arteries. This buildup is called plaque.
These drugs block an enzyme that your body needs to make cholesterol. As a result, your body makes less of it. This helps reduce the risk of plaque and prevent ministrokes and heart attacks caused by clogged arteries. Notice that these drugs are used both for MI and CVA as these two disease share many of the same causes and risk factors.
Common Statins include:
atorvastatin (Lipitor)
fluvastatin (Lescol)
lovastatin (Altoprev)
pitavastatin (Livalo)
pravastatin (Pravachol)
rosuvastatin (Crestor)
simvastatin (Zocor)
Common Side effects and black box warnings:
While statin drugs are taken by millions of people without problems there are some warnings a CMA must know about.
The FDA's advice to patients and healthcare professionals include: A warning that statins may cause cognitive impairment. These issues include memory loss, confusion, and forgetfulness.
As with many drugs, grapefruit and grapefruit juice should not be taken with statins.
Muscle pain, gas, liver damage especially in those with existing liver issues.
Signs and Symptoms of a CVA (stroke) This picture is great for stroke S/S and make it easy to remember. Remember, if someone is experiencing a CVA Time = Brain and is the reason why swift action must be taken.
