7/25/2019 MED DRUGS

1/17

Nurse Learner:

Gu, Jojie Faye

Clinical facilitator:

Karen Dianne D. Andiso , RN

DRUG SUD

7/25/2019 MED DRUGS

2/17

Ampicillin Sulbactam(Unasyn)

Drug class

anti"acterial

#re$nancy Cate$ory: %

Therapeutic efects%actericidal action a$ainst sensiti&e or$anis's( in)i"its synt)esis of "acterial

cell *all, causin$ cell deat).Indications

reat'ent of s+in and s+in structure, intraa"do'inal, and $ynecolo$ic

infections caused "y susce-ti"le 'icroor$anis's.

Contraindications

y-ersensiti&ity to -enicillins.

Side efects

Der'atolo$ic: Ras) /less t)an 012( eryt)e'a 'ultifor'e, e3foliati&e der'atitis,

urticaria. G4: Diarr)ea /512( "lac+, )airy ton$ue( Clostridiu' di6cile 7associated diarr)ea(

enterocolitis( $astritis( -seudo'e'"ranous colitis( sto'atitis. Genitourinary: 4ncreased %UN and creatinine( -resence of R%Cs and )yaline casts

in urine. e'atolo$ic: A$ranulocytosis( decreased ct, $", ly'-)ocytes, neutro-)ils,

R%C, -latelets, and 8%C( increased "aso-)ils, eosino-)ils, ly'-)ocytes,'onocytes, and -latelets( -ositi&e direct Coo'"s tests.

y-ersensiti&ity: y-ersensiti&ity /ana-)ylactic2 reactions /so'eti'es fatal2.

Local: #ain at 49 injection site /;12( -ain at 4< injection site, t)ro'"o-)le"itis at

injection site /512. 9eta"olic: =le&ated seru' al+aline -)os-)atase, AL, AS, and LD( reduced

seru' al"u'in and total -roteins.

Nursing implications

Assess'ent

istory: Aller$ies to -enicillins, ce-)alos-orins, or ot)er aller$ens( renal disorders(

lactation #)ysical: Culture infected area( s+in color, lesion( R, ad&entitious sounds( "o*el

sounds( C%C, LFs, renal function tests, seru' electrolytes, ct, urinalysis

eac)in$ -oints

a+e t)is dru$ aroundt)ecloc+. a+e t)e full course of t)era-y( do not sto- ta+in$ t)e dru$ if you feel "etter.

)is anti"iotic is s-eci>c to your -ro"le' and s)ould not "e used to selftreat

ot)er infections. !ou 'ay e3-erience t)ese side e?ects: Nausea, &o'itin$, G4 u-set /eat fre@uent

s'all 'eals2, diarr)ea. Re-ort -ain or disco'fort at sites, unusual "leedin$ or "ruisin$, 'out) sores,

ras), )i&es, fe&er, itc)in$, se&ere diarr)ea, di6culty "reat)in$.

Simvastatin/ocor2

http://www.rxlist.com/script/main/art.asp?articlekey=10215http://www.rxlist.com/script/main/art.asp?articlekey=10215

7/25/2019 MED DRUGS

3/17

Drug class

Anti)y-erli-ide'ic

9GCoA reductase in)i"itor

#re$nancy Cate$ory: B

Therapeutic efects 4t reduces total c)olesterol, LDLc)olesterol and tri$lycerides and increases

DLc)olesterol le&els.

Indications

o reduce t)e ris+ of coronary disease, 'ortality, and C< e&ents, includin$ C

7/25/2019 MED DRUGS

4/17

Therapeutic efects 4n)i"its &asoconstricti&e and aldosteronesecretin$ action of an$iotensin 44 "y

"loc+in$ an$iotensin 44 rece-tor on t)e surface of &ascular s'oot) 'uscle

and ot)er tissue cells..

Indications

y-etension, Ne-)e-atically in ty-e 0 dai"etic -atients, to reduce ris+ of C

7/25/2019 MED DRUGS

5/17

Side efects

A"do'inal fullness, atulence, "elc)in$.

/e3cessi&e dose2( nausea, &o'itin$, colon accu'ulation of )ydro$en $as(

)y-ernatre'ia.

Nursing implications

Assess'ent

istory: Aller$y to lactulose, lo*$alactose diet. dia"etes, -re$nancy, and lactation.

#)ysical: A"do'inal e3a'ination, "o*el sounds, seru' electrolytes, seru'

a''onia le&els.

eac)in$ -oints

Do not freeEe la3ati&e for'. As+ -atient to re-ort diarr)ea, se&ere "elc)in$,

a"do'inal fullness. Do not ad'inister ot)er la3ati&es *it) lactulose.

9ay "e ta+en *it) fruit juice or 'il+ to increase -alata"ility.

Notify -)ysician if diarr)ea /i.e., 'ore t)an 0 or 5 soft stoolsd2 -ersists 'ore

t)an 0H7HI ). Diarr)ea is a si$n of o&erdosa$e. Dose adjust'ent 'ay "e

indicated.

Aspirin /Salicylate2

Drug class

Anticoa$ulants,Anti-lateletsFi"rinolytics/)ro'"olytics2

Anti-yreticAnal$esic/nono-ioid2

Antir)eu'atic

NSA4D

#re$nancy Cate$ory: D

Therapeutic efects =3)i"its anti-yretic, antiina''atory and anal$esic e?ects. )e

anti-yretice?ect is due to an action on t)e )y-ot)ala'us,resultin$ in )eat

loss "y &asodilation of -eri-)eral "lood &essels. Antiina''atory e?ects are

'ediated "y a decrease in -rosta$landin synt)esis. 4t also decreases -latelet

a$$re$ation.

Indications

9ild to 'oderate -ain

Fe&er

4na''atory conditionsr)eu'atic fe&er, r)eu'atoid art)ritis, osteoart)ritis

Reduction of ris+ of recurrent stro+e

Reduction of ris+ of deat) or nonfatal 94 in -atients *it) )istory of infarction or

unsta"le an$ina -ectoris 94 -ro-)yla3is

Contraindications

7/25/2019 MED DRUGS

6/17

y-ersensiti&ity tosalicylates, se&ereane'ia, )istory of "lood coa$ulationdefects,

&ita'in K de>ciency, *ee+"efore and aftersur$ery,-re$nancy in t)elast

tri'ester

Side efects

G4:dys-e-sia, )eart"urn,anore3ia, nausea,e-i$astric disco'fort,-otentiation of

-e-ticulcer

Aller$ic:%ronc)os-as',ast)'ali+e sy'-to's,ana-)yla3is, s+in ras)es,urticaria

e'atolo$ic:-rolon$ation of "leedin$ti'e, t)ro'"ocyto-enia,leuco-enia,

t)er:)irst, fe&er,di'ness of &ision

Nursing implications

Assess'ent

istory: Aller$y to salicylates or NSA4Ds( aller$y to tartraEine( )e'o-)ilia,

"leedin$ ulcers, )e'orr)a$ic states, "lood coa$ulation defects,

)y-o-rot)ro'"ine'ia, &ita'in K de>ciency( i'-aired )e-atic function(

i'-aired renal function

#)ysical: S+in color, lesions( ( ei$)t) cranial ner&e function, orientation,

ree3es, a?ect( #, %#, -erfusion( R, ad&entitious sounds( li&er e&aluation,"o*el sounds( C%C, clottin$ ti'es, urinalysis, stool $uaiac, LFs, renal

function tests

eac)in$ -oints

Use t)e dru$ only as su$$ested( a&oid o&erdose. A&oid t)e use of ot)er o&er

t)ecounter dru$s *)ile ta+in$ t)is dru$. 9any of t)ese dru$s contain as-irin,

and serious o&erdose can occur. a+e t)e dru$ *it) food or after 'eals if G4 u-set occurs.

'ay e3-erience t)ese side e?ects: Nausea, G4 u-set, )eart"urn /ta+e dru$

*it) food2( easy "ruisin$, $u' "leedin$ /related to as-irins e?ects on "lood

clottin$2 Re-ort rin$in$ in t)e ears( diEEiness, confusion( a"do'inal -ain( ra-id or

di6cult "reat)in$( nausea, &o'itin$, "loody stools.

Azithromycin/it)ro'a32

Drug class

9acrolide /ty-ically anti"iotics2

#re$nancy Cate$ory: %

Therapeutic efects )e 'ec)anis' of action of aEit)ro'ycin is in)i"ition of -rotein synt)esis in

"acteria "y "indin$ to t)e MS ri"oso'al su"unit and -re&entin$

translocation of -e-tides.9acrolides are -rotein synt)esis in)i"itors. )e

'ec)anis' of action of 'acrolides is in)i"ition of "acterial

-rotein"iosynt)esis, and t)ey are t)ou$)t to do t)is "y -re&entin$

-e-tidyltransferase fro' addin$ t)e -e-tidyl attac)edto tRNA to t)e ne3t

a'ino acid /si'ilarily to c)lora'-)enicol2 as *ell as in)i"itin$

ri"oso'altranslocation.Anot)er -otential 'ec)anis' is -re'ature

dissociation of t)e -e-tidyltRNA fro' t)e ri"oso'e

7/25/2019 MED DRUGS

7/17

Indications

U--er lo*er res- tract infections, s+in soft tissue infections

Contraindications

y-ersensiti&ity to 'acrolides

Side efects

nausea and &o'itin$, )eadac)e, diEEiness, fati$ue, diarr)ea, dys-e-sia,a"do'inal -ain, anore3ia

Nursing implications

9onitor -atient for su-er infection /Dru$ 'ay cause o&er$ro*t) of none

susce-ti"le "acteria or fun$i2 a+e t)e full course -rescri"ed. Do not ta+e *it) antacids

Re-ort se&ere or *atery diarr)ea, se&ere nausea or &o'itin$, ras) or itc)in$,

'out) sores,&a$inal sores

sodium chloride

Drug class

=lectrolyte

#re$nancy Cate$ory: C

Therapeutic efects re-laces and 'aintains sodiu' and c)loride le&els *)ic) are essential ions

necessary in nor'al cellular 'eta"olis' Sodiu' is t)e 'ajor cation of t)e "odys e3tracellular uid. 4t -lays a crucial

role in 'aintainin$ t)e uid and electrolyte "alance. =3cess retention of

sodiu' results in o&er)ydration/ede'a, )y-er&ole'ia2, *)ic) is often treated

*it) diuretics. A"nor'ally lo* le&els of sodiu' result in de)ydration.

Indications

-ro-)yla3is of )eat -rostration or 'uscle cra'-s( c)loride de>ciency due to

dieresis or salt restrictions y-onatre'ia

Contraindications

con$esti&e )eart failure, se&erely i'-aired renal function, )y-ernatre'ia, uid

retention

Side efects

y-ernatre'ia, )y-o-otasse'ia, acidosis. Fluid and solute o&erload leadin$ todilution of seru' electrolyte le&el, CF, o&er)ydration, acute -ul'onary ede'a

Nursing implications

9onitor electrolytes, =CG, li&er and renal function studies".

Note le&el of consciousness.

Assess t)e )eart and lun$ sounds.

"ser&e SS of )y-ernatre'ia, us)ed s+in, ele&ated te'-erature, rou$) dry

ton$ue, and ede'a. 9onitor c $ra&ity and seru' sodiu' le&els

7/25/2019 MED DRUGS

8/17

otassium Chloride !Kaliu' Durules2

Drug class

=lectrolyte and *ater "alance a$ent

#re$nancy Cate$ory: A

Therapeutic efects re-laces and 'aintains sodiu' and c)loride le&els *)ic) are essential ions

necessary in nor'al cellular 'eta"olis' Sodiu' is t)e 'ajor cation of t)e "odys e3tracellular uid. 4t -lays a crucial

role in 'aintainin$ t)e uid and electrolyte "alance. =3cess retention of

sodiu' results in o&er)ydration/ede'a, )y-er&ole'ia2, *)ic) is often treated

*it) diuretics. A"nor'ally lo* le&els of sodiu' result in de)ydration.

Indications

-ro-)yla3is of )eat -rostration or 'uscle cra'-s( c)loride de>ciency due to

dieresis or salt restrictions y-onatre'ia

Contraindications

con$esti&e )eart failure, se&erely i'-aired renal function, )y-ernatre'ia, uid

retention

Side efects

y-ernatre'ia, )y-o-otasse'ia, acidosis. Fluid and solute o&erload leadin$ to

dilution of seru' electrolyte le&el, CF, o&er)ydration, acute -ul'onary ede'a

Nursing implications

9onitor electrolytes, =CG, li&er and renal function studies". Note le&el of consciousness.

Assess t)e )eart and lun$ sounds.

"ser&e SS of )y-ernatre'ia, us)ed s+in, ele&ated te'-erature, rou$) dry

ton$ue, and ede'a. 9onitor c $ra&ity and seru' sodiu' le&els

7/25/2019 MED DRUGS

9/17

Therapeutic efects ASA

Anal$esic and antir)eu'atic e?ects are attri"uta"le to as-irins a"ility to

in)i"it t)e synt)esis of -rosta$landins, i'-ortant 'ediators of ina''ation.

Anti-yretic e?ects are not fully understood, "ut as-irin -ro"a"ly acts in t)e

t)er'ore$ulatory center of t)e )y-ot)ala'us to "loc+ e?ects of endo$enous

-yro$en "y in)i"itin$ synt)esis of t)e -rosta$landin inter'ediary. 4n)i"itionof -latelet a$$re$ation is attri"uta"le to t)e in)i"ition of -latelet synt)esis of

t)ro'"o3ane A0, a -otent &asoconstrictor and inducer of -latelet

a$$re$ation. )is e?ect occurs at lo* doses and lasts for t)e life of t)e

-latelet /I days2. i$)er doses in)i"it t)e synt)esis of -rostacyclin, a -otent

&asodilator and in)i"itor of -latelet a$$re$ation

)e *ord cere"ro&ascular is 'ade u- of t*o -arts 7 cere"ro *)ic) refers to t)e lar$e -artof t)e "rain, and &ascular *)ic) 'eans arteries and &eins. o$et)er, t)e *ordcere"ro&ascular refers to "lood o* in your "rain. )e ter' cere"ro&ascular disease includesall disorders in *)ic) an area of t)e "rain is te'-orarily or -er'anently a?ected "yisc)e'ia or "leedin$ and one or 'ore of t)e cere"ral "lood &essels are in&ol&ed in t)e-at)olo$ical -rocess. Cere"ro&ascular disease includes stro+e, carotid stenosis, &erte"ralstenosis and intracranial stenosis, aneurys's, and &ascular 'alfor'ations.Restrictions in "lood o* 'ay occur fro' &essel narro*in$ /stenosis2, clot for'ation/t)ro'"osis2, "loc+a$e /e'"olis'2, or "lood &essel ru-ture /)e'orr)a$e2. Lac+ of su6cient"lood o* /isc)e'ia2 a?ects "rain tissue and 'ay cause a stro+e.%lood Flo* to t)e %rain

!our )eart -u'-s "lood u- to t)e "rain t)rou$) t*o sets of arteries, t)e carotid arteries andt)e &erte"ral arteries. )e carotid arteries are located in t)e front of your nec+ and are *)atyou feel *)en you ta+e your -ulse just under your ja*. )e carotid arteries s-lit into t)ee3ternal and internal arteries near t)e to- your nec+ *it) t)e e3ternal carotid arteriessu--lyin$ "lood to your face and t)e internal carotid arteries $oin$ into t)e s+ull. 4nside t)es+ull, t)e internal carotid arteries "ranc) into t*o lar$e arteries 7 t)e anterior cere"ral and'iddle cere"ral arteries, and se&eral s'aller arteries 7 t)e o-)t)al'ic, -osterior

7/25/2019 MED DRUGS

10/17

co''unicatin$, and anterior c)oroidal arteries. )ese arteries su--ly "lood to t)e front t*ot)irds of your "rain.

)e &erte"ral arteries e3tend alon$ side your s-inal colu'n and cannot "e felt fro' t)eoutside. )e &erte"ral arteries join to for' a sin$le "asilar artery near t)e "rain ste', *)ic)is located near t)e "ase of your s+ull. )e &erte"ro"asilar syste' sends 'any s'all"ranc)es into t)e "rain ste' and "ranc)es o? to for' t)e -osterior cere"ellar and -osterior'enin$eal arteries, *)ic) su--ly t)e "ac+ t)ird of your "rain. )e ju$ular and ot)er &einscarry "lood out of t)e "rain.%ecause t)e "rain relies on only t*o sets of 'ajor arteries for its "lood su--ly, it is &eryi'-ortant t)at t)ese arteries are )ealt)y. ften, t)e underlyin$ cause of an isc)e'ic stro+eis carotid arteries "loc+ed *it) a fatty "uildu- called -la@ue. Durin$ a )e'orr)a$ic stro+e,an artery in or on t)e surface of t)e "rain )as ru-tured or lea+s, causin$ "leedin$ andda'a$e in or around t)e "rain.8)ate&er t)e underlyin$ condition and cause are, it is crucial t)at -ro-er "lood o* ando3y$en "e restored to t)e "rain as soon as -ossi"le. 8it)out o3y$en and i'-ortantnutrients, t)e a?ected "rain cells are eit)er da'a$ed or die *it)in a fe* 'inutes. nce"rain cells die, t)ey cannot re$enerate, and de&astatin$ da'a$e 'ay occur, so'eti'esresultin$ in -)ysical, co$niti&e and 'ental disa"ilities.

tro+eStro+e is an a"ru-t interru-tion of constant "lood o* to t)e "rain t)at causes loss ofneurolo$ical function. )e interru-tion of "lood o* can "e caused "y a "loc+a$e, leadin$ tot)e 'ore co''on isc)e'ic stro+e, or "y "leedin$ in t)e "rain, leadin$ to t)e 'ore deadly)e'orr)a$ic stro+e. 4sc)e'ic stro+e constitutes an esti'ated IM -ercent of all stro+e cases.Stro+e 'ay occur suddenly, so'eti'es *it) little or no *arnin$, and t)e results can "ede&astatin$.Stro+e Sy'-to's8arnin$ si$ns 'ay include so'e or all of t)e follo*in$ sy'-to's, *)ic) are usually sudden:DiEEiness, nausea, or &o'itin$Unusually se&ere )eadac)eConfusion, disorientation or 'e'ory lossNu'"ness, *ea+ness in an ar', le$ or t)e face, es-ecially on one sideA"nor'al or slurred s-eec)Di6culty *it) co'-re)ensionLoss of &ision or di6culty seein$Loss of "alance, coordination, or t)e a"ility to *al+

y-es of Stro+e and reat'ent4sc)e'ic Stro+e4sc)e'ic stro+e is "y far t)e 'ost co''on ty-e of stro+e, accountin$ for a lar$e 'ajority ofstro+es. )ere are t*o ty-es of isc)e'ic stro+e: t)ro'"otic and e'"olic. A t)ro'"otic stro+eoccurs *)en a "lood clot, called a t)ro'"us, "loc+s an artery to t)e "rain and sto-s "loodo*. An e'"olic stro+e occurs *)en a -iece of -la@ue or t)ro'"us tra&els fro' its ori$inalsite and "loc+s an artery do*nstrea'. )e 'aterial t)at )as 'o&ed is called an e'"olus.o* 'uc) of t)e "rain is da'a$ed or a?ected de-ends on e3actly )o* far do*nstrea' int)e artery t)e "loc+a$e occurs.4n 'ost cases, t)e carotid or &erte"ral arteries do not "eco'e co'-letely "loc+ed and as'all strea' of "lood tric+les to t)e "rain. )e reduced "lood o* to t)e "rain star&es t)ecells of nutrients and @uic+ly leads to a 'alfunctionin$ of t)e cells. As a -art of t)e "rainsto-s functionin$, sy'-to's of a stro+e occur. Durin$ a stro+e, t)ere is a core area *)ere

"lood is al'ost co'-letely cut o? and t)e cells die *it)in >&e 'inutes. o*e&er, t)ere is a'uc) lar$er area +no*n as t)e isc)e'ic -enu'"ra t)at surrounds t)e core of dead cells.

)e isc)e'ic -enu'"ra consists of cells t)at are i'-aired and cannot function, "ut are stillali&e. )ese cells are called idlin$ cells, and t)ey can sur&i&e in t)is state for a"out t)ree)ours.4sc)e'ic stro+e is treated "y re'o&in$ t)e o"struction and restorin$ "lood o* to t)e "rain.ne treat'ent for isc)e'ic stro+e is t)e FDAa--ro&ed dru$, tissue -las'ino$en acti&ator/t#A2, *)ic) 'ust "e ad'inistered *it)in a t)ree)our *indo* fro' t)e onset of sy'-to'sto *or+ "est. Unfortunately, only 5 to -ercent of t)ose *)o su?er a stro+e reac) t)e)os-ital in ti'e to "e considered for t)is treat'ent. )is 'edication carries a ris+ forincreased intracranial )e'orr)a$e and is not used for )e'orr)a$ic stro+e. For -atients"eyond t)e t)ree)our ti'e *indo*, intrarterial t)ro'"olysis *it) dru$s or 'ec)anical

7/25/2019 MED DRUGS

11/17

de&ices 'ay "e an o-tion. Carotid endartercto'y, and or stentin$ of t)e cer&ical andintracranial &essels 'ay )el- reduce recurrent stro+e in so'e cases.

)e 9erci Retrie&er, a--ro&ed recently "y t)e FDA, is a cor+scre*s)a-ed de&ice used to)el- re'o&e "lood clots fro' t)e arteries of stro+e -atients. A s'all incision is 'ade in t)e-atients $roin, into *)ic) a s'all cat)eter is fed until it reac)es t)e arteries in t)e nec+. Att)e nec+, a s'all cat)eter inside t)e lar$er cat)eter is $uided t)rou$) t)e arteries until itreac)es t)e "rain clot. )e 9erci Retrie&er, a strai$)t *ire inside t)e s'all cat)eter -o+esout "eyond t)e clot and auto'atically coils into a cor+scre* s)a-e. 4t is -ulled "ac+ into t)eclot, t)e cor+scre* s-innin$ and $ra""in$ t)e clot. A "alloon inates in t)e nec+ artery,cuttin$ o? "lood o*, so t)e de&ice can -ull t)e clot out of t)e "rain safely. )e clot isre'o&ed t)rou$) t)e cat)eter *it) a syrin$e.e'orr)a$ic Stro+eA )e'orr)a$ic stro+e can "e caused "y )y-ertension, ru-ture of an aneurys' or &ascular'alfor'ation, or as a co'-lication of anticoa$ulation 'edications. An intracere"ral)e'orr)a$e occurs *)en t)ere is "leedin$ directly into t)e "rain tissue, *)ic) often for's aclot *it)in t)e "rain. A su"arac)noid )e'orr)a$e occurs *)en t)e "leedin$ >lls t)ecere"ros-inal uid s-aces around t)e "rain. %ot) conditions are &ery serious.e'orr)a$ic stro+e usually re@uires sur$ery to relie&e intracranial /*it)in t)e s+ull2 -ressurecaused "y "leedin$. Sur$ical treat'ent for )e'orr)a$ic stro+e caused "y an aneurys' ordefecti&e "lood &essel can -re&ent additional stro+es. Sur$ery 'ay "e -erfor'ed to seal o?t)e defecti&e "lood &essel and redirect "lood o* to ot)er &essels t)at su--ly "lood to t)esa'e re$ion of t)e "rain.=ndo&ascular treat'ent in&ol&es insertin$ a lon$, t)in, e3i"le tu"e /cat)eter2 into a 'ajorartery, usually in t)e t)i$), $uidin$ it to t)e aneurys' or t)e defecti&e "lood &essel, andinsertin$ tiny -latinu' coils /called stents2 into t)e "lood &essel t)rou$) t)e cat)eter. Stentssu--ort t)e "lood &essel to -re&ent furt)er da'a$e and additional stro+es.Reco&ery and re)a"ilitation are i'-ortant as-ects of stro+e treat'ent. 4n so'e cases,unda'a$ed areas of t)e "rain 'ay "e a"le to -erfor' functions t)at *ere lost *)en t)estro+e occurred. Re)a"ilitation includes -)ysical t)era-y, s-eec) t)era-y, and occu-ationalt)era-y.Re$ardless of *)at ty-e of stro+e )as "een su?ered, it is critical t)at &icti's recei&ee'er$ency 'edical treat'ent as soon as -ossi"le for t)e "est -ossi"le outco'e to "erealiEed. %y learnin$ t)e si$ns and sy'-to's of stro+e and treatin$ ris+ factors -re&enti&ely,you can )el- a&ert t)e de&astatin$ results of t)is disease.

ransient 4sc)e'ic Attac+ /4A2A 4A is a te'-orary cere"ro&ascular e&ent t)at lea&es no -er'anent da'a$e. 9ost li+ely

an artery to t)e "rain is te'-orarily "loc+ed, causin$ stro+eli+e sy'-to's, "ut t)e "loc+a$edislod$es "efore any -er'anent da'a$e occurs.Sy'-to's of a 4A 'ay "e si'ilar to stro+e, "ut t)ey resol&e @uic+ly. 4n fact, sy'-to's 'ay"e so &a$ue and eetin$ t)at -eo-le just "rus) t)e' o?, es-ecially *)en t)ey last just afe* 'inutes. 4A sy'-to's include:Sudden nu'"ness or *ea+ness of t)e face, ar' or le$, es-ecially on one side of t)e "odySudden confusion, trou"le s-ea+in$ or understandin$Sudden trou"le seein$ in one or "ot) eyesSudden trou"le *al+in$, diEEiness, loss of "alance or coordinationSudden, se&ere )eadac)e *it) no +no*n cause8)ile t)ere is no treat'ent for t)e 4A itself, it is essential t)at t)e source of t)e 4A "eidenti>ed and a--ro-riately treated "efore anot)er attac+ occurs. 4f you e3-erience 4Asy'-to's, see+ e'er$ency 'edical )el- and notify your -ri'ary care -)ysician

i''ediately. A"out 5M -ercent of all -eo-le *)o su?er a 'ajor stro+e e3-erience a -rior 4A,and M -ercent of all 4A &icti's su?er a stro+e *it)in t*o *ee+s. )e @uic+er you see+'edical attention, t)e sooner a dia$nosis can "e 'ade and a course of treat'ent started.=arly inter&ention is essential to e?ecti&ely -re&entin$ a 'ajor stro+e. reat'ent o-tions for

4A -atients focus on treatin$ carotid artery disease or cardiac -ro"le's.Ris+ FactorsAlt)ou$) t)ey are 'ore co''on in older adults, stro+es can occur at any a$e. Stro+e-re&ention can )el- reduce disa"ility and deat) caused "y t)e disease. Controlla"le ortreata"le ris+ factors for stro+e include:S'o+in$: !ou can decrease your ris+ "y @uittin$ s'o+in$. !our ris+ 'ay "e increased furt)erif you use so'e for's of oral contrace-ti&es and are a s'o+er. )ere is recent e&idence t)atlon$ter' second)and s'o+e e3-osure 'ay increase your ris+ of stro+e.

7/25/2019 MED DRUGS

12/17

i$) "lood -ressure: %lood -ressure of HMOM '' $ or )i$)er is t)e 'ost i'-ortant ris+factor for stro+e. Controllin$ your "lood -ressure is crucial to stro+e -re&ention.Carotid or ot)er artery disease: )e carotid arteries in your nec+ su--ly "lood to your "rain.A carotid artery narro*ed "y fatty de-osits fro' at)erosclerosis /-la@ue "uildu-s in artery*alls2 'ay "eco'e "loc+ed "y a "lood clot.istory of transient isc)e'ic attac+s /4As2.Dia"etes: 4t is crucial to control your "lood su$ar le&els, "lood -ressure, and c)olesterolle&els. Dia"etes, es-ecially *)en untreated, -uts you at $reater ris+ of stro+e and )as 'anyot)er serious )ealt) i'-lications.i$) "lood c)olesterol: A )i$) le&el of total c)olesterol in t)e "lood /0HM '$dL or )i$)er2 isa 'ajor ris+ factor for )eart disease, *)ic) raises your ris+ of stro+e.#)ysical inacti&ity and o"esity: %ein$ inacti&e, o"ese or "ot) can increase your ris+ of )i$)"lood -ressure, )i$) "lood c)olesterol, dia"etes, )eart disease and stro+e.Recent researc) s)o*s e&idence t)at -eo-le recei&in$ )or'one re-lace'ent t)era-y /R2)a&e an o&erall 0O -ercent increased ris+ of stro+e, in -articular isc)e'ic stro+e.Uncontrolla"le ris+ factors include:A$e: #eo-le of all a$es, includin$ c)ildren, )a&e stro+es. %ut t)e older you are, t)e $reateryour ris+ of stro+e.Gender: Stro+e is 'ore co''on in 'en t)an in *o'en.eredity and race: !ou )a&e a $reater ris+ of stro+e if a -arent, $rand-arent, sister or"rot)er )as )ad a stro+e. %lac+s )a&e a 'uc) )i$)er ris+ of deat) fro' a stro+e t)anCaucasians do, -artly "ecause t)ey are 'ore -rone to )a&in$ )i$) "lood -ressure, dia"etesand o"esity.#rior stro+e or )eart attac+: 4f you )a&e )ad a stro+e, you are at 'uc) )i$)er ris+ of )a&in$anot)er one. 4f you )a&e )ad a )eart attac+, you are also at )i$)er ris+ of )a&in$ a stro+e.Carotid Stenosis

)e carotid arteries su--ly o3y$enric) "lood to your "rain. #la@ue for's *)en t)e internalcarotid arteries "eco'e "loc+ed "y fat and c)olesterol "uildu-. )is -rocess is calledat)erosclerosis. Se&ere "loc+a$e is called carotid stenosis. Carotid stenosis 'ay cause youto e3-erience a 4A.Carotid stenosis is fre@uently asy'-to'atic. !our doctor 'ay detect it t)rou$) an a"nor'alsound called a "ruit /%RPe2 *)en listenin$ to your carotid arteries *it) a stet)osco-e.#atients usually >rst under$o a t)orou$) -)ysical e3a'ination. )is e3a'ination can re&eals-eci>c neurolo$ical, 'otor, and sensory de>cits t)at can -ro&ide clues a"out "ot) t)ee3tent and location of t)e "loc+a$e. 4f t)e -)ysician sus-ects stenosis, dia$nostic tests suc)as Do--ler ultrasound, carotid du-le3, or cere"ral an$io$ra-)y *ill "e reco''ended.

9edical reat'entreat'ent is deter'ined "y t)e e3tent of t)e narro*in$ and t)e condition of t)e -atient. For'any -eo-le *it) arteries narro*ed less t)an M -ercent, 'edication is -rescri"ed to )el-reduce t)e ris+ of isc)e'ic stro+e. )ese include anti)y-ertensi&es to control )i$) "lood-ressure, 'edications to reduce c)olesterol le&els, and anticoa$ulants to t)in "lood and-re&ent it fro' clottin$.Sur$eryCarotid endarterecto'y is a -rocedure in *)ic) t)e neurosur$eon 'a+es an incision in yourcarotid artery and re'o&es t)e -la@ue usin$ a dissectin$ tool. Re'o&in$ t)e -la@ue isacco'-lis)ed "y *idenin$ t)e -assa$e*ay, *)ic) )el-s to restore nor'al "lood o*. !ourartery *ill "e re-aired *it) sutures or a $raft. )e entire -rocedure usually ta+es a"out t*o)ours. !ou 'ay e3-erience -ain near t)e incision in your nec+ and so'e di6cultys*allo*in$ durin$ t)e >rst fe* days after sur$ery. 9ost -atients are a"le to $o )o'e after

one or t*o days, and return to *or+, usually *it)in a 'ont). !ou s)ould a&oid dri&in$ andli'it -)ysical acti&ities for a fe* *ee+s after your sur$ery.Carotid An$io-lasty and Stentin$An alternati&e, ne* for' of treat'ent, carotid an$io-lasty and stentin$, s)o*s so'e-ro'ise in -atients *)o 'ay "e at too )i$) ris+ to under$o sur$ery. Carotid stentin$ is a-rocedure in *)ic) a tiny, slender 'etal'es) tu"e is >tted inside your carotid artery toincrease t)e o* of "lood "loc+ed "y -la@ues. )e stent is inserted follo*in$ a -rocedurecalled an$io-lasty, in *)ic) t)e doctor $uides a "alloonti--ed cat)eter into your "loc+edartery. )e "alloon is inated and -ressed a$ainst t)e -la@ue, attenin$ it and reo-enin$t)e artery. )e stent acts as sca?oldin$ to -re&ent t)e artery fro' colla-sin$ or fro' closin$u- a$ain after t)e -rocedure is co'-leted.Cere"ral Aneurys's

7/25/2019 MED DRUGS

13/17

A cere"ral /or cranial2 aneurys' is an area *)ere a "lood &essel in t)e "rain *ea+ens,resultin$ in a "ul$in$ or "alloonin$ out of -art of t)e &essel *all. Usually, aneurys's de&elo-at t)e -oint *)ere a "lood &essel "ranc)es, "ecause t)e for+ is structurally 'ore&ulnera"le. )e disorder 'ay result fro' con$enital defects or fro' ot)er conditions suc) as)i$) "lood -ressure, at)erosclerosis /t)e "uildu- of fatty de-osits in t)e arteries2, or )eadtrau'a.Aneurys's occur in all a$e $rou-s, "ut t)e incidence increases steadily for indi&iduals a$e0 and older, is 'ost -re&alent in -eo-le a$es M to ;M, and a"out t)ree ti'es 'ore-re&alent in *o'en. )e outco'e for -atients treated "efore a ru-tured aneurys' is 'uc)"etter t)an for t)ose treated after, so t)e need for ade@uate e&aluation of -atientssus-ected of )a&in$ a cere"ral aneurys' is &ery i'-ortant.Unru-tured cere"ral aneurys's can "e detected "y nonin&asi&e 'easures, includin$ 9RAand a carotid an$io$ra'. A ru-ture can "e detected "y a C scan or lu'"ar -uncture. 4ft)ese tests su$$est t)e -resence of an aneurys', for'al cere"ral an$io$ra-)y 'ay "e-erfor'ed.#eo-le *)o su?er a ru-tured "rain aneurys' 'ay )a&e so'e or all of t)ese *arnin$ si$ns:localiEed )eadac)e, nausea and &o'itin$, sti? nec+, "lurred or dou"le &ision, sensiti&ity toli$)t /-)oto-)o"ia2, or loss of sensation. 9any -eo-le *it) unru-tured "rain aneurys's)a&e no sy'-to's. t)ers 'i$)t e3-erience so'e or all of t)e follo*in$ sy'-to's, *)ic)'ay "e -ossi"le si$ns of an aneurys': cranial ner&e -alsy, dilated -u-ils, dou"le &ision,-ain a"o&e and "e)ind eye, and localiEed )eadac)e.8)en cere"ral aneurys's ru-ture, t)ey usually cause "leedin$ in t)e "rain, resultin$ in asu"arac)noid )e'orr)a$e. %lood can also lea+ into t)e cere"ros-inal uid /CSF2 or areassurroundin$ t)e "rain and cause an intracranial )e'ato'a /a "lood clot2. %lood can irritate,da'a$e, or destroy near"y "rain cells. )is 'ay cause -ro"le's *it) "odily functions or'ental s+ills. 4n 'ore serious cases, t)e "leedin$ 'ay cause "rain da'a$e, -aralysis orco'a. Ru-tured "rain aneurys's are fatal in a"out M -ercent of cases.Sur$eryAn o-eration to cli- t)e aneurys' is -erfor'ed "y doin$ a cranioto'y /o-enin$ t)e s+ullsur$ically2, and isolatin$ t)e aneurys' fro' t)e "loodstrea' usin$ one or 'ore cli-s, *)ic)allo*s it to deate. Sur$ical re-air of cere"ral aneurys's is not -ossi"le if t)ey are locatedin unreac)a"le -arts of t)e "rain. An$io$ra-)y is used to &isualiEe closure of t)e aneurys'and -reser&e nor'al o* of "lood in t)e "rain.A less in&asi&e tec)ni@ue *)ic) does not re@uire an o-eration, called endo&ascular t)era-y,uses 'icro cat)eters to deli&er coils to t)e site of t)e enlar$ed "lood &essel t)at occludes/closes u-2 t)e aneurys' fro' inside t)e "lood &essel. A -rocedure called "alloon assisted

coilin$ uses a tiny "alloon cat)eter to )el- )old t)e coil in -lace. A -rocedure calledco'"ination stent and coilin$ utiliEes a s'all e3i"le cylindrical 'es) tu"e t)at -ro&ides asca?old for t)e coilin$. Aneurys's 'ay "e treated *it) endo&ascular tec)ni@ues *)en t)eris+ of sur$ery is too )i$).8)ile t)e "est 'et)od of securin$ t)e aneurys' s)ould "e 'ade on an indi&idual "asis, in$eneral, -atients *it) a ru-tured cere"ral aneurys' s)ould "e treated as soon as -ossi"le.Sur$ical ris+s and outco'es de-end on *)et)er or not t)e aneurys' )as ru-tured, t)e siEeand location of t)e aneurys', and t)e -atients a$e and o&erall )ealt).#ostsur$ical co'-lications can include &asos-as' and )ydroce-)alus.

7/25/2019 MED DRUGS

14/17

"rain da'a$e. =&ery year, a"out four out of e&ery MM -eo-le *it) an A

7/25/2019 MED DRUGS

15/17

An$io$ra' 7 a study *)ic) s)o*s t)e "lood &essels leadin$ to and in t)e "rain "y injectin$ adye or contrast su"stance t)rou$) a cat)eter -laced in t)e artery of t)e le$.An$io$ra-)y 7 Radio$ra-)y of "lood &essels usin$ t)e injection of 'aterial o-a@ue to 3rays,to "etter de>ne t)e &essels.Anticoa$ulant 7 Any 'edicine t)at +ee-s "lood fro' clottin$( a "lood t)inner.Anti)y-ertensi&e 7 Any 'edicine or ot)er t)era-y t)at lo*ers "lood -ressure.Arac)noid 7 9iddle layer of 'e'"ranes co&erin$ t)e "rain and s-inal cord.Arterio&enous 7 Relatin$ to "ot) arteries and &eins.Artery 7 A "lood &essel t)at carries "lood a*ay fro' t)e )eart to t)e "ody.At)erosclerosis 7 A disease -rocess t)at leads to t)e "uildu- of fat and c)olesterol, called-la@ue, inside "lood &essels.%rain attac+ 7 Anot)er na'e for stro+e.%ruit 7 A sound 'ade in t)e "lood &essels resultin$ fro' tur"ulence, -er)a-s due to a"uildu- of -la@ue or da'a$e to t)e &essels.Carotid artery 7 A 'ajor artery on t)e ri$)t and left side of t)e nec+ su--lyin$ "lood to t)e"rain.Cere"ral e'"olis' 7 A "lood clot fro' one -art of t)e "ody t)at is carried "y t)e"loodstrea' to t)e "rain, *)ere it "loc+s an artery.Cere"ral )e'orr)a$e 7 %leedin$ *it)in t)e "rain resultin$ fro' a ru-tured "lood &essel,aneurys', or )ead injury.Cere"ral infarction 7 A stro+e caused "y interru-tion or "loc+a$e of "lood o* to t)e "rain(also called isc)e'ic stro+e.Cere"ral t)ro'"osis 7 For'ation of a "lood clot in an artery t)at su--lies "lood to -art of t)e"rain.Cere"ro&ascular 7 #ertainin$ to t)e "rain and t)e "lood &essels t)at su--ly it.Cere"ro&ascular occlusion 7 )e "loc+in$ or closin$ u- of a "lood &essel in t)e "rain.=ndarterecto'y 7 Re'o&al of fatty or c)olesterol -la@ues and calci>ed de-osits fro' t)einternal *all of an artery.=ndo&ascular 7 #ertainin$ to a sur$ical -rocedure in *)ic) a cat)eter containin$ 'edicationsor 'iniature instru'ents is inserted t)rou$) t)e s+in into a "lood &essel for t)e treat'ent of&ascular disease.ydroce-)alus 7 a condition in *)ic) e3cess cere"ros-inal uid /CSF2 "uilds u- *it)in t)e&entricles /uidcontainin$ ca&ities2 of t)e "rain and 'ay increase -ressure *it)in t)e )ead.4sc)e'ia 7 4nade@uate circulation of "lood $enerally due to a "loc+a$e of an artery.4sc)e'ic stro+e 7 A stro+e caused "y interru-tion or "loc+a$e of "lood o* to t)e "rain.

Ju$ular &eins 7 )e &eins t)at carry "lood "ac+ fro' t)e )ead to t)e )eart.

#la@ue 7 A de-osit of fatty /and ot)er2 su"stances in t)e inner linin$ of t)e artery *all, *)ic)usually leads to at)erosclerosis.Stent 7 A de&ice 'ade of e3-anda"le, 'etal 'es) t)at is -laced /"y usin$ a "allooncat)eter2 at t)e site of a narro*in$ artery. )e stent is t)en e3-anded and left in -lace to+ee- t)e artery o-en.Su"arac)noid )e'orr)a$e 7 %lood in, or "leedin$ into, t)e s-ace under t)e arac)noid'e'"rane, 'ost co''only fro' trau'a or fro' ru-ture of an aneurys'.

ransient isc)e'ic attac+ /4A2 7 A te'-orary interru-tion of t)e "lood su--ly to an area oft)e "rain( also called a 'inistro+e. 4t usually lasts only a fe* 'inutes and causes no-er'anent da'a$e or disa"ility.

7/25/2019 MED DRUGS

16/17

A stroke happens when the blood supply to part of the brain is blocked or interrupted for e#ample by a blood clot (where theblood thickens and solidifies). This is the most common cause of stroke and is known as an ischaemic stroke.The lack of blood causes part of the brain to die a process known as cerebral infarction. About %&' of strokes are caused bybleeding from the arteries in the brain which directly damages the brain!s tissues and can also cause loss of blood supply. Thisis known as haemorrhagic stroke or cerebral haemorrhage.The main symptoms of a stroke can be remembered using the acronym A"T which describes the aceArms"peechTimetest. *ach part of the test is e#plained below.ace the person!s face may have fallen on one side they may be unable to smile or their mouth or eye may have droopedArms they may be unable to raise one or both arms and keep them up as a result of weakness"peech they may have slurred speech and difficulty finding words or understanding what is said to themTime it!s time to dial +++ immediately if you see any of these signs or symptoms,ther common symptoms of stroke include sudden onset of:confusionunsteadiness or inability to walkloss of vision in one eye or on one side of the field of visionA stroke is a medical emergency the sooner treatment is given in hospital the less damage is likely to occur. -inutes count sodon!t delay calling +++.Transient ischaemic attack (TIA)A transient ischaemic attack (TIA) or ministroke is caused by a temporary disruption in the blood supply to part of the brain.This results in a lack of o#ygen and nutrition to that part of the brain which stops it working until the blood supply is restored.A TIA causes similar symptoms to a stroke but only lasts for a short period of time TIAs usually last from a few minutes up toan hour but any ischaemic attack lasting less than /0 hours is officially classed as a TIA.A TIA should always be taken seriously if it!s confirmed TIA is an early warning sign of an impending stroke that could happen

at any time particularly in the ne#t few days or weeks.If you or someone you know has a TIA contact your 12 local hospital or outofhours service immediately to arrange for aspecialist assessment."ubarachnoid haemorrhageA subarachnoid haemorrhage is a less common cause of a haemorrhagic stroke. It happens when blood leaks from bloodvessels on to the surface of the brain.The bleeding occurs in the arteries that run underneath a membrane in the brain known as the arachnoid which is located 3ustbelow the surface of the skull.The bleeding can cause a sudden and very severe headache often with neck stiffness. "omeone who!s had a subarachnoidhaemorrhage may not have any other symptoms of stroke although these may develop later as a result of complications of thebleeding.A subarachnoid haemorrhage is a medical emergency and needs immediate medical treatment to prevent serious complicationsbrain damage and death.

Around three4uarters of all subarachnoid haemorrhages are the result of an aneurysm rupturing (bursting). An aneurysm is abulge in a blood vessel caused by a weakness in the blood vessel wall.,ther causes of a subarachnoid haemorrhage include severe head in3ury and a rare type of birth defect called arteriovenousmalformation which affects normal blood vessel formation.5ascular dementia5ascular dementia is a common form of dementia that affects more than %67&&& people in the 89.The term vascular dementia describes a widespread and persistent loss of mental ability caused by damage to brain cells asthe result of a haemorrhage or a shortage of blood supply.5ascular dementia can occur as the result of a single stroke or multiple strokes or it can occur without any any other symptoms.hildrenerebrovascular diseases are much less common in children. $owever stroke can sometimes affect children.The "troke Association estimate that childhood stroke affects around ; out of every %&&&&& children in the 89 each year.hildren can have an ischaemic or haemorrhagic stroke as well as a TIA. $owever the common underlying causes are differentin children.In children stroke is often the result of pree#isting conditions such as congenital heart disease or sickle cell disease. It can alsobe caused by infections or an in3ury to the arteries in the neck during vigorous activities.The classic warning signs of a stroke are the same in adults and children.

7/25/2019 MED DRUGS

17/17

Acute coronary syndro'e is a ter' used for any condition "rou$)t on "y sudden, reduced"lood o* to t)e )eart. Acute coronary syndro'e sy'-to's 'ay include t)e ty-e of c)est-ressure t)at you feel durin$ a )eart attac+, or -ressure in your c)est *)ile youPre at restor doin$ li$)t -)ysical acti&ity /unsta"le an$ina2. )e >rst si$n of acute coronary syndro'ecan "e sudden sto--in$ of your )eart /cardiac arrest2. Acute coronary syndro'e is oftendia$nosed in an e'er$ency roo' or )os-ital.

Acute coronary syndro'e is treata"le if dia$nosed @uic+ly. Acute coronary syndro'e

treat'ents &ary, de-endin$ on your si$ns, sy'-to's and o&erall )ealt) condition.

Acute coronary syndro'e sy'-to's are t)e sa'e as t)ose of a )eart attac+. And if acutecoronary syndro'e isnPt treated @uic+ly, a )eart attac+ *ill occur. 4tPs i'-ortant to ta+eacute coronary syndro'e sy'-to's &ery seriously as t)is is a lifet)reatenin$ condition. CallO or your local e'er$ency nu'"er ri$)t a*ay if you )a&e t)ese si$ns and sy'-to's andt)in+ youPre )a&in$ a )eart attac+:

C)est -ain /an$ina2 t)at feels li+e "urnin$, -ressure or ti$)tness

#ain else*)ere in t)e "ody, suc) as t)e left u--er ar' or ja* /referred -ain2

Nausea