ASC ASC Stroke Pharmacotherapy & Medication Management 2 — Questions and Answers
Question 1: Which oral anticoagulant class is preferred over warfarin for secondary stroke prevention in patients with non-valvular atrial fibrillation per current AHA guidelines?
- Direct oral anticoagulants (DOACs) (Correct answer)
- Warfarin with INR 2–3
- Low-molecular-weight heparin
- Aspirin plus warfarin combination
Correct answer: Direct oral anticoagulants (DOACs)
DOACs (apixaban, rivaroxaban, dabigatran, edoxaban) are preferred over warfarin for AF-related stroke prevention due to superior efficacy and safety profiles.
Question 2: A stroke patient with atrial fibrillation and acute ischemic stroke should typically have anticoagulation initiated within what timeframe to balance stroke recurrence versus hemorrhagic transformation risk?
- 4–14 days after stroke depending on infarct size (Correct answer)
- Immediately on admission
- After 30 days of antiplatelet therapy
- Only after MRI confirms no hemorrhage at 6 months
Correct answer: 4–14 days after stroke depending on infarct size
Guidelines recommend initiating anticoagulation between day 4 and 14 based on stroke severity and infarct size, balancing recurrence and bleeding risk.
Question 3: Which agent is the reversal medication for dabigatran in a stroke patient with life-threatening hemorrhage?
- Idarucizumab (Praxbind) (Correct answer)
- Protamine sulfate
- Vitamin K
- Andexanet alfa
Correct answer: Idarucizumab (Praxbind)
Idarucizumab is the specific reversal agent for dabigatran, a direct thrombin inhibitor, approved for emergency reversal.
Question 4: Statin therapy is recommended after ischemic stroke primarily to reduce recurrence risk through which mechanism?
- Plaque stabilization and LDL reduction (Correct answer)
- Blood pressure lowering
- Platelet inhibition
- Anticoagulant effect
Correct answer: Plaque stabilization and LDL reduction
Statins reduce recurrent stroke risk primarily by stabilizing atherosclerotic plaque and lowering LDL cholesterol levels.
Question 5: A patient with acute ischemic stroke not treated with tPA has a blood pressure of 220/120 mmHg. Per AHA guidelines, when should antihypertensive therapy be initiated?
- Only if BP exceeds 220/120 mmHg persistently or symptomatic end-organ damage is present (Correct answer)
- Immediately to prevent hemorrhagic transformation
- After 48 hours regardless of blood pressure value
- Only after neurology consult confirms no large vessel occlusion
Correct answer: Only if BP exceeds 220/120 mmHg persistently or symptomatic end-organ damage is present
For non-tPA patients, guidelines recommend withholding antihypertensives unless BP exceeds 220/120 or there is evidence of acute end-organ damage within the first 24–48 hours.
Question 6: Which pharmacologic agent is used to treat symptomatic cerebral vasospasm following subarachnoid hemorrhage in stroke program patients?
- Nimodipine (Correct answer)
- Nifedipine
- Amlodipine
- Verapamil
Correct answer: Nimodipine
Nimodipine, an oral calcium channel blocker with selective cerebrovascular activity, is the standard pharmacologic therapy for reducing vasospasm-related neurological deficits after SAH.
ASC ASC Stroke Pharmacotherapy & Medication Management 2
Which oral anticoagulant class is preferred over warfarin for secondary stroke prevention in patients with non-valvular atrial fibrillation per current AHA guidelines?