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Pharmacological Management Flashcards

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  1. A patient with acute ischemic stroke presents within 3 hours of symptom onset. Which medication is the first-line thrombolytic therapy?

    Answer: Alteplase (tPA)

    Alteplase (IV tPA) is the FDA-approved first-line thrombolytic for acute ischemic stroke within the 3–4.5 hour window.

  2. What is the maximum dose of IV alteplase for acute ischemic stroke treatment?

    Answer: 0.9 mg/kg, max 90 mg

    The standard dose of IV alteplase is 0.9 mg/kg with a maximum total dose of 90 mg.

  3. A patient receiving IV alteplase for acute ischemic stroke develops sudden severe headache and hypertension. What is the priority action?

    Answer: Stop the infusion and obtain emergent CT head

    Sudden severe headache and hypertension during tPA infusion suggest hemorrhagic transformation, requiring immediate cessation and emergent CT imaging.

  4. Which antiplatelet agent is recommended for secondary stroke prevention in patients with non-cardioembolic ischemic stroke?

    Answer: Clopidogrel or aspirin

    AHA/ASA guidelines recommend aspirin or clopidogrel (or their combination for high-risk TIA/minor stroke) for secondary prevention of non-cardioembolic ischemic stroke.

  5. A patient with ischemic stroke secondary to atrial fibrillation is started on anticoagulation. Which drug class is preferred for long-term secondary prevention?

    Answer: Direct oral anticoagulants (DOACs)

    DOACs (e.g., apixaban, rivaroxaban) are preferred over warfarin for secondary prevention in non-valvular atrial fibrillation-related ischemic stroke due to superior safety profiles.

  6. What is the target blood pressure goal during IV alteplase infusion for acute ischemic stroke?

    Answer: < 180/105 mmHg

    Blood pressure must be maintained below 180/105 mmHg during and for 24 hours after IV alteplase to minimize hemorrhagic risk.

  7. Which medication is used to rapidly lower blood pressure in a hypertensive emergency associated with acute ischemic stroke when tPA is indicated?

    Answer: Labetalol or nicardipine

    Labetalol (IV bolus) and nicardipine (IV infusion) are preferred agents for acute BP management pre-tPA due to their controllable, titratable effects.

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Sources & references

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  1. abnncertification.org — Fees, passing score, retake policy, score release, score validity, late registration, exam format, time limit, test dates, eligibility · verified Oct 2026
  2. test-takers.psiexams.com — Test delivery · verified Oct 2026