SCRN Pharmacological Management 1 — Questions and Answers
Question 1: A patient with acute ischemic stroke presents within 3 hours of symptom onset. Which medication is the first-line thrombolytic therapy?
- Alteplase (tPA) (Correct answer)
- Reteplase
- Streptokinase
- Tenecteplase
Correct answer: Alteplase (tPA)
Alteplase (IV tPA) is the FDA-approved first-line thrombolytic for acute ischemic stroke within the 3–4.5 hour window.
Question 2: What is the maximum dose of IV alteplase for acute ischemic stroke treatment?
- 0.9 mg/kg, max 90 mg (Correct answer)
- 1.2 mg/kg, max 120 mg
- 0.6 mg/kg, max 60 mg
- 0.9 mg/kg, max 100 mg
Correct 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.
Question 3: A patient receiving IV alteplase for acute ischemic stroke develops sudden severe headache and hypertension. What is the priority action?
- Stop the infusion and obtain emergent CT head (Correct answer)
- Slow the infusion rate and monitor closely
- Administer antihypertensive medication and continue infusion
- Administer fresh frozen plasma immediately
Correct 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.
Question 4: Which antiplatelet agent is recommended for secondary stroke prevention in patients with non-cardioembolic ischemic stroke?
- Aspirin
- Clopidogrel or aspirin (Correct answer)
- Warfarin
- Heparin
Correct 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.
Question 5: A patient with ischemic stroke secondary to atrial fibrillation is started on anticoagulation. Which drug class is preferred for long-term secondary prevention?
- Direct oral anticoagulants (DOACs) (Correct answer)
- Unfractionated heparin
- Low molecular weight heparin
- Aspirin plus clopidogrel
Correct 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.
Question 6: What is the target blood pressure goal during IV alteplase infusion for acute ischemic stroke?
- < 180/105 mmHg (Correct answer)
- < 140/90 mmHg
- < 160/100 mmHg
- < 200/110 mmHg
Correct 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.
Question 7: Which medication is used to rapidly lower blood pressure in a hypertensive emergency associated with acute ischemic stroke when tPA is indicated?
- Labetalol or nicardipine (Correct answer)
- Nitroprusside
- Hydralazine alone
- Oral amlodipine
Correct 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.
SCRN Pharmacological Management 1
A patient with acute ischemic stroke presents within 3 hours of symptom onset.
Which medication is the first-line thrombolytic therapy?