SCRN Pharmacological Management 2 — Questions and Answers
Question 1: A stroke patient on warfarin has an INR of 3.2 and presents with acute ischemic stroke. Which reversal agent is recommended?
- 4-factor prothrombin complex concentrate (PCC) (Correct answer)
- Fresh frozen plasma alone
- Vitamin K only
- Protamine sulfate
Correct answer: 4-factor prothrombin complex concentrate (PCC)
4-factor PCC rapidly reverses warfarin anticoagulation and is preferred over FFP alone due to faster onset and lower volume requirements.
Question 2: Which medication is specifically used to reverse dabigatran (a direct thrombin inhibitor) in acute hemorrhagic stroke?
- Idarucizumab (Praxbind) (Correct answer)
- Andexanet alfa
- Protamine sulfate
- Vitamin K
Correct answer: Idarucizumab (Praxbind)
Idarucizumab is a specific reversal agent for dabigatran, binding it with high affinity and rapidly neutralizing its anticoagulant effect.
Question 3: A patient with hemorrhagic stroke has been taking apixaban. Which reversal agent should the nurse anticipate administering?
- Andexanet alfa (Correct answer)
- Idarucizumab
- Protamine sulfate
- Fresh frozen plasma
Correct answer: Andexanet alfa
Andexanet alfa reverses factor Xa inhibitors such as apixaban and rivaroxaban by binding and sequestering the drug.
Question 4: Nimodipine is administered after subarachnoid hemorrhage primarily to prevent which complication?
- Cerebral vasospasm (Correct answer)
- Rebleeding
- Hydrocephalus
- Seizures
Correct answer: Cerebral vasospasm
Nimodipine, a calcium channel blocker, is administered for 21 days after SAH to reduce the incidence and severity of cerebral vasospasm.
Question 5: A stroke patient develops symptomatic cerebral edema. Which osmotic agent is commonly used to reduce intracranial pressure?
- Mannitol (Correct answer)
- Furosemide
- Dexamethasone
- Normal saline
Correct answer: Mannitol
Mannitol is an osmotic diuretic that creates an osmotic gradient to draw water from cerebral tissue, effectively reducing ICP.
Question 6: Which antiepileptic drug is most commonly used as prophylaxis or treatment for seizures in the early post-stroke period?
- Levetiracetam (Correct answer)
- Phenobarbital
- Valproic acid
- Carbamazepine
Correct answer: Levetiracetam
Levetiracetam is widely used for post-stroke seizure management due to its favorable side-effect profile and minimal drug interactions.
Question 7: A patient with ischemic stroke develops elevated glucose of 210 mg/dL. What is the recommended glucose management approach?
- Treat hyperglycemia with insulin to maintain glucose 140–180 mg/dL (Correct answer)
- Allow permissive hyperglycemia up to 250 mg/dL
- Administer dextrose to avoid hypoglycemia
- No glucose treatment required in acute stroke
Correct answer: Treat hyperglycemia with insulin to maintain glucose 140–180 mg/dL
Hyperglycemia worsens stroke outcomes; AHA/ASA guidelines recommend treating glucose > 180 mg/dL and maintaining levels between 140–180 mg/dL.
SCRN Pharmacological Management 2
A stroke patient on warfarin has an INR of 3.2 and presents with acute ischemic stroke.
Which reversal agent is recommended?