SCRN Pharmacological Management

Question 1

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

Accepted Answer

Alteplase (tPA)

Answer

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?

Accepted Answer

0.9 mg/kg, max 90 mg

Answer

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?

Accepted Answer

Stop the infusion and obtain emergent CT head

Answer

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?

Accepted Answer

Clopidogrel or aspirin

Answer

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?

Accepted Answer

Direct oral anticoagulants (DOACs)

Answer

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.

(SCRN) Stroke Certified Registered Nurse Practice Test

(SCRN) Stroke Certified Registered Nurse Practice Test

SCRN Pharmacological Management