STROKE EDUCATION

PHARMACY

STROKE MEDICATIONS

OBJECTIVES FOR THIS CLASS

1. Discuss how your medications help:

– Prevent clots– Control blood pressure– Reduce cholesterol – Help control blood sugar– Control or alleviate pain– Prevent and relieve constipation

OBJECTIVES FOR THIS CLASS

2. Discuss why it is important to take your medications as directed:

– Prevent strokes– Reduce cardiovascular disease– Prevent diabetic complications– Reduce pain– Prevent constipation

MEDICATIONS THAT PREVENT PLATELETS FROM STICKING TOGETHER

• Aspirin (Bayer) – stops the production of natural substances that makes platelets stick together

• Aggrenox (Aspirin/• Dipyridamole) – has two • Antiplatelet medicines that work together

• Clopidogrel (Plavix) – • Blocks the substance that makes platelets stick

together

ANTICOAGULANTS PREVENT CLOTS FROM FORMING

Medications that interfere with the chemicals that form the webbing in a clot

Warfarin (Coumadin)Rivaroxaban (Xarelto)Dabigatran (Pradaxa) Heparin Enoxaparin (Lovenox)

ANTICOAGULANTS MEDICATION REMINDERS

• Warfarin (Coumadin) – grapefruit juice, antibiotics and pain relievers can increase INR, while green leafy vegetable can decrease INR

• Rivaroxaban (Xarelto) - is not used with artificial heart valves

• Dabigatran (Pradaxa) – swallow the pills whole and take with a full glass of water to help the pill get to your stomach

• Heparin – smoking can decrease the effect of this medication

• Enoxaparin (Lovenox) – inject under the skin on the abdomen, change sites each time, is not used if you have an allergy to pork

SIDE EFFECTS OF ANTIPLATELET AND ANTICOAGULANT MEDICATIONS

• Antiplatelets– Stomach ulcers - burning pain in the stomach

between meals or at night– Vomiting up contents that look like coffee

grounds– Intestinal bleeding - black, dark red or bright

red stools

• Anticoagulants– Intestinal or other bleeding – if it is severe

enough it can result in high losses of blood

MEDICATIONS THAT CONTROL BLOOD PRESSURE

• Enalapril (Vasotec), Lisinopril (Zestril), Ramipril (Altace)– can help the blood vessels enlarge to reduce blood pressure

• Amlodipine (Norvasc), Diltiazem (Cardizem) – dilates the arteries and slows down your heart rate to reduce blood pressure

• Hydrochlorothiazide (Microzide) – increases the production of urine to reduce blood volume, which lowers your blood pressure

• Metoprolol (Lopressor), Carvedilol (Coreg), Atenolol (Tenormin) – decreases the force of the heart’s contractions and dilates blood vessels to improve blood flow

SIDE EFFECTS OF BLOOD PRESSURE MEDICATIONS

• Dizziness• Fainting from low blood pressure

ALWAYS MAKE SURE YOU STAND UP SLOWLY

MEDICATIONS THAT LOWER YOUR CHOLESTEROL

• Atorvastatin (Lipitor), Simvastatin (Zorcor), Rosuvastatin (Crestor) – lowers your levels by stopping the process of making cholesterol in your body

• Decreases total cholesterol levels and low-density lipoprotein (LDL)

REDUCES YOUR RISK OF HEART ATTACK AND STROKE

SIDE EFFECTS OF CHOLESTEROL LOWERING MEDICATIONS

• Statins– Muscle soreness – the medication can reduce

the energy production in your muscle cells – Monitor liver and kidney functions – to see if

any damage is happening to your muscles

• Other medications – Constipation – Diarrhea

DIABETES MEDICATIONS REDUCE YOUR RISK FOR STROKE

• Blood with too much sugar can increase your blood pressure, damage the walls of your vessels and lead to the formation of plaques

• Oral medications – increase sensitivity or release of insulin

• Metformin (Glucophage), Glyburide (Diabeta), Glipizide (Glucotrol), Glimepiride (Amaryl)

• Sitagliptin (Januvia), Saxagliptin (Onglyza )• Injectable medications – replace insulin or increase

release of insulin– Insulin – Humalog, Lantus, Levemir– Exenatide (Byetta), liraglutide (Victoza)

SIDE EFFECTS OF DIABETIC MEDICATIONS

• Low blood sugar (hypoglycemia)• Diarrhea • Headache• Weight gain

TAKE THESE MEDICATIONS AS PRESCRIBED CHECK YOUR BLOOD SUGAR AS DIRECTEDFOLLOW YOUR DIETARY PROGRAM

PAIN

• Pain after a stroke can be:– Mild, moderate or severe– Constant or Intermediate (on then off type of pain)– Aching, burning, sharp, stabbing or itching

COULD COVER THE WHOLE SIDE OF YOUR BODY AFFECTED BY STROKE

DIFFERENT PAINS MEAN DIFFERENT TREATMENT KINDS OF TREATMENT

TRY TO DESCRIBE YOUR PAIN TO YOUR DOCTOR

COMMON CAUSES OF PAIN

• Inflammation• Weakness of the muscles that support limbs • Can be traced to nerve damage, bedsores or

immobilized joints– Lying or sitting in one position for too long causes

the body and joints to stiffen and ache• Improperly fitted braces, slings or special shoes

Sometimes stroke damage to the brain can make a normal touch feel painful

WAYS TO MANAGE PAIN

• Always report pain to your doctor• Weakened or paralyzed arms or legs can

be positioned or splinted to reduce discomfort

• Heat packs or simple exercises may help relieve pain

• Supporting the paralyzed arm on a lapboard or while in bed using a pillow to elevate the arm

• Pain medications

DIFFERENT TYPES OF PAIN MEDICATIONS

Mild to moderate pain – Acetaminophen (Tylenol)– Ibuprofen (Advil), naproxen (Aleve), aspirin (Bayer)

Moderate to severe pain– Morphine (MS Contin), hydrocodone (Vicodin,

Norco), oxycodone (OxyContin)

•Topical patches and creams could be used with other pain medications at the site of pain

– Lidoderm patches, capsaicin cream, icy hot, deep heat rub

THINGS TO REMEMBER WHEN USING THESE MEDICATIONS

– Acetaminophen (Tylenol) – do not exceed recommended daily dose

• 4,000 mg or 3,000 mg a day if you have liver disease

– Ibuprofen (Advil), Naproxen (Aleve), Aspirin (Bayer) – use can increase your risk of stomach bleeding

• Black, dark red or bright red stools

– Morphine (MS Contin), Hydrocodone (Vicodin, Norco), Oxycodone (Oxycontin)

• can cause sedation, constipation

– Lidoderm patches, capsaicin cream, icy hot, deep heat rub• Skin irritation

CONSTIPATION CAN BE CAUSED BY:

• Poor water intake• Not enough fiber in your diet• A disruption of your diet, routine or exercise• Not enough activity or immobility• A lot of dairy in your diet• Stress• Not using the restroom when you need to • Overusing stimulant laxatives• Neurological conditions• Opioid pain and antidepressant medications, iron pills

COMMON MEDICATIONS FOR CONSTIPATION

• Psyllium (Metamucil), polycarbophil (Fibercon) – makes stool bulkier to stimulate a movement– 2-3 days to work, see your doctor if you are still constipated for

>1 week

• Senna (Senokot), bisacodyl (Dulcolax )– irritates the lining of the bowel, causing a stimulant laxative affect– Do not use for more than 10 days without talking to your

doctor

• Docusate (Colace) – softens the stool– Do not use for more than 10 days without talking to your

doctor

• Polyethylene glycol (Miralax) – draws water into the colon to soften the stool– Causes a bowel movement in 1-3 days, use for >7 days

TAKING MEDICATIONS AS DIRECTED

– Prevent strokes– Reduce cardiovascular disease– Prevent diabetic complications– Reduce pain– Prevent constipation

WAYS TO HELP YOU TAKE YOUR MEDICATIONS

PHILLIPS MEDICATION DISPENSING SERVICE

ST. LUKE’S PHARMACY PHONE NUMBER 473-6008

• Medication tracking card – card you carry in your purse/wallet so you can

give your medication information to other health care providers

THANK YOU

Any questions?