Pharmaceutical care of stroke patients. Course activities

Transcription

1 Pharmaeutial are of stroke patients Course ativities

2 Pharmaeutial are of stroke patients Course ativities page 2 Case Stuy 1 4 Case Stuy 2 6 Case Stuy 3 8 Multiple Choie Questionnaire

3 Case Stuy 1 Mr Ferguson s wife omes in with a presription for a seven ay ourse of larithromyin 500mg twie a ay an for simvastatin 40mg at night. Mr Ferguson ha a stroke four months ago an was in the aute stroke unit at the loal hospital for two weeks followe y a perio in the rehailitation unit. Your reors show that he was starte on warfarin for atrial firillation after his stroke. His INR has een stale for five weeks. The last time simvastatin was ispense, the ose was 20mg at night. His other urrent meiines are: Aspirin 75mg aily Dipyriamole MR 200mg twie a ay Lisinopril 5mg aily Omeprazole 20mg aily pharmaeutial are of stroke patients 2

4 Disussion points Case Stuy 1 What are issues have you ientifie for this patient? What avie woul you offer? What woul you presrie or what reommenations woul you make aout this patient to their GP? ourse ativities 3

5 Case Stuy 2 The loal nursing home weekly presriptions arrive in the pharmay. One of the patients is on: Digoxin talets 125mirograms in the morning Phenytoin apsules 300mg aily Aspirin EC talets 75mg in the morning Dipyriamole MR apsules 200mg twie aily The nursing home manager asks for these in a suitale formulation for aministration via a nasogastri (NG) tue. In partiular, think aout: 1. What formulations woul you supply? 2. Whih formulations are not suitale for aministration via the NG tue? 3. Whih meiine formulation requires osage moifiation? pharmaeutial are of stroke patients 4

6 Disussion points Case Stuy 2 What are issues have you ientifie for this patient? What avie woul you offer? What woul you presrie or what reommenations woul you make aout this patient to their GP? ourse ativities 5

7 Case Stuy 3 Mr Best omes in to ollet his presription an asks why the ose of his Ramipril has een inrease. He says he was feeling fine ut when he was at the GP surgery, the nurse heke his loo pressure an the GP gave him the new presription. His reors show that Mr Best is an overweight 65 year ol non-insulin epenent iaeti with previous pepti uler who ha a TIA iagnose at the neurovasular lini five weeks ago an was starte on the following meiines: Clopiogrel 75mg aily Simvastatin 40mg The GP was instrute to monitor Mr Best s BP y the neurovasular lini. Mr Best s other meiines are: Glipizie 5mg at reakfast Metformin 500mg twie a ay Lansoprazole 15mg aily In partiular think aout: 1. Ientifying Mr Best s risk fators for a further stroke. 2. How you woul explain the reasons for the osage inrease to Mr Best? 3. What is the target BP that the GP shoul e aiming for? 4. What is the target HBA1 that the GP shoul e aiming for? 5. Is lopiogrel the most appropriate antiplatelet for Mr Best? pharmaeutial are of stroke patients 6

8 Disussion points Case Stuy 3 What are issues have you ientifie for this patient? What avie woul you offer? What woul you presrie or what reommenations woul you make aout this patient to their GP? ourse ativities 7

9 Multiple hoie questionnaire. This multiple hoie questionnaire (MCQ) allows you to test your unerstaning. Please tik either TRUE or FALSE for eah part (a to ) for eah of the 20 questions on the next five pages (page 9-13). Tear off the answer sheet on page 15 an opy your tiks onto this sheet, whih you an then return to NES Pharmay at the aress elow: NHS Euation for Sotlan (Pharmay) 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW Completion of this MCQ is optional to partiipants an you will not reeive an iniviual sore. However, suessful ompletion of the MCQ will arue an aitional 2.5 NES CE hours. Moel answers will e sent, at the en of the urrent euation an training year, to partiipants who have sumitte this MCQ. pharmaeutial are of stroke patients 8

10 Pharmaeutial are of stroke patients 1. In the ategorisation of stroke: a Ishaemi stroke aounts for approximately 80% of all strokes True False Thromoti strokes aount for approximately 50% of True False ishaemi strokes Haemorrhagi strokes aount for approximately 30% of all strokes True False Launar strokes aount for approximately 30% of ishaemi strokes True False 2. Treatale risk fators for stroke inlue: a smoking True False oesity True False family history True False hypertension True False 3. Non-treatale risk fators for stroke inlue: a previous stroke True False eing male True False raise holesterol True False iaetes True False 4. Some of the signs or symptoms of stroke are: a slurre speeh True False weakness own one sie True False heaahe True False hypothermia True False 5. With regar to signs an symptoms of stroke: a Speeh is likely to e affete if the stroke ours in the left ereral hemisphere True False Balane will e affete if the stroke ours in the ereellum True False Brain stem stroke is likely to affet respiration an alertness True False Emotion will e affete y a stroke in the ereellum True False ourse ativities 9

11 6. With regar to seonary prevention of ishaemi stroke: a stopping smoking reues the risk of stroke y approximately 80% True False antiplatelet therapy ereases the relative risk of vasular events y approximately 25% True False stopping smoking reues the risk of stroke y up to 50% True False antiplatelet therapy ereases the relative risk of stroke y approximately 45% True False 7. These meiines shoul e given within 48 hours of ishaemi stroke onset: a Alteplase True False Aspirin True False Enoxaparin True False Warfarin True False 8. The following shoul e use with aution in a patient with 75% aroti stenosis: a Aspirin True False Clopiogrel True False Dipyriamole True False Antihypertensives True False 9. The first line hoie of antiplatelets for seonary prevention of ishaemi stroke is: a Aspirin alone True False Aspirin an Clopiogrel True False Aspirin an Dipyriamole MR True False Clopiogrel alone True False pharmaeutial are of stroke patients 10

12 10. The following oses are reommene oses for antiplatelets use in seonary prevention of ishaemi stroke after the first 24 hours: a Aspirin 300mg aily for 14 ays then 75mg aily True False Clopiogrel 75mg aily True False Dipyriamole 100mg three times a ay True False Dipyriamole Moifie Release 200mg twie a ay True False 11. Some of the sie effets assoiate with ipyriamole are: a Nausea/vomiting True False Taste isturane True False Can worsen angina True False Heaahe True False 12. Whih of the following is true/false? a Statins shoul e isontinue if the ALT liver funtion test is more than three times the upper limit of normal True False Myopathy is a sie effet of statins True False Simvastatin is ontrainiate if warfarin is to e presrie True False Liver funtion tests shoul e taken efore starting a statin an within 12 weeks of starting therapy True False 13. Warfarin is iniate post ishaemi stroke in patients: a with non-arioemoli stroke True False with atrial firillation an over 80 years ol True False with atrial firillation True False with a aria emolus True False ourse ativities 11

13 14. The PROGRESS trial: a showe that lowering loo pressure reue reurrent stroke iniene True False use a thiazie iureti an an ACE inhiitor to lower loo pressure True False showe a reution in reurrent stroke even in normotensive patients True False was a ranomise linial trial True False 15. The following are the linial targets to e aime at post stroke: a Target loo pressure in a iaeti is 140/80mm Hg True False Target loo pressure in a iaeti is 130/85 mmhg True False Target loo pressure is 140/85 mmhg True False Target loo pressure is 130/80 mm Hg True False 16. With regar to stroke seonary prevention meiines: a Warfarin interats with simvastatin ut not atorvastatin True False Warfarin interats with atorvastatin ut not simvastatin True False Digoxin interats with simvastatin ut not atorvastatin True False Digoxin interats with atorvastatin ut not simvastatin True False 17. Dysphagia is: a asene of swallow True False iffiulty swallowing True False iffiulty speaking True False asene of speeh True False pharmaeutial are of stroke patients 12

14 18. The following formulations shoul NOT e aministere to patients at risk of aspiration: a talets True False liquis True False apsules True False suspensions True False 19. The moifie Rankin sale (mrs) is a tool to: a ientify iniviuals at high risk of stroke after TIA True False help iagnose if a patient has ha a stroke True False ategorise funtional outome after stroke True False reor level of isaility True False 20. The following avie shoul e given to patients to prevent stroke: a stop smoking True False take vitamin supplements True False if overweight, reommen weight loss True False inrease fruit an vegetale onsumption True False ourse ativities 13

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16 Pharmaeutial are of stroke patients: MCQ answer sheet Name Aress RPSGB Reg. No. 1. a T F 6. a T F 11. a T F 16. a T F 2. a 7. a 12. a 17. a 3. a 8. a 13. a 18. a 4. a 9. a 14. a 19. a 5. a 10. a 15. a 20. a T = True F = False ourse ativities 15

17 Please return to: NHS Euation for Sotlan (Pharmay) 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW pharmaeutial are of stroke patients 16

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19 3r Floor, 2 Central Quay 89 Hyepark Street Glasgow G3 8BW Tel: Fax: