STROKE EDUCATION
PHARMACY
STROKE MEDICATIONS
OBJECTIVES FOR THIS CLASS
1. Discuss how your medications help:
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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:
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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 lowdensity 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
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Low blood sugar (hypoglycemia)
Diarrhea
Headache
Weight gain
TAKE THESE MEDICATIONS AS PRESCRIBED
CHECK YOUR BLOOD SUGAR AS DIRECTED
FOLLOW 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:
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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?