Clinical Pharmacy Note RE: Stroke

Mar 6/17 1330h Clinical Pharmacy Note RE: Secondary Stroke Prevention

ID: 41 yo male admitted with stroke
(Mar 6 Head CT showed established infarct in L side with no signs of hemorrhage)

S/O: v/s: T 36.5, BP 125/65, HR 76, RR 9

  • RASS -1 to 0, aphasia but still able to answer yes/no questions
  • Aspirin 325mg PR load given at 1720 hr on Mar 5, 17 but 80mg daily is held by neurology until infective endocarditis (IE) can be ruled out with negative BCx
  • Due to previous IVDU (on methadone daily, urine + cannabis, opioids, amphetamines), suspecting septic emboli from IE
    • ECHO for IE w/u pending (currently empirically txed with pip/taz and vanco)
    • BCx prelim, results (Mar 5): G+ cocci likely streptococcus or enterococcus
  • Hgb (Mar 6): 78 (stable)

A:

  • Maintenance aspirin is necessary to help ↓ the risk of early and future recurrent ischemic stroke and ↓ the risk of mortality
  • There are no contraindications to use of aspirin with IE. No suspected intracranial hemorhage
  • Patient has no previous history of CVA or TIA, therefore currently no strong need for clopidogrel
  • No significant drug interactions with ASA (low risk of increased bleeding with escitalopram)

P: Suggest

  • Start ASA 80mg daily (life long). Continue Dalteparin SC (VTE Px dose)
  • Monitor for s/s of ischemic stroke: one-sided weakness, numbness, trouble speaking, trouble seeing, severe headache, confusion
  • Monitor for SEs of ASA: bleeding (tarry stools, hematuria), GI upset, hemorrhagic stroke (severe headache, bizarre behaviour), daily CBCs
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