1. STROKE EDUCATION
PHARMACY

2. STROKE MEDICATIONS

3. OBJECTIVES FOR THIS CLASS
Discuss how your medications help:
Prevent clots
Control blood pressure
Reduce cholesterol
Help control blood sugar
Control or alleviate pain
Prevent and relieve constipation

4. OBJECTIVES FOR THIS CLASS
Discuss why it is important to take your medications as directed:
Prevent strokes
Reduce cardiovascular disease
Prevent diabetic complications
Reduce pain
Prevent constipation

5. 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

6. 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)

7. 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

8. 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

9. 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

10. SIDE EFFECTS OF BLOOD PRESSURE MEDICATIONS
Dizziness
Fainting from low blood pressure
ALWAYS MAKE SURE YOU STAND UP SLOWLY

11. 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

12. 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

13. 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)

14. SIDE EFFECTS OF DIABETIC MEDICATIONS
Low blood sugar (hypoglycemia)
Diarrhea
Headache
Weight gain
TAKE THESE MEDICATIONS AS PRESCRIBED
CHECK YOUR BLOOD SUGAR AS DIRECTED
FOLLOW YOUR DIETARY PROGRAM

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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
Polyethylene glycol (Miralax) – draws water into the colon to soften the stool
Causes a bowel movement in 1-3 days, use for >7 days

23. TAKING MEDICATIONS AS DIRECTED
Prevent strokes
Reduce cardiovascular disease
Prevent diabetic complications
Reduce pain
Prevent constipation

24. WAYS TO HELP YOU TAKE YOUR MEDICATIONS

25. PHILLIPS MEDICATION DISPENSING SERVICE

26. 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

27. THANK YOU
Any questions?