ASC ASC Stroke Pharmacotherapy & Medication Management 1 — Questions and Answers
Question 1: What is the standard IV alteplase (tPA) dose for acute ischemic stroke in eligible adult patients?
- 0.9 mg/kg (max 90 mg), 10% as bolus then remainder over 60 min (Correct answer)
- 1.0 mg/kg (max 100 mg) over 30 minutes
- 0.6 mg/kg (max 60 mg) over 60 minutes
- 0.9 mg/kg (max 90 mg) infused over 30 minutes
Correct answer: 0.9 mg/kg (max 90 mg), 10% as bolus then remainder over 60 min
The AHA-recommended alteplase dose is 0.9 mg/kg with a maximum of 90 mg, with 10% given as an IV bolus and the remaining 90% infused over 60 minutes.
Question 2: Which antihypertensive agent is considered first-line for blood pressure management in acute ischemic stroke patients who are tPA candidates with BP > 185/110 mmHg?
- IV labetalol or IV nicardipine (Correct answer)
- Oral amlodipine
- IV hydralazine alone
- Sublingual nifedipine
Correct answer: IV labetalol or IV nicardipine
AHA guidelines recommend IV labetalol or IV nicardipine to lower BP below 185/110 prior to tPA administration in acute ischemic stroke.
Question 3: For how long after IV tPA administration should blood pressure be maintained below 180/105 mmHg?
- 24 hours (Correct answer)
- 12 hours
- 6 hours
- 48 hours
Correct answer: 24 hours
AHA guidelines specify BP must be kept below 180/105 mmHg for 24 hours after tPA to reduce the risk of hemorrhagic transformation.
Question 4: A patient receives IV tPA and develops orolingual angioedema 30 minutes into the infusion. What is the immediate pharmacologic intervention?
- Stop infusion, administer diphenhydramine, ranitidine, and IV methylprednisolone (Correct answer)
- Continue infusion and give epinephrine only if airway threatened
- Administer subcutaneous epinephrine and continue tPA at half dose
- Stop infusion and administer protamine sulfate
Correct answer: Stop infusion, administer diphenhydramine, ranitidine, and IV methylprednisolone
Orolingual angioedema from tPA requires stopping the infusion and administering antihistamines, H2 blockers, and corticosteroids; epinephrine is added for severe airway compromise.
Question 5: Which antiplatelet agent is recommended for secondary stroke prevention in patients with non-cardioembolic ischemic stroke who cannot tolerate aspirin?
- Clopidogrel (Correct answer)
- Ticagrelor
- Prasugrel
- Dipyridamole alone
Correct answer: Clopidogrel
Clopidogrel is guideline-recommended as an alternative antiplatelet agent for secondary prevention when aspirin is contraindicated or not tolerated.
Question 6: What is the recommended early dual antiplatelet therapy (DAPT) regimen for minor ischemic stroke (NIHSS ≤ 3) or high-risk TIA within 24 hours of symptom onset?
- Aspirin plus clopidogrel for 21 days then aspirin alone (Correct answer)
- Aspirin plus ticagrelor for 90 days
- Clopidogrel plus warfarin for 30 days
- Aspirin alone indefinitely
Correct answer: Aspirin plus clopidogrel for 21 days then aspirin alone
The POINT and CHANCE trials support aspirin plus clopidogrel started within 24 hours and continued for 21 days to reduce early recurrent stroke risk.
ASC ASC Stroke Pharmacotherapy & Medication Management 1
What is the standard IV alteplase (tPA) dose for acute ischemic stroke in eligible adult patients?