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  1. 1. Stroke Treatment Options
  2. 2. Treatment for Stroke• Medication• Rehabilitation and Therapy• Surgery• Lifestyle Changes• References
  3. 3. Stroke Medication• Emergency – Clot-busters: • Thrombolytic medications e.g. tissue Plasminogen Activator (tPA) (alteplase, Activase; Cathflo Activase) – Aspirin – Swelling reduction: • Corticosteroids such as cortisone and hydrocortisone – Neuroprotective agents (in development)• After stabilization
  4. 4. Stroke Medications• Anticoagulants (blood thinners) – warfarin (Coumadin), – enoxaparin (Lovenox) and – heparin.• Antiplatelet (prevent platelets from sticking) – aspirin, – clopidogrel (Plavix) and – dipyridamole (Aggrenox)
  5. 5. Stroke Medications• Statins (lower cholesterol) – atorvastatin (Lipitor), – rosuvastatin (Crestor), and – simvastatin (Zocor).• Blood pressure medicines (hypertensives)
  6. 6. Blood Pressure (BP) Medicines• Diuretics• Beta-Blockers• Alpha-Blockers• Calcium Channel Blockers• Angiotensin-Converting-Enzyme (ACE) Inhibitors• Angiotensin II Receptor Blockers• Vasodilators
  7. 7. BP Medicine (Diuretics)• Thiazide diuretics – chlorothiazide (Diuril), – chlorthalidone (Hygroton), – indapamide (Lozol), – hydrochlorothiazide (Esidrix, HydroDiuril) – , bendroflumethiazide (Naturen), – methylclothiazide, (Edduran), and – metolazone (Mykrox, Zaroxolyn).
  8. 8. BP Medicine (Diuretics)• Potassium sparing – amiloride (Midamor), – spironolactone (Aldactone), and – triamterene (Dyrenium).• Loop diuretics – bumetanide (Bumex), – furosemide (Lasix), – ethacrynic acid (Edecrin), and – torsemide (Demadex).
  9. 9. BP Medicine (Beta Blockers)• atenolol (Tenormin),• metoprolol (Lopressor),• nadolol (Corgard),• propranolol (Inderal), and• timolol (Blocadren
  10. 10. BP Medicine (Alpha Blockers)• Doxazosin (Cardura),• Phentolamine,• Tamsulosin (Flomax), and• Terazosin
  11. 11. BP Medicine (Calcium Channel Blockers)• Amlodipine (Norvasc),• Diltiazem (Cardizem LA, Tiazac),• Felodipine,• Isradipine (DynaCirc CR),• Nicardipine (Cardene SR),• Nifedipine (Procardia, Procardia XL, Adalat CC),• Nisoldipine (Sular),and• Verapamil (Calan, Verelan, Covera-HS)
  12. 12. BP Medicine (Angiotensin-Converting- Enzyme (ACE) Inhibitors )• benazepril• captopril• enalapril• fosinopril• lisinopril• moexipril• quinapril• ramipril
  13. 13. BP Medicine (Angiotensin II Receptor Blockers )• Candesartan (Atacand),• Eprosartan (Teveten),• Irbesartan (Avapro),• Losartan (Cozaar),• Olmesartan (Benicar),• Telmisartan (Micardis), and• Valsartan (Diovan)
  14. 14. BP Medicine (Vasodilators)• Hydralazine HCI (Apresoline)• Minoxidil (Loniten)
  15. 15. Rehabilitation and Therapy• Physical• Occupational• Speech• Mental Health• Other
  16. 16. Physical Rehabilitation & Therapy helps patients:• Retrain the brain• Strengthen muscles,• Improve balance and gait, and• Regain as much physical control as possible.
  17. 17. Occupational Rehabilitation & Therapy helps patients:• Apply physical skills to activities of daily living• Relearn eating, dressing, bathing and caring for oneself• Redevelop cognitive skills such as difficulty with attention, memory or poor judgment.• Develop new ways to do tasks successfully with new limitations
  18. 18. Occupational Rehabilitation & Therapy helps patients:• Learn to safely reduce potential injury,• Use prostheses and orthotics and• Adjust to assistive devices – Canes, – Crutches, – Walkers and – Wheelchairs
  19. 19. Speech Rehabilitation & Therapy helps patients:• Relearn how to express themselves,• Relearn how to process language input,• Retrain swallowing mechanisms• Develop communication tricks when typical speech is lost• Improve articulation and enunciation, and• Use devices such as computer-aided speech technology.
  20. 20. Mental Health Rehabilitation & Therapy helps patients:• Counseling for depression and anxiety• Retraining in social skills.• Setting short term and long term goals
  21. 21. Other Rehabilitation and Therapy:• Music Therapy.• Mirror Therapy using the unaffected side to envisioning the affected side moving,• Robotic Therapy (sophisticated exercise machines),• Virtual Reality, (such as WII Hab - using a gaming system to practice movement),• Mental Practice envisioning movement• Recreational Therapy
  22. 22. SurgerySurgery for stroke is used in threedifferent ways:• To prevent stroke• Immediately after the stroke• To repair damage after the patient is stable
  23. 23. Surgeries for ischemic stroke and to prevent future stroke• Carotid Artery Surgery (Endarterectomy) and• Carotid Stenting.
  24. 24. Surgeries for hemorrhagic stroke • Draining leaking blood • Treating an aneurysm Endovascular coil Clipping embolization
  25. 25. Lifestyle Changes• Quitting smoking,• Lowering blood pressure,• Losing weight,• Eating right,• Being physically active,• Limiting alcohol to the recommended consumption, and• Taking medication as prescribed.
  26. 26. Nutritional Changes• Include a variety of foods and foods of different colors• Eat whole grains, vegetables and fruits.• Foods low in saturated fat and cholesterol.• Foods with limited added sugar.• Foods with limited of salt and sodium.
  27. 27. Why Exercise?• Recover pre-stroke strength and abilities,• Prevent recurrent stroke,• Improve aerobic fitness, and• Cognitive exercise – Keep the mind sharp, – Retrain damaged neural – memory practice, puzzle solving, or word games.
  28. 28. References
  29. 29. Depression and Other Mental Health Diagnoses after Stroke Increase Inpatientand Outpatient Medical Utilization Three Years PoststrokeSushmita Shoma Ghose, Linda S. Williams and Ralph W. SwindleMedical Care , Vol. 43, No. 12 (Dec., 2005), pp. 1259-1264Published by: Lippincott Williams & WilkinsArticle Stable URL:
  30. 30. W., M. (n.d). Common medical presentations: Stroke. Medicine, 37(Acutemedicine Part 2 of 2), 109-114. doi:10.1016/j.mpmed.2008.11.004
  31. 31. Fisher M, Lees K, Spence JD. Nutrition and strokeprevention. Stroke.2006;37:2430–5. Published online before print July27, 2006,doi: 10.1161/​01.STR.0000236633.40160.eeGordon NF,Gulanick M, Costa F, Fletcher G, Franklin BA, Roth EJ, etal.Physical activity and exercise recommendations for stroke survivors: anAmerican Heart Association scientific statement from the Council on ClinicalCardiology, Subcommittee on Exercise, Cardiac Rehabilitation, andPrevention; the Council on Cardiovascular Nursing; the Council onNutrition, Physical Activity, and Metabolism; and the StrokeCouncil.Circulation 2004;109(16):2031-41.Surtees PG, Wainwright NWJ, Luben RN, Wareham NJ, Bingham SA, KhawKT. Psychological distress, major depressive disorder, and risk ofstroke.Neurology. March 4, 2008;70(10):788-794.(