WELL Duquesne University Mylan School of Pharmacy
aware
UPDATE from the Pharmacy Care Awareness Program
May-June 2004
Stroke Smart–What is a Stroke?
A
stroke occurs when the blood supply to your brain is interrupted and brain tissue is deprived of oxygen and nutrients. Within minutes, brain cells begin to die. This is a medical emergency and prompt treatment could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability. When brain cells die, functions which that area of the brain once controlled are lost. These include speech, movement, and memory. The specific abilities lost or affected depend on where the stroke occurs as well as the size of the stroke. Typically, 80% of strokes are classified as ischemic (blockage of blood flow) with the remaining 20% classified as hemorrhagic (blood vessel rupture). In the United States, stroke is the third leading cause of death and the most frequent cause of adult disability. Every year, about
750,000 Americans experience a stroke and nearly 160,000 of these individuals die.
Signs and Symptoms of Stroke
Signs and Symptoms
• Sudden numbness, weakness, or paralysis of your face, arm, or leg- usually on one side of your body
It is important to know the signs and symptoms of a stroke so you or someone you know can get prompt treatment. The most common signs and symptoms are listed in the table below. For most people, a stroke gives no warning. One possible sign of an impending stroke is a transient ischemic attack (TIA). A TIA is a temporary interruption of blood flow to a part of the brain. The symptoms of a TIA are the same as for a stroke, but they are more brief (several minutes to 24 hours) and generally disappear without leaving permanent effects. About a third of people who have a TIA go on to have a full stroke within the next 5 years.
• Loss of speech, inability to understand speech, or trouble talking • Sudden blurred, double, or decreased vision • Dizziness, loss of balance, or loss of coordination • Sudden headache which may be accompanied by a stiff neck, facial pain, pain between the eyes, vomiting, or altered consciousness • Difficulty swallowing • Confusion or problems with memory, spatial orientation, or perception • Seizures, fainting, or blacking out
Upcoming Events Mark Your Calendar
All events will be held in the Center for Pharmacy Care, Room 320 Bayer Learning Center, unless otherwise noted.
Center for Pharmacy Care – New Hours!! 9:00 AM -1:00 PM May 3,10 & 17 June 7, July 19 & August 16 During May-August and April the Center will be offering the following complimentary screenings on Mondays by appointment: Bone Density, Body Composition Analysis, Facial Skin Analysis, and Cholesterol Screening. Please call 412-396-5874 for an appointment.
MAY – Stroke Awareness Month • May 5, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • May 12, 2004, 11:00 a.m.-1:00 p.m. Blood Pressure/Stroke Screening Location: Union, 3rd Floor Concourse • May 19, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • May 26, 2004, 11:00 a.m.-1:00 p.m. Blood Pressure/Stroke Screening Location: Union, 2nd Floor Concourse JUNE • June 1, 2004, 12:00-12:30 p.m. Here comes the sun! Enjoy it safely! Frequently asked questions about sunscreens and medication-induced sun sensitivity Christine O’Neil, Pharm.D., BCPS • June 2, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up
• June 9, 2004, 11:00 a.m.-1:00 p.m. Blood Pressure/Stroke Screening Location: Union, 3rd Floor Concourse • June 16, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up JULY • July 7, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up • July 19, 2004, 9:00 a.m.-1:00 p.m. DermaView Screening – Facial Skin Analysis • July 21, 2004, 11:30 a.m.-12:30 p.m. Blood Pressure Check-Up AUGUST • August 4, 2004, 11:30-12:30 Blood Pressure Check-Up • August 18, 2004, 11:30-12:30 Blood Pressure Check-Up
Call x5874 to RSVP for screenings and lunchtime lectures.
www.duq.edu
Suggested Treatments... Risk Factors There are many things you can do to significantly reduce your risk of stroke. These are often not emphasized during usual visits to the physician. Let’s discuss these risk-reducing strategies in further detail.
What risk factors for stroke can’t be changed? • Age - The chance of having a stroke more than doubles for each decade of life after age 55. While stroke is common among the elderly, many people under 65 also have strokes. • Race - African Americans have a much higher risk of death and disability from a stroke than whites, in part because they have a greater incidence of high blood pressure. • Sex - Stroke is more common in men than women. In most age groups, more men than women will have a stroke in a given year. However, more than half of total stroke deaths occur in women. At all ages, more women die of stroke than men. Use of birth control pills and pregnancy pose special stroke risks for women. • Diabetes mellitus - Diabetes is an independent risk factor for stroke and is strongly correlated with high blood pressure. While diabetes is treatable, the presence of the disease still increases your risk of stroke. • Prior stroke - The risk of stroke for someone who has already had one is many times that of a person who has not.
• Heart disease - After high blood pressure, heart disease is the most important risk factor for stroke. Heart attack is also the major cause of death among stroke survivors. • Cigarette smoking - In recent years, studies have shown cigarette smoking to be an important risk factor for stroke. The nicotine and carbon monoxide in cigarette smoke damage the cardiovascular system in many ways. The use of oral contraceptives combined with cigarette smoking greatly increases stroke risk. • Transient ischemic attacks (TIAs) - TIAs are strong predictors of stroke. A person who has had one or more TIAs is almost 10 times more likely to have a stroke than a normal healthy individual.
Treatment Getting prompt medical treatment for a possible stroke is very important. One reason is that therapy with clot-dissolving (thrombolytic) drugs must start within 3 hours. In addition, quick treatment not only improves the chances of survival, but it may also reduce the amount of disability resulting from the stroke. Currently, only 5% of Americans who have had a stroke receive thrombolytic therapy. Reasons for this include: the three hour time window for use, their contraindication against administration in hemorrhagic stroke, and the overall risk vs. benefit of thrombolytic therapy in the individual patient. Aspirin, other anti-platelet drugs and Coumadin® have been used to prevent subsequent strokes.
Tr e a t m e n t O p t i o n s f o r S t r o k e TPA (Tissue Plasminogen Activator)
Injected into veins to dissolve a blood clot – may be more effective in increasing chances of full recovery compared with other treatment options.
Carotid Endarterectomy
Surgical incision in neck to remove plaques from carotid artery – can itself trigger a stroke or heart attack.
Angioplasty
Widens the inside of an artery leading to the brain, usually the carotid artery – balloon tipped catheter inserted into obstructed area to compress plaques against artery walls and metallic stent left in artery to prevent recurrent narrowing.
Anti-platelet Drugs
Makes platelets less sticky and less likely to clot. (aspirin, Aggrenox®, Plavix®, Ticlid®)
Anticoagulants
Affects the clotting system to decrease clot formation (heparin, Coumadin®) – close monitoring required.
• Heredity - The chance of stroke is greater in people who have a family history of stroke
What stroke risk factors can be treated with the help of a healthcare professional? • High blood pressure - High blood pressure is the most important controllable risk factor for stroke. Many people believe the effective treatment of high blood pressure is a key reason for the accelerated decline in the death rates for stroke.
Newsletter Contributors John G. Lech, Pharm.D. David C. Burrow, Pharm.D. Candidate Joel A. Leonberg, Pharm.D. Candidate
As mentioned earlier, stroke is the leading cause of disability in adults. Recognition and elimination of risk factors as well as appropriate drug therapy are critical for the prevention and management of this condition.
For more information on strokes check out the following Web sites: • www.mayoclinic.com
• www.strokeassociation.org
• www.stroke.com
• www.nlm.nih.gov/medlineplus/stroke.html
A publication of the Duquesne University Mylan School of Pharmacy Pharmacy Care Awareness Program (PCAP) & Pharmaceutical Information Center (PIC) Additional information on any of the topics discussed may be obtained from the Pharmaceutical Information Center by calling 412-396-4600 or sending an e-mail to pic@duq.edu. Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417 5/04 1.5M DIH