PHARMACOTHERAP

Y OF STROKE
BY
JASTRIA PUSMARANI, M. Sc.,
Apt.
DEFENITION
• Stroke involves abrupt onset of focal neurologic deficit
that lasts at least 24 hours and is presumed to be of
vascular origin.
• Stroke can be either ischemic or hemorrhagic.
• Transient ischemic attacks (TIAs) are focal ischemic
neurologic deficits lasting less than 24 hours and usually
less than 30 minutes.
• Strokes  ischemic (88%) or hemorrhagic (12%)
• Hemorrhagic stroke is a result of bleeding into the brain
and subarachnoid hemorrhage, intracerebral hemorrhage,
and subdural hematomas.
PATHOPHYSIOLOGY OF ISCHEMIC
STROKE
• Ischemic strokes (87% of all strokes) are due either to
local thrombus formation or emboli occluding a cerebral
artery.
• Cerebral atherosclerosis  is a cause in most cases, but
30% are of unknown etiology. Emboli arise either from
intra- or extracranial arteries. ‘
• Twenty percent of ischemic strokes arise from the heart.
• Carotid atherosclerotic plaques may rupture, resulting in
collagen exposure, platelet aggregation, and thrombus
formation
• Thrombus formation and embolism result in arterial
occlusion, decreasing cerebral blood flow and causing
ischemia and ultimately infarction distal to the occlusion.
HEMORRHAGIC STROKE
• Blood in the brain parenchyma damages surrounding
tissue through a mass effect and the neurotoxicity of blood
components and their degradation products.
• Hemorrhagic stroke can result in abrupt increased
intracranial pressure leading to death.
Symptoms
• The patient may complain of weakness on one side of the
body,
• inability to speak,
• loss of vision,
• vertigo, or falling.
• Stroke patients may complain of headache; however, with
hemorrhagic stroke, the headache can be severe.
Signs
• Hemiparesis or monoparesis occur commonly, as does a
hemisensory deficit.
• Patients with vertigo and double vision (diplopia) are
likely to have posterior circulation involvement.
• Aphasia
• Patients may also suffer from dysarthria,
• visual field defects
Aspirin
• Aspirin  started between 24 and 48 hours after
completion of alteplase also reduces long-term death
and disability.
Oral anticoagulation
• Oral anticoagulation is recommended for atrial
fibrillation and a presumed cardiac source of
embolism.
• A vitamin K antagonist (warfarin) is first line,
• other Oral anticoagulants (eg, dabigatran)
Statins
• Statins  reduce risk of stroke by approximately 30%
in patients with coronary artery disease and elevated
plasma lipids.
• Mechanism of Action by competitively inhibiting
3-hydroxy-3-methyl glutaryl-coenzyme A (HMG-
CoA) reductase, the enzyme that catalyzes the rate-
limiting step in cholesterol biosynthesis
Clopidogrel
• MechanismThis active metabolite irreversibly blocks
the P2Y12 component of ADP receptors on the platelets
urface, which prevents activation of the GPIIb/IIIa
receptor complex, thereby reducing platelet aggregation.
• terapi stroke iskemik.docx
TERAPI STROKE
• VITAMIN B6
• SITIKOLIN
• MANITOL (DIURETIK OSMOTIK) DIBERIKAN PADA
PASIEN STROKE HEMORRHAGI
• ANTIPLATELET
• TERAPI ANTI HIPERTENSIACE-I, OR ARB OR CCB
DIHIDROPIDIN
• STATINDISLIPIDEMIA
• METFORMINDIABETES MELITUS
• ANTIKOAGULANJK ADA RIWAYAT PENYAKIT
FIBRILASI ATRIUM OR KARDIAK EMBOLI