Terms in this set (842)

Hyperlipidemia

All patients with a history of TIA or CVA should be placed on high-intensity statin such as atorvastatin 40 or 80 mg or rosuvastatin 20 mg.

Class I, Level A
Hypertension

Antihypertensive treatment is recommended for prevention of recurrent stroke and other vascular events in persons who have had an ischemic stroke and are beyond the hyperacute period.
The JNC 8 guidelines recommend a thiazide diuretic or a calcium channel blocker as first line therapy for African American patients with hypertension. Other agents may be added as needed to achieve the appropriate blood pressure goal.
For more REQUIRED information about hypertension management, see the MedU Hypertension module.

Class I, Level A
Smoking

All ischemic stroke or TIA patients who have smoked in the past year should be strongly encouraged not to smoke.

Class I, Level C
Diet

The ACC/AHA Lifestyle Guidelines recommend all adults consume a Mediterranean diet to reduce their risk of ASCVD.
Furthermore, patients with hypertension should limit sodium intake to 2,400 mg per day or less.

Class I, Level A
Physical activity

On the basis of moderate quality evidence, all adults are encouraged to engage in moderate-to-vigorous intensity physical activity 3-4 times per week for 40 minutes per session. For those with disability after ischemic stroke, a supervised therapeutic exercise regimen is recommended.

Class IIb, Level C
Stroke education

Stroke education including knowledge of stroke warning signs and need to call 911 in the event of a cerebrovascular event as well as awareness of individual's own risk factors.
Penicillin V (50 mg/kg in 2-3 divided doses for 10 days, or 250 mg 2-3 times a day for children less than 27 kg) is the antibiotic of choice for strep pharyngitis due to low cost, narrow spectrum of activity, safety and effectiveness. Penicillin V is recommended as a first-line treatment for strep pharyngitis by several organizations (AAFP: American Academy of Family Physicians, AAP: American Academy of Pediatrics, AHA: American Heart Association, WHO: World Health Organization, and IDSA: Infectious Disease Society of America).

Penicillin G IM (benzathine penicillin G 600,000 units IM for children less than 27 kg) is an appropriate choice when the patient is otherwise unlikely to finish the entire course of oral antibiotics. An injection can cause significant discomfort and has an increased risk of anaphylaxis although a form of injectable penicillin mixed with benzathine/procaine (Bicillin C-R) lessens discomfort.

Amoxicillin liquid is often given to children instead of penicillin because it tastes better. However, penicillin has a narrower spectrum of activity effective against strep and is less likely to contribute to antimicrobial antibiotic resistance. Amoxicillin dosing is 50 mg/kg divided 2-3 times a day for 10 days. Single dose amoxicillin is not approved for children younger than 12.

First generation cephalosporins (Cephalexin and Cefadroxil) are as effective as penicillins. They also have a broader spectrum of activity than penicillin and may contribute to antibiotic resistance. They are recommended for patients who have an allergy to penicillin that is not an immediate-type hypersensitivity. Cephalexin dosing is 25-50 mg/kg divided 2-3 times a day for 10 days.

Macrolides (Erythromycin ethlysuccinate or Erythromycin estolate) are reserved for patients with penicillin allergy. They also have a broader spectrum of activity than penicillin and may contribute to antibiotic resistance. Azithromycin or clarithromycin may have fewer gastrointestinal side effects than erythromycin.
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