NAPLEX Question of the Week: Stroke Management

Stroke management utilizing thrombolytics is an important part of hospital practice as it can save a person's life or prevent them from permanent disability. Knowledge of dosing and contraindications is crucial for appropriate usage as this information is typically required stat!

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PH is a 67 yo F with a PMH of CKD (baseline SCr 2.0 mg/dL which is same today), atrial fibrillation, diabetes mellitus, and hypertension who presents with facial drooping, left sided weakness, and slurred speech. Last known well time was 2 hours ago. The decision to administer tPA has been made with pharmacy consulted to dose. How much tPA should the patient receive and how should it be administered?

Ht: 5’4”, Wt: 100 kg 

A.      100 mg: 10 mg bolus followed by a 90 mg infusion over 1 hour

B.      90 mg: 9 mg bolus followed by an 81 mg infusion over 1 hour

C.      9 mg: 1 mg bolus followed by a 9 mg infusion over 1 hour

D.      10 mg: 1 mg bolus followed by a 9 mg infusion over 1 hour


Answer and Rationale:

The correct answer is B. How many calculations have you done in your rotation year? Chances are you haven't done many outside of possibly pharmacokinetics or TPN. Many students are rusty when it comes to calculations and is definitely an area of importance for the exam. For this question, tPA is dosed 0.9 mg/kg with a maximum dose of 90 mg. 10 % of that dose is infused as a bolus over 1 minute. The remaining 90% is infused over 1 hour. Answer A is incorrect because it exceeds the maximum dose. Answers C and D are incorrect because they are below 0.9 mg/kg. Additionally, knowing absolute contraindications is key to prevent a patient from having a life threatening bleed from tPA such as the patient receiving active anticoagulation.

Spend some time working through calculation problems to remove the rust and improve your chances for scoring well on the exam.

See everyone next week. Can you believe it is March...

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.