Many questions I get from patients and families are “What are all these medications for?” and “Are all of these really necessary?”
After an individual has a hemorrhagic stroke, there are many issues that will follow them immediately after, during recovery, and possibly for the rest of their lives.
It’s essential for anyone who has had a hemorrhagic stroke or anyone caring for such an individual to know what medications are, what they do, and how they help in recovery as well as prevention of another stroke!
A hemorrhagic stroke is caused by bleeding that occurs within the brain. This can be caused by chronic hypertension (high blood pressure), aneurysm, head injury, brain tumors, drug abuse, and abnormalities of the vessels.
My husband Mark was the picture of health until he suffered a hemorrhagic stroke at the age of 46 years old from a rare disease called MoyaMoya that was not discovered until his event. This is an example of abnormal vessels that just burst, for no known reason.
Symptoms of a hemorrhagic stroke can include headache, confusion, seizures, nausea and vomiting, weakness, changes in vision, and trouble speaking. If you have ever witnessed this event, it is very scary to see.
Depending on what caused the brain bleed and where it occurs in the brain, different individuals may present with different signs or symptoms. These factors will also determine what medications should be used to treat immediate symptoms as well as prevention of future recurrences.
Initially, during hospitalizations, anticonvulsant drugs are administered to prevent any seizures or seizure activity.
Benzodiazepines:
Lorazepam or Diazepam (also known as Ativan or Valium)
Hydrantions: Phenytoin or Fosphenytoin (also known as Dilantin or Cerebyx)
There is an increased risk after a subarachnoid hemorrhage or hemorrhagic stroke of a seizure, causing an increased risk to the patient. (Doria, 2019) Until the patient is stable, these medications will generally be prescribed for some time. Often providers will want diagnostic studies completed and a certain amount of time to pass without any seizures before they feel comfortable stopping these medications.
Beta Blockers:
Labetalol and esmolol (also known as Trandate or Brevibloc)
The purpose of these medications is to help with stroke prevention by reducing blood pressure, which in turn, decreases the chances of another hemorrhagic stroke.
Mark is a good example of this kind of medication because he does not and has never had hypertension or high blood pressure. However, due to his risk of another brain bleed, his providers prefer that his blood pressure stays at the very lowest end of normal, to decrease his risk.
Vasodilators:
Hydralazine (also known as Apresoline)
This medication can actually relax smooth vascular muscles, which in turn improves the way blood flows through arterioles, decreasing the risk of another brain bleed or hemorrhagic stroke.
Calcium Channel Blockers:
Nicardipine (also known as Cardene)
Relaxing blood vessels will help to improve overall blood flow, without causing increased demands on the heart.
ACE or Angiotensin-Converting Enzyme Inhibitors:
Enalapril, Ramipril, Lisinopril (also known as Vasotec, Altace, Zestril)
These medications are helpful because they control blood pressure and keep the risk of another stroke to a minimum.
Angiotensin Receptor Blockers:
Losartan, Candeartan, Valsartan (also known as Cozaar, Atacand, Diovan)
This medication may be more appropriate for some patients to control blood pressure because a common side effect of the ACE inhibitors is a dry, persistent cough.
Diuretics:
Hydrochlorothiazide, Chlorthalidone, Mannitol (also known as Microzide, Diuril, Osmitrol)
The reason diuretics are important is that they ensure that the pressure in the brain, or intracranial pressure, is kept at a minimum. (Lu, et. al, 2018)
Analgesics:
Acetaminophen (also known as Tylenol)
Often with a subarachnoid hemorrhage, comes fever. The reason this is important to control is that increased body temperature can lead to hyperthermia (fever) causing increased brain damage. (Liddle, et. al, 2022)
Hemostatics:
Vitamin K1, Fresh Frozen Plasma, Prothrombin Complex
These interventions will help the body to clot the blood more quickly. These interventions will generally be done upon admission to the emergency room to try to control the bleeding as quickly as possible.
Protamine:
This medication may be used if an individual is on a blood thinning medication like Warfarin or Aspirin. This is to help counter the effects of these medications and to stop the bleeding as quickly as possible.
When you are in the throes of recovering from a hemorrhagic stroke or caring for someone who is, the amount of education and instruction you may receive can be overwhelming. Just managing to understand drug names with all the generic and brand names can be confusing for anyone.
If you are unsure, please ask your provider or pharmacist for help. Always consult with the provider or pharmacist before taking any over-the-counter medications or herbal supplements. Did you know that even something as simple as grapefruit or grapefruit juice can interfere with many medications?
Another great tool is an online medication interaction checker. You just plug in all of your medications and it will tell you if there are any severe interactions. This is a great tool if you use multiple providers who are prescribing medications or if you use different pharmacies to fill your prescriptions. Here is one of the most helpful that I have found:
https://www.webmd.com/interaction-checker/default.htm
One thing I have experienced with patients and families is that some providers may speak in medical jargon, too quickly or can just be downright condescending, making patients and their family members feel like they can’t ask questions.
Please know that if you are uncomfortable asking your provider, often their nurse, nurse practitioner, or pharmacist will be more than happy to spend time with you explaining your medications, as well as symptom management and prevention of future events.
You can always reach out to me as well. I’m a real person who responds to ALL of my emails at:
hello@familycaregiverlanding.com
References:
Doria JW, Forgacs PB. Incidence, Implications, and Management of Seizures Following Ischemic and Hemorrhagic Stroke. Curr Neurol Neurosci Rep. 2019 May 27;19(7):37. doi: 10.1007/s11910-019-0957-4. PMID: 31134438; PMCID: PMC6746168.
Liddle, L.J., Dirks, C.A., Almekhlafi, M. et al. An Ambiguous Role for Fever in Worsening Outcome After Intracerebral Hemorrhage. Transl. Stroke Res. (2022). https://doi.org/10.1007/s12975-022-01010
Lu, Peipei1; Zhang, Ying1; Meng, Xu1; Fan, Peng1; Li, Yanqi2; Wang, Shu2; Hu, Aihua2; Ma, Lihong3; Zhou, Xianliang1; Wang, Wen2; Liu, Lisheng2. A15829 Stroke Prevention with Diuretics-based Treatment in High-risk Hypertensive Patients. Journal of Hypertension: October 2018 – Volume 36 – Issue – p e326
