The client diagnosed with atrial fibrillation has experienced a transient ischemic attack (TIA). Which medication would the nurse anticipate being ordered for the client on discharge?
A. A thrombolytic medication
B. A beta-blocker medication
C. An anti-hyperuricemic medication
D. An oral anticoagulant medication
Correct Answer: D. An oral anticoagulant medication.
Thrombi form secondary to atrial fibrillation. Therefore, an anticoagulant would be anticipated to prevent thrombus formation; and oral (warfarin [Coumadin]) at discharge versus intravenous. Oral anticoagulation is indicated for patients with atrial fibrillation or other sources of cardioembolic sources of TIA.
Option A: Thrombolytic medication might have been given at initial presentation but would not be a drug prescribed at discharge. Hackam et al did a meta-analysis in 2007 showing that a combination of diet, exercise, antiplatelet, statin, and antihypertensive therapy may reduce the subsequent stroke by 80-90%.
Option B: Beta-blockers slow the heart rate and lower the blood pressure. Beta-blockers, as a class of drugs, are primarily used to treat cardiovascular diseases and other conditions. Beta receptors exist in three distinct forms: beta-1 (B1), beta-2 (B2), and beta-3 (B3). Beta-1 receptors located primarily in the heart mediate cardiac activity. Beta-2 receptors with their diverse location in many organ systems control various aspects of metabolic activity and induce smooth muscle relaxation. Beta-3 receptors induce the breakdown of fat cells and are less clinically relevant at present.
Option C: Anti-hyperuricemic medication is given to clients with gout. Urate lowering medications in asymptomatic patients are only indicated in those undergoing cytolytic therapy for malignancy to prevent tumor lysis syndrome. Allopurinol like xanthine oxidase inhibitors; used as prophylaxis against gouty arthritis, nephrolithiasis, and chemo related hyperuricemia.
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