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Old 04-17-2013, 04:34 PM   #1
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Over dosed with anti-hypertensive drugs?

Hi all,

I have questions about meds and tests after
a stroke.

My boyfriend had an ischemic stroke last
summer. It mostly affected his physical balance,
but his recovery is doing pretty well. He's been
through all the rehabilitation. He was in the
hospital 3 weeks, and did not have surgery of any kind.

We have to find him a new general practitioner.
He's been going to a cardiologist, but that doctor
does the bare minimum of anything,
so I want to ditch him soon.

So while I am looking for a new doctor, I'd like
to know more about what kind of follow-up tests
my bf should have. He has not had any kind of
follow-up brain scan since leaving the hospital,
so: What kind of brain scan test is recommended?
what are all the possibilities?

He did have a basic metabolic panel and lipid panel
done last August, but since then he's only been
getting the PT/ INR tests.

So what additional blood tests should we ask for?

Also, imo, he's on rather high does of some of these meds.

My bf is on:

zetia (10 mg) per day
Procardia time release 120 mg per day
warfarin 9 mg per day
lisinopril 40 mg per day
flomax .4 mg per day

He also has the "dry hacking cough" thing from
the lisinopril I guess. And he has trouble with
mucous buildup too.

His weight is about 145 pounds, height is 5
foot 9 inches. He lost a lot of muscle after
getting out of the hospital. His appetite
is much less than it used to be. Sixty two years
old. His blood pressure these days runs about
115/76 or thereabouts.

Is he being over-dosed with anti-hypertensive
drugs?


Someone once recommended to me that he
should get a doppler or CT angio of his
carotids. Where can I find out more
about these tests?

Thanks for your advice!

 
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Old 04-17-2013, 06:40 PM   #2
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Re: Over dosed with anti-hypertensive drugs?

A workup for stroke should include a doppler ultrasound of carotids as suggested, an echocardiogram to check heart valves, and an evaluation for hypercoagulability (excess tendency to form blood clots), as well as cholesterol/ lipids, and homocysteine levels. A repeat brain image isn't really needed at this point. The goal should be to find out what caused the stroke, so future ones can be prevented. The Lisinopril, causing the cough, could be changed to Losartan, which is similar but doesn't have that side effect.

Last edited by ladybud; 04-17-2013 at 06:44 PM. Reason: added

 
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Old 04-18-2013, 09:40 PM   #3
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Re: Over dosed with anti-hypertensive drugs?

I do know that 115/76 is pretty good. That's great actually.

Kind of sounds like they already did all the tests. Must have been detailed blood work to put him on all those. Like ladybud wrote once they determine the cause.

I am on Warfine 5 mg. I have an INR every month to check levels. I also have detailed blood work every 3-4 months to make sure the Warfine has not damaged anything internally.

Last edited by max55; 04-18-2013 at 09:45 PM.

 
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Old 04-21-2013, 06:52 PM   #4
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Re: Over dosed with anti-hypertensive drugs?

Hello. I too had a ischemic stroke seven months ago.
I find the lack of his knowledge concerning what he needs to be checking out.
Is his weakness on right or left side. A MRI will clear this up. What about pt/out. This is very important.
I know there are people medical staff who will help or put him on thre right track and start his reilibation therpary. I strongly suggest asking other people on health boards

We all needed help at one time.


Allen. Aka cactus al

Last edited by cactus al; 04-21-2013 at 06:59 PM. Reason: confusing words

 
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Old 04-24-2013, 04:06 PM   #5
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Re: Over dosed with anti-hypertensive drugs?

HI all,

@ladybud: When you say he should be evaluated for hypercoagulability, are you referring to the Pt/INR? So will these tests you mention help find out what caused the stroke?

@max55: those are pretty much the meds (and doses) he left the hospital with.
The doctors he has seen since have been pretty crappy, and we will have to keep looking to find a half way decent one. I don't see why he has to live with such high doses the rest of his life.

Thanks Al, I really appreciate getting advice here, because the doctors in Nevada do the absolute bare minimum, imo.

Since I made my original post, we've had some unpleasant news: he is being forced to retire early because they don't feel he can handle the paperwork anymore. He can still translate in the courts, but can't do the clerical work.
It could be him, but it could also be the drugs.

When I asked the first doctor he saw to get him off the Statin, he had about a week when he was mentally much perkier. Then the doctor doubled his Lisinopril to 40 mg per day, and that was the end of that. So I want to get him on lower doses of the meds!

Hi blood pressure actually has come down a lot since that time.

It's too late now for him to keep his job, but thanks goodness he gets a pension. He will have to work as a freelancer now, and I will have to do his bookkeeping.

I want to find more natural means for him to keep his cholesterol and blood pressure down.

Thanks all for your thoughts.

 
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Old 04-25-2013, 12:28 AM   #6
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Re: Over dosed with anti-hypertensive drugs?

The tests I mentioned will help to find out the cause of his stroke. The Dopler ultrasound of carotids is done in radiology dep't of hospitals or imaging center. It is non-invasive, ie, no needles or anything inserted. It measures the sound waves of the arteries in neck leading to brain, and picks up signs of placque buildup, where little blood clots can form. They break off and flow to the brain, lodging in a smaller artery causing the stroke. The placque, if extensive, can be cleaned out of the artery, helping to prevent further strokes. The hypercoag tests are blood tests done to pick up abnormalities in the clotting mechansim that predispose to clots. Those are different tests than the INR, which is used to monitor and adjust the dose of coumadin which prevents clotting. Those tests are ordered by a hematologist. The echocardiogram looks for abnormal areas of the heart, particularly the valves, where clots can form and break off, flowing to the brain. That test can be ordered by any physician, but is interpreted by a cardiologist. I hope your boyfriend is doing better. They are trying to keep his BP low to prevent any further strokes, especially a hemorrhage, which can happen if BP gets too high on Coumadin, So I wouldn't worry about his meds, as long as he isn't dropping too low on BP. If his cough is persisting, he might ask about switching to Losartan instead of Lisinopril.

 
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Old 04-25-2013, 02:31 PM   #7
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Re: Over dosed with anti-hypertensive drugs?

Thanks very much for the explanation, Ladybud!

Quote:
The placque, if extensive, can be cleaned out of the artery, helping to prevent further strokes.
How can the the plaque be cleaned out of the artery?

Also, how often do these particular tests need to be done for best monitoring of his condition?

 
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