\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{vujmicro}
\pdfinfo{
  /Title (stroke.pdf)
  /Creator (Cheatography)
  /Author (vujmicro)
  /Subject (Stroke Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{A3A3A3}
\definecolor{LightBackground}{HTML}{F3F3F3}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Stroke Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{vujmicro} via \textcolor{DarkBackground}{\uline{cheatography.com/143692/cs/35505/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}vujmicro \\
  \uline{cheatography.com/vujmicro} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 16th November, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.


\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Stroke Overview}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{A stroke, or cerebrovascular accident (CVA), occurs when blood flow to an area of the brain is interrupted.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{There are two main types of stroke: ischemic stroke, which is caused by a blockage in a blood vessel in the brain, and hemorrhagic stroke, which is caused by bleeding in the brain or surrounding area.} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Strokes can cause long-lasting disability or even death; however, early treatment and preventive measures can reduce the brain damage that occurs because of stroke.} \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{In both ischemic and hemorrhagic stroke, one or more areas of the brain can be damaged.} \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{Depending upon the area affected, a person may lose the ability to move one side of the body, the ability to speak, or a number of other functions.} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{The damage from a stroke may be temporary or permanent.} \tn 
% Row Count 18 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{A person's long-term outcome depends upon how much of the brain is damaged, how quickly treatment begins, and several other factors.} \tn 
% Row Count 21 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Ischemic stroke}} & Ischemic strokes are caused by a blockage (clog) in one of the blood vessels that supply oxygen and other important nutrients to the brain. &  \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
 & There are two main subtypes of ischemic stroke, thrombotic and embolic. &  \tn 
% Row Count 15 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{17.67cm}}{} \tn 
% Row Count 15 (+ 0)
% Row 3
\SetRowColor{white}
 & {\bf{Thrombotic stroke}} & A thrombotic stroke results from a problem within an artery (blood vessel) that supplies blood to the brain. \tn 
% Row Count 23 (+ 8)
% Row 4
\SetRowColor{LightBackground}
 &  & This is most likely to occur in arteries that are clogged with fatty deposits, called plaques. \tn 
% Row Count 30 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
 &  & Plaques partially block the artery, and can rupture and bleed, forming a blood clot. \tn 
% Row Count 6 (+ 6)
% Row 6
\SetRowColor{white}
 &  & This blood clot ("thrombus") can further clog or completely block the artery, which then slows or prevents blood flow to the area of brain fed by that artery. \tn 
% Row Count 17 (+ 11)
% Row 7
\SetRowColor{LightBackground}
 &  & Blood clotting disorders can also cause clots to form within arteries in some people. \tn 
% Row Count 23 (+ 6)
% Row 8
\SetRowColor{white}
 & {\bf{Embolic stroke}} & An embolic stroke occurs when a blood clot or other particle breaks loose from another part of the body, often the heart or a large artery in the neck, and travels through the bloodstream to the brain where it lodges in a smaller blood vessel. \tn 
% Row Count 40 (+ 17)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
 &  & The blood clot or particle, called an "embolus," then blocks blood flow to that area of the brain, reducing the amount of oxygen and nutrients that reach that area. \tn 
% Row Count 11 (+ 11)
% Row 10
\SetRowColor{white}
 &  & One of the most common causes of embolic strokes is an irregular heart rhythm called "atrial fibrillation." \tn 
% Row Count 19 (+ 8)
% Row 11
\SetRowColor{LightBackground}
 &  & Emboli can also originate in the aorta and in the arteries within the neck and head and travel further along within arteries within the brain. \tn 
% Row Count 29 (+ 10)
% Row 12
\SetRowColor{white}
 & {\bf{Transient ischemic attack (TIA)}} & Transient ischemic attacks are episodes in which a person has signs or symptoms of a stroke (eg, weakness; inability to speak) that last for a short time, but without any sign of stroke on brain scans such as MRI or CT. \tn 
% Row Count 44 (+ 15)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke (cont)}}  \tn
% Row 13
\SetRowColor{LightBackground}
 &  & Symptoms of a TIA usually last between a few minutes and a few hours. \tn 
% Row Count 5 (+ 5)
% Row 14
\SetRowColor{white}
 &  & A person may have one or many TIAs. \tn 
% Row Count 8 (+ 3)
% Row 15
\SetRowColor{LightBackground}
 &  & People recover completely from the symptoms of a TIA. \tn 
% Row Count 12 (+ 4)
% Row 16
\SetRowColor{white}
\mymulticolumn{3}{x{17.67cm}}{} \tn 
% Row Count 12 (+ 0)
% Row 17
\SetRowColor{LightBackground}
{\bf{Hemorrhagic stroke}} & Hemorrhagic strokes occur when blood vessels in the brain leak or rupture (break), causing bleeding in or around the brain. &  \tn 
% Row Count 21 (+ 9)
% Row 18
\SetRowColor{white}
 & There are two main subtypes of hemorrhagic stroke, intracerebral and subarachnoid. &  \tn 
% Row Count 27 (+ 6)
% Row 19
\SetRowColor{LightBackground}
\mymulticolumn{3}{x{17.67cm}}{} \tn 
% Row Count 27 (+ 0)
% Row 20
\SetRowColor{white}
 & {\bf{Intracerebral hemorrhage}} & In an intracerebral hemorrhage (ICH), bleeding occurs within the brain. \tn 
% Row Count 32 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke (cont)}}  \tn
% Row 21
\SetRowColor{LightBackground}
 &  & This damages the brain as blood collects and puts pressure on the surrounding tissue. \tn 
% Row Count 6 (+ 6)
% Row 22
\SetRowColor{white}
 &  & Causes of ICH: \tn 
% Row Count 7 (+ 1)
% Row 23
\SetRowColor{LightBackground}
 &  & • High blood pressure \tn 
% Row Count 9 (+ 2)
% Row 24
\SetRowColor{white}
 &  & • Injury \tn 
% Row Count 10 (+ 1)
% Row 25
\SetRowColor{LightBackground}
 &  & • Bleeding disorders \tn 
% Row Count 12 (+ 2)
% Row 26
\SetRowColor{white}
 &  & • Deformities in blood vessels, such as an aneurysm (a weakening in the lining of the blood vessel) \tn 
% Row Count 19 (+ 7)
% Row 27
\SetRowColor{LightBackground}
 & {\bf{Subarachnoid hemorrhage}} & Subarachnoid hemorrhage occurs when a blood vessel on the surface of the brain ruptures. \tn 
% Row Count 25 (+ 6)
% Row 28
\SetRowColor{white}
 &  & The blood builds up and causes pressure in the "subarachnoid" space, which is between two layers of the tissue covering the brain. \tn 
% Row Count 34 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{3.7114 cm} x{6.5793 cm} x{6.5793 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Types of Stroke (cont)}}  \tn
% Row 29
\SetRowColor{LightBackground}
 &  & The most common early symptom of a subarachnoid hemorrhage is a severe headache called "thunderclap headache," which many patients describe as the worst headache of their life. \tn 
% Row Count 12 (+ 12)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Stroke Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Ischemic stroke risk factors}}} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Hypertension & Diabetes \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Atrial fibrillation & Prior stroke or TIA \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
Sex (females \textgreater{} males) & Physical inactivity \tn 
% Row Count 5 (+ 2)
% Row 4
\SetRowColor{LightBackground}
Ethnicity (highest risk in African Americans) & Smoking \tn 
% Row Count 8 (+ 3)
% Row 5
\SetRowColor{white}
Age \textgreater{} 55 years & Dyslipidemia \tn 
% Row Count 9 (+ 1)
% Row 6
\SetRowColor{LightBackground}
Atherosclerosis & Patent foramen ovale (PFO) \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
Sickle cell disease & Illegal drug use \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Obesity} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 13 (+ 0)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Hemorrhagic stroke risk factors}}} \tn 
% Row Count 14 (+ 1)
% Row 11
\SetRowColor{white}
High blood pressure & Use of warfarin or other blood thinning medicines \tn 
% Row Count 17 (+ 3)
% Row 12
\SetRowColor{LightBackground}
Smoking & Illegal drug use (especially cocaine and "crystal meth" \tn 
% Row Count 20 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.647 cm} p{1.647 cm} x{5.9292 cm} x{7.2468 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{4}{x{17.67cm}}{\bf\textcolor{white}{Stroke Symptoms}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{Signs and symptoms of stroke often develop suddenly and then may temporarily improve or slowly worsen, depending upon the type of stroke and area of the brain affected.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{4}{x{17.67cm}}{} \tn 
% Row Count 4 (+ 0)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{{\bf{Classic symptoms}}} \tn 
% Row Count 5 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{4}{x{17.67cm}}{Classic stroke symptoms can be recalled with the acronym {\bf{FAST}}} \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{F}} & Face & Sudden weakness or droopiness of the face, or problems with vision & Ask the person to smile. Does one side droop? \tn 
% Row Count 12 (+ 5)
% Row 5
\SetRowColor{white}
{\bf{A}} & Arm & Sudden weakness or numbness of one or both arms & Ask the person to raise both arms.  it through lifestyle changes and medicine are critical to reducing stroke risks.  There are several steps you can take to reduce your risk for stroke:  Does one arm drift downward? \tn 
% Row Count 25 (+ 13)
% Row 6
\SetRowColor{LightBackground}
{\bf{S}} & \seqsplit{Speech} & Difficulty speaking, slurred speech, or garbled speech & Ask the person to repeat a simple sentence. Are the words slurred? \tn 
% Row Count 29 (+ 4)
% Row 7
\SetRowColor{white}
{\bf{T}} & Time & Time is very important in stroke treatment. The sooner treatment begins, the better the chances are for recovery. & If the person shows any of these signs, call 9-1-1 immediately. Stroke treatment can begin in the ambulance. \tn 
% Row Count 38 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.647 cm} p{1.647 cm} x{5.9292 cm} x{7.2468 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{4}{x{17.67cm}}{\bf\textcolor{white}{Stroke Symptoms (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{} \tn 
% Row Count 0 (+ 0)
% Row 9
\SetRowColor{white}
\mymulticolumn{4}{x{17.67cm}}{{\bf{Other common signs of stroke}}} \tn 
% Row Count 1 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{Sudden dizziness, trouble walking, or loss of balance or coordination} \tn 
% Row Count 3 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{4}{x{17.67cm}}{Sudden trouble seeing in one or both eyes} \tn 
% Row Count 4 (+ 1)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{Sudden severe headache with no known cause} \tn 
% Row Count 5 (+ 1)
% Row 13
\SetRowColor{white}
\mymulticolumn{4}{x{17.67cm}}{Sudden numbness of the face, arm, or leg} \tn 
% Row Count 6 (+ 1)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{4}{x{17.67cm}}{Sudden confusion or trouble understanding others} \tn 
% Row Count 7 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}----}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Stroke Diagnosis}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Brain and blood vessel imaging}} & After doing a quick physical exam, the doctor or nurse usually sends the patient right away for an imaging test of the brain (eg, CT scan or MRI scan) and an imaging test of the blood vessels in the neck and head (eg, CT angiography or MR angiography) that supply the brain with blood. \tn 
% Row Count 14 (+ 14)
% Row 1
\SetRowColor{white}
 & The imaging allows the doctor or nurse to see the area of the brain affected by the stroke, as well as to confirm the type of stroke (ischemic or hemorrhagic). \tn 
% Row Count 22 (+ 8)
% Row 2
\SetRowColor{LightBackground}
 & Occasionally, a catheter must be inserted through a blood vessel in the groin and threaded up to the blood vessels of the neck, where dye is injected to highlight any areas of blockage. \tn 
% Row Count 31 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{7.9442 cm} x{9.3258 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Stroke Diagnosis (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 0 (+ 0)
% Row 4
\SetRowColor{white}
{\bf{Heart testing}} & An electrocardiogram (ECG) is performed in most people who are thought to be having a stroke. \tn 
% Row Count 5 (+ 5)
% Row 5
\SetRowColor{LightBackground}
 & Because many people with ischemic strokes also have coronary artery disease, there may be a lack of blood flow (called "ischemia") in the heart during the stroke. \tn 
% Row Count 13 (+ 8)
% Row 6
\SetRowColor{white}
 & Other heart testing may also be recommended, such as an echocardiogram. \tn 
% Row Count 17 (+ 4)
% Row 7
\SetRowColor{LightBackground}
 & This test uses sound waves to examine the heart and the aorta (the main artery that supplies the whole body). \tn 
% Row Count 23 (+ 6)
% Row 8
\SetRowColor{white}
 & In some people with embolic strokes, the heart or the aorta is the source of the blood clot that led to the stroke. \tn 
% Row Count 29 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Ensure adequate respiratory and cardiac support and determine quickly from CT  scan whether the lesion is ischemic or hemorrhagic.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Evaluate ischemic stroke patients presenting within hours of symptom onset for  reperfusion therapy.} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{Elevated blood pressure (BP) should remain untreated in the acute period (first 7 days) after ischemic stroke to avoid decreasing cerebral blood flow and worsening symptoms.} \tn 
% Row Count 9 (+ 4)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{BP should be lowered if it exceeds 220/120 mm Hg or there is evidence of aortic dissection, acute myocardial infarction (MI), pulmonary edema, or hypertensive encephalopathy.} \tn 
% Row Count 13 (+ 4)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{If BP is treated in the acute phase, short-acting parenteral agents (eg,  labetalol, nicardipine, nitroprusside) are preferred.} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{Assess patients with hemorrhagic stroke to determine whether they are candidates  for surgical intervention.} \tn 
% Row Count 19 (+ 3)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{After the hyperacute phase, focus on preventing progressive deficits, minimizing complications, and instituting secondary prevention strategies.} \tn 
% Row Count 22 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{6.5626 cm} x{10.7074 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Nonpharmacologic Therapy}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Acute ischemic stroke}} & Surgical decompression is sometimes necessary to reduce intracranial pressure. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
 & An interprofessional team approach that includes early rehabilitation can reduce long-term disability. \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & In secondary prevention, carotid endarterectomy and stenting may be effective in reducing stroke incidence and recurrence in  appropriate patients. \tn 
% Row Count 16 (+ 7)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 16 (+ 0)
% Row 4
\SetRowColor{LightBackground}
{\bf{Hemorrhagic stroke}} & In SAH, surgical intervention to clip or ablate the vascular abnormality reduces mortality from rebleeding. \tn 
% Row Count 21 (+ 5)
% Row 5
\SetRowColor{white}
 & After primary intracerebral hemorrhage, surgical evacuation may be beneficial in some situations. \tn 
% Row Count 26 (+ 5)
% Row 6
\SetRowColor{LightBackground}
 & Insertion of an external ventricular drain with monitoring of intracranial pressure is commonly performed in these patients. \tn 
% Row Count 32 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.3175 cm} x{12.9525 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Pharmacologic Therapy of Ischemic Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Alteplase}} & (t-PA, tissue plasminogen activator) initiated within 4.5 hours of symptom onset reduces disability from ischemic stroke. \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
 & Adherence to a strict protocol is essential to achieving positive outcomes: \tn 
% Row Count 8 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & (1) activate the stroke team; \tn 
% Row Count 9 (+ 1)
% Row 3
\SetRowColor{white}
 & (2) treat as early as possible within 4.5 hours of onset; \tn 
% Row Count 11 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & (3) obtain CT scan to rule out hemorrhage; \tn 
% Row Count 13 (+ 2)
% Row 5
\SetRowColor{white}
 & (4) meet all inclusion and no exclusion criteria; \tn 
% Row Count 15 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & (5) administer alteplase  0.9 mg/kg (maximum 90 mg) infused IV over 1 hour, with 10\% given as initial bolus over 1 minute; \tn 
% Row Count 20 (+ 5)
% Row 7
\SetRowColor{white}
 & (6) avoid anticoagulant and antiplatelet therapy for 24 hours; \tn 
% Row Count 23 (+ 3)
% Row 8
\SetRowColor{LightBackground}
 & (7) monitor the patient closely for elevated BP, response, and hemorrhage. \tn 
% Row Count 26 (+ 3)
% Row 9
\SetRowColor{white}
{\bf{Aspirin}} & 160 to 325 mg/day started between 24 and 48 hours after completion of  alteplase also reduces long-term death and disability. \tn 
% Row Count 31 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Ischemic Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Drug}} & {\bf{Alteplase {\emph{(Activase)}}}} Injection \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & {\bf{{\emph{Cathflo Activase}}}} (single-use 2 mg vial) used to restore function of potentially clotted central lines and devices \tn 
% Row Count 7 (+ 5)
% Row 2
\SetRowColor{LightBackground}
{\bf{Dosing}} & {\bf{0.9 mg/kg (maximum dose 90 mg)}}; give 10\% of the dose as a bolus over 1 minute then infuse the remainder over 60 minutes \tn 
% Row Count 12 (+ 5)
% Row 3
\SetRowColor{white}
 & Must {\bf{rule out}} an {\bf{intracranial hemorrhage before use}} \tn 
% Row Count 15 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Contraindications}} & {\bf{Active internal bleeding}} or bleeding diathesis (predisposition) \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
 & {\bf{History of recent stroke}} (within the past 3 months) \tn 
% Row Count 21 (+ 3)
% Row 6
\SetRowColor{LightBackground}
 & {\bf{Severe uncontrolled hypertension (BP \textgreater{} 185/110 mmHg)}} \tn 
% Row Count 24 (+ 3)
% Row 7
\SetRowColor{white}
 & Any prior intracranial hemorrhage (ICH) \tn 
% Row Count 26 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & Other conditions that increase bleeding risk: recent intracranial or intraspinal surgery, trauma (within the past 3 months), intracranial neoplasm, arteriovenous malformation or aneurysm \tn 
% Row Count 34 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Ischemic Stroke (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
 & Labs that increase bleeding risk: {\bf{INR \textgreater{} 1.7}}, aPTT \textgreater{} 40 seconds, platelet count \textless{} 100,000/mm\textasciicircum{}3\textasciicircum{} \tn 
% Row Count 4 (+ 4)
% Row 10
\SetRowColor{white}
 & Treatment dose of {\bf{LMWH}} (within the previous 24 hours), use of a {\bf{direct thrombin inhibitor or direct factor Xa inhibitor}} (within the previous 48 hours) \tn 
% Row Count 11 (+ 7)
% Row 11
\SetRowColor{LightBackground}
 & Blood glucose \textless{} 50 mg/dL \tn 
% Row Count 12 (+ 1)
% Row 12
\SetRowColor{white}
{\bf{Side Effects}} & {\bf{Major bleeding (i.e., ICH)}} \tn 
% Row Count 14 (+ 2)
% Row 13
\SetRowColor{LightBackground}
{\bf{Monitoring}} & {\bf{Hgb, Hct, s/sx of bleeding}} \tn 
% Row Count 16 (+ 2)
% Row 14
\SetRowColor{white}
 & {\bf{Neurological assessments and BP}} \tn 
% Row Count 18 (+ 2)
% Row 15
\SetRowColor{LightBackground}
 & Head CT 24 hrs after treatment, before starting anticoagulants or antiplatelet drugs \tn 
% Row Count 22 (+ 4)
% Row 16
\SetRowColor{white}
{\bf{Notes}} & {\bf{Contraindications}} and {\bf{dosing differ}} when used for {\bf{ACS}} and pulmonary embolism, due to a higher risk of hemorrhagic conversion (i.e., brain bleed) in stroke \tn 
% Row Count 29 (+ 7)
% Row 17
\SetRowColor{LightBackground}
 & If severe headache, acute hypertension, nausea, vomiting or worsening neurological function occurs, discontinue the infusion and obtain an emergent head CT \tn 
% Row Count 35 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Ischemic Stroke (cont)}}  \tn
% Row 18
\SetRowColor{LightBackground}
 & The abbreviation "tPa" is prone to errors; not recommended by ISMP, but used commonly \tn 
% Row Count 4 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Secondary Prevention of Ischemic Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Antiplatelets}} & Use antiplatelet therapy in noncardioembolic stroke. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & Aspirin, clopidogrel, and extended-release dipyridamole plus aspirin are all first-line agents \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Cilostazol is also a first-line agent, but its use has been limited by lack of data. \tn 
% Row Count 13 (+ 5)
% Row 3
\SetRowColor{white}
 & Limit the combination of clopidogrel and ASA to select patients with a recent MI history or intracranial stenosis and only with ultra–low-dose ASA to minimize bleeding risk. \tn 
% Row Count 22 (+ 9)
% Row 4
\SetRowColor{LightBackground}
{\bf{Anticoagulants}} & Oral anticoagulation is recommended for atrial fibrillation and a presumed cardiac source of embolism. \tn 
% Row Count 28 (+ 6)
% Row 5
\SetRowColor{white}
 & A vitamin K antagonist (warfarin) is first line, but other oral anticoagulants (eg, dabigatran) may be recommended for some patients. \tn 
% Row Count 35 (+ 7)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{8.635 cm} x{8.635 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Secondary Prevention of Ischemic Stroke (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
{\bf{Antihypertensives}} & Treatment of elevated BP after ischemic stroke reduces risk of stroke recurrence. \tn 
% Row Count 5 (+ 5)
% Row 7
\SetRowColor{white}
 & Treatment guidelines recommend BP reduction in patients with stroke or TIA after  the acute period (first 7 days). \tn 
% Row Count 11 (+ 6)
% Row 8
\SetRowColor{LightBackground}
{\bf{Statins}} & Reduce risk of stroke by approximately 30\% in patients with coronary artery disease and elevated plasma lipids. \tn 
% Row Count 17 (+ 6)
% Row 9
\SetRowColor{white}
 & Treat ischemic stroke patients, regardless of baseline cholesterol, with high-intensity statin therapy to achieve a reduction of at least  50\% in LDL for secondary stroke prevention. \tn 
% Row Count 27 (+ 10)
% Row 10
\SetRowColor{LightBackground}
{\bf{Low-molecular-weight heparin or low-dose subcutaneous unfractionated heparin}} & (5000 units three times daily) is recommended for prevention of deep vein thrombosis in hospitalized patients with decreased mobility due to stroke and should be used in all but the most minor strokes. \tn 
% Row Count 38 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Antiplatelet Drugs}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Drug}} & {\bf{Aspirin ({\emph{Bayer, Buffferin, Ecotrin}}}}, {\emph{Ascriptin, Durlaza}}, others) \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & + omeprazole ({\emph{Yosprala}}) \tn 
% Row Count 4 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & OTC: tablet, chewable tablet, enteric coated tablet, suppository \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
 & Rx: {\bf{ER}} capsule ({\emph{Durlaza}}), {\bf{delayed-release}} tablet ({\emph{Yosprala}}) \tn 
% Row Count 10 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Dosing}} & {\bf{50-325 mg daily}} \tn 
% Row Count 11 (+ 1)
% Row 5
\SetRowColor{white}
 & {\emph{Yosprala}}: 81 mg/40mg or 325 mg/40 mg daily \tn 
% Row Count 13 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Do not crush enteric-coated, delayed-release or ER products \tn 
% Row Count 16 (+ 3)
% Row 7
\SetRowColor{white}
{\bf{Contraindications}} & NSAID or {\bf{salicylate allergy; children and teenagers}} with viral infection due to risk of {\bf{Reye's syndrome}} (symptoms include somnolence, N/V, confusion); rhinitis, nasal polyps or asthma (due to risk of urticaria, angioedema or bronchospasm) \tn 
% Row Count 26 (+ 10)
% Row 8
\SetRowColor{LightBackground}
{\bf{Warnings}} & {\bf{Bleeding}} {[}including GI bleed/ulceration, increase risk with heavy alcohol use or other drugs with bleeding risk (i.e., NSAIDs, anticoagulants, other antiplatelets){]}, {\bf{tinnitus}} (salicylate {\bf{overdose}}) \tn 
% Row Count 34 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Antiplatelet Drugs (cont)}}  \tn
% Row 9
\SetRowColor{LightBackground}
{\bf{Side Effects}} & {\bf{Dyspepsia, heartburn, bleeding}}, nausea \tn 
% Row Count 2 (+ 2)
% Row 10
\SetRowColor{white}
{\bf{Monitoring}} & Symptoms of bleeding, bruising \tn 
% Row Count 4 (+ 2)
% Row 11
\SetRowColor{LightBackground}
{\bf{Notes}} & To decrease nausea, use EC or buffered product or take with food \tn 
% Row Count 7 (+ 3)
% Row 12
\SetRowColor{white}
 & {\bf{PPIs}} may be {\bf{used to protect the gut}} with chronic NSAID use; {\bf{consider the risks}} from chronic PPI use ({\bf{decrease bone density, increase infection risk}}) \tn 
% Row Count 14 (+ 7)
% Row 13
\SetRowColor{LightBackground}
 & {\emph{Yosprala}} is indicated for those at risk of developing aspirin-associated gastric ulcers \tn 
% Row Count 18 (+ 4)
% Row 14
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 18 (+ 0)
% Row 15
\SetRowColor{LightBackground}
{\bf{Drug}} & {\bf{Extended-release dipyridamole/aspirin ({\emph{Aggrenox}})}} \tn 
% Row Count 21 (+ 3)
% Row 16
\SetRowColor{white}
 & Capsule \tn 
% Row Count 22 (+ 1)
% Row 17
\SetRowColor{LightBackground}
{\bf{Dosing}} & 200 mg/25 mg BID \tn 
% Row Count 23 (+ 1)
% Row 18
\SetRowColor{white}
 & If intolerable headache: 200 mg/25 mg QHS (+ low-dose aspirin daily in the morning), then resume BID dosing within 1 week \tn 
% Row Count 28 (+ 5)
% Row 19
\SetRowColor{LightBackground}
{\bf{Contraindications}} & As above for aspirin component plus: \tn 
% Row Count 30 (+ 2)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Antiplatelet Drugs (cont)}}  \tn
% Row 20
\SetRowColor{LightBackground}
{\bf{Warnings}} & {\bf{Hypotension}} and chest pain (in patients with coronary artery disease) can occur due to the vasodilatory effects of dipyridamole \tn 
% Row Count 6 (+ 6)
% Row 21
\SetRowColor{white}
{\bf{Side Effects}} & {\bf{Headache}} \tn 
% Row Count 8 (+ 2)
% Row 22
\SetRowColor{LightBackground}
{\bf{Notes}} & {\bf{Not interchangeable}} with the individual components of aspirin and dipyridamole \tn 
% Row Count 12 (+ 4)
% Row 23
\SetRowColor{white}
 & Amount of aspirin provided is not adequate for prevention of cardiac events (i.e., MI) \tn 
% Row Count 16 (+ 4)
% Row 24
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 16 (+ 0)
% Row 25
\SetRowColor{white}
{\bf{Drug}} & {\bf{Clopidrogel ({\emph{Plavix}})}} \tn 
% Row Count 17 (+ 1)
% Row 26
\SetRowColor{LightBackground}
 & Tablet \tn 
% Row Count 18 (+ 1)
% Row 27
\SetRowColor{white}
 & Indicated for ACS, recent MI, stroke and PAD \tn 
% Row Count 20 (+ 2)
% Row 28
\SetRowColor{LightBackground}
{\bf{Dosing}} & {\bf{75 mg daily}} \tn 
% Row Count 21 (+ 1)
% Row 29
\SetRowColor{white}
{\bf{Boxed Warnings}} & Clopidogrel is a {\bf{prodrug}}. Effectiveness depends on the {\bf{conversion}} to an {\bf{active metabolite}}, mainly by {\bf{CYP450 2C19}}. Poor metabolizers of CYP2C19 exhibit higher cardiovascular events than patients with normal CYP2C19 function. {\bf{Tests to check CYP2C19 genotype}} can be used as an aid in determining a therapeutic strategy. Consider alternative treatments in patients identified as CYP2C19 poor metabolizers. \tn 
% Row Count 38 (+ 17)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Antiplatelet Drugs (cont)}}  \tn
% Row 30
\SetRowColor{LightBackground}
{\bf{Contraindications}} & Active {\bf{serious bleeding}} (i.e., GI bleed, intracranial hemorrhage) \tn 
% Row Count 3 (+ 3)
% Row 31
\SetRowColor{white}
{\bf{Warnings}} & {\bf{Bleeding risk: stop}} 5 days {\bf{prior to elective surgery, do not use with omeprazole}} or {\bf{esomeprazole}}, premature discontinuation (increase risk of thrombosis), thrombotic thrombocytopenic purpura ({\bf{TTP}}) \tn 
% Row Count 12 (+ 9)
% Row 32
\SetRowColor{LightBackground}
{\bf{Side Effects}} & Generally well tolerated, unless {\bf{bleeding}} occurs \tn 
% Row Count 14 (+ 2)
% Row 33
\SetRowColor{white}
{\bf{Monitoring}} & Symptoms of bleeding, Hgb/Hct as necessary \tn 
% Row Count 16 (+ 2)
% Row 34
\SetRowColor{LightBackground}
{\bf{Notes}} & Drug of choice in stroke/TIA if a {\bf{contraindication or allergy to aspirin}}; do not use ini combination with aspirin long-term for stroke prevention \tn 
% Row Count 22 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.2175 cm} x{6.4106 cm} x{6.2419 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Treatment of Modifiable Risk Factors}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Hypertension}} & Blood pressure lowering treatment is often initiated after the first several days following a stroke. &  \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
 & {\bf{Thiazide diuretics, ACE inhibitors and ARBs}} have the best evidence for stroke risk reduction. &  \tn 
% Row Count 14 (+ 7)
% Row 2
\SetRowColor{LightBackground}
 & A {\bf{goal BP \textless{} 130/80 mmHg}} is recommended for most patients. &  \tn 
% Row Count 19 (+ 5)
% Row 3
\SetRowColor{white}
 & Lifestyle modifications are an important part of hypertension management. &  \tn 
% Row Count 24 (+ 5)
% Row 4
\SetRowColor{LightBackground}
{\bf{Dyslipidemia}} & Treat with a {\bf{high-intensity statin}}, with atorvastatin 80 mg/day being preferred. &  \tn 
% Row Count 30 (+ 6)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.2175 cm} x{6.4106 cm} x{6.2419 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Treatment of Modifiable Risk Factors (cont)}}  \tn
% Row 5
\SetRowColor{LightBackground}
 & In patients at higher risk, consider adding ezetimibe or a PCSK9 inhibitor to achieve an LDL \textless{} 70 mg/dL. &  \tn 
% Row Count 7 (+ 7)
% Row 6
\SetRowColor{white}
{\bf{Diabetes}} & Patients with no established history should be screened for diabetesin the post-stroke period; an A1C is the preferred test. &  \tn 
% Row Count 16 (+ 9)
% Row 7
\SetRowColor{LightBackground}
 & Treat diabetes according to the most recent ADA guidelines. &  \tn 
% Row Count 20 (+ 4)
% Row 8
\SetRowColor{white}
{\bf{Atrial Fibrillation}} & {\bf{Cardioembolic stroke}} due to {\bf{atrial fibrillation}} requires {\bf{anticoagulation}} to prevent future strokes. &  \tn 
% Row Count 28 (+ 8)
% Row 9
\SetRowColor{LightBackground}
{\bf{Lifestyle Modifications}} & Patients should be screened for obesity and counseled on lifestyle modifications for hypertension and cardiovascular risk reduction (i.e., {\bf{smoking cessation}}, diet, exercise, weight loss). &  \tn 
% Row Count 41 (+ 13)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.2175 cm} x{6.4106 cm} x{6.2419 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Treatment of Modifiable Risk Factors (cont)}}  \tn
% Row 10
\SetRowColor{LightBackground}
 & Nutrition & {\bf{Sodium restriction}} to \textless{} 2.4 grams/day, or \textless{} 1.5 grams/day for greater {\bf{blood pressure reduction}} and a \seqsplit{Mediterranean-type} {\bf{diet}} (emphasizing vegetables, fruits, whole grains, fish, poultry, legumes, nuts and olive oil) is recommended. \tn 
% Row Count 18 (+ 18)
% Row 11
\SetRowColor{white}
 & Physical activity & If capable, patients should engage in \seqsplit{moderate-intensity} exercise (at least 10 minutes four days per week) and avoid long periods of sitting. \tn 
% Row Count 29 (+ 11)
% Row 12
\SetRowColor{LightBackground}
 & Weight reduction & Maintain a {\bf{BMI 18.5 - 24.9 kg/m\textasciicircum{}2\textasciicircum{}}} and a {\bf{waist circumference \textless{} 35 inches for women}} and {\bf{\textless{} 40 inches for men}}. \tn 
% Row Count 38 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{4.2175 cm} x{6.4106 cm} x{6.2419 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{3}{x{17.67cm}}{\bf\textcolor{white}{Treatment of Modifiable Risk Factors (cont)}}  \tn
% Row 13
\SetRowColor{LightBackground}
 & Alcohol intake & Limit to \textless{} 2 drinks/day for males and \textless{} 1 drink/day for females. \tn 
% Row Count 5 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}---}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Pharmacologic Therapy of Hemorrhagic Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{There are no standard pharmacologic strategies for treating intracerebral hemorrhage.} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Follow medical guidelines for managing BP, increased intracranial pressure,  and other medical complications in acutely ill patients in neurointensive care units.} \tn 
% Row Count 6 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{SAH due to aneurysm rupture is often associated with delayed cerebral ischemia in the 2 weeks after the bleeding episode.} \tn 
% Row Count 9 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{Vasospasm of the cerebral vasculature is thought to be responsible for the delayed ischemia and occurs between 3 and 21 days after the bleed.} \tn 
% Row Count 12 (+ 3)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{The calcium channel blocker nimodipine 60 mg every 4 hours for 21 days, along with maintenance of intravascular volume with pressor therapy, is recommended to reduce the incidence and severity of neurologic deficits resulting from delayed ischemia.} \tn 
% Row Count 17 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Hemorrhagic Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Drug}} & Mannitol ({\emph{Osmitrol, Resectisol}}) \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & {\bf{Injection}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Dosing}} & 5\%, 10\%, 15\%, 20\%, 25\% \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
 & Mannitol 20\%: 0.25-1 g/kg/dose IV Q6-8H PRN \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
{\bf{Contraindications}} & Severe {\bf{renal disease}} (anuria), severe hypovolemia, pulmonary edema or congestion, active intracranial bleed (except during craniotomy) \tn 
% Row Count 12 (+ 6)
% Row 5
\SetRowColor{white}
{\bf{Warnings}} & CNS toxicity (can accumulate in the brain, causing rebound increases in ICP, if used for long periods of time as a continuous infusion; intermittent boluses preferred), extravasation (vesicant), nephrotoxicity, fluid and electrolyte imbalances (i.e., dehydration, hyperosmolar-induced hyperkalemia, acidosis, increase osmolar gap) \tn 
% Row Count 25 (+ 13)
% Row 6
\SetRowColor{LightBackground}
{\bf{Side Effects}} & Dehydration, headache, lethargy, increase or decrease BP \tn 
% Row Count 28 (+ 3)
% Row 7
\SetRowColor{white}
{\bf{Monitoring}} & Renal function, daily fluid intake and output, serum electrolytes, serum and urine osmolality, ICP, CPP \tn 
% Row Count 32 (+ 4)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Hemorrhagic Stroke (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
{\bf{Notes}} & Maintain serum omlolality \textless{} 300-320 mOsm/kg \tn 
% Row Count 2 (+ 2)
% Row 9
\SetRowColor{white}
 & {\bf{Inspect for crystals}} before administering; if crystals are present, warm the solution to redissolve \tn 
% Row Count 6 (+ 4)
% Row 10
\SetRowColor{LightBackground}
 & Use a {\bf{filter for administration}} \tn 
% Row Count 8 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{} \tn 
% Row Count 8 (+ 0)
% Row 12
\SetRowColor{LightBackground}
{\bf{Drug}} & Nimodipine ({\emph{Nymalize}}) \tn 
% Row Count 9 (+ 1)
% Row 13
\SetRowColor{white}
 & Capsule, oral solution \tn 
% Row Count 10 (+ 1)
% Row 14
\SetRowColor{LightBackground}
{\bf{Dosing}} & 60 mg PO Q4H for 21 days \tn 
% Row Count 11 (+ 1)
% Row 15
\SetRowColor{white}
 & Start within 96 hours of SAH onset \tn 
% Row Count 13 (+ 2)
% Row 16
\SetRowColor{LightBackground}
 & Swallow capsules whole; administer on an empty stomach, at least 1 hour before or 2 hours after meals \tn 
% Row Count 17 (+ 4)
% Row 17
\SetRowColor{white}
 & Cirrhosis: 30 mg PO Q4H for 21 days (closely monitor) \tn 
% Row Count 20 (+ 3)
% Row 18
\SetRowColor{LightBackground}
{\bf{Boxed Warnings}} & {\bf{Do not administer}} nimodipine {\bf{IV}} or by other parenteral routes; {\bf{death and serious life-threatening adverse events}} have occurred (including cardiac arrest, cardiovascular collapse, hypotension and bradycardia) when the {\bf{contents of nimodipine capsules}} have been inadvertently {\bf{injected parenterally}} \tn 
% Row Count 33 (+ 13)
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{x{5.8718 cm} x{11.3982 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Drugs Used For Hemorrhagic Stroke (cont)}}  \tn
% Row 19
\SetRowColor{LightBackground}
{\bf{Contraindications}} & Increase risk of significant hypotension when used in combination with strong inhibitors of CYP3A4 \tn 
% Row Count 4 (+ 4)
% Row 20
\SetRowColor{white}
{\bf{Side Effects}} & {\bf{Hypotension}} \tn 
% Row Count 6 (+ 2)
% Row 21
\SetRowColor{LightBackground}
{\bf{Monitoring}} & CPP, ICP, BP, HR, neurological checks \tn 
% Row Count 8 (+ 2)
% Row 22
\SetRowColor{white}
{\bf{Notes}} & {\bf{If capsules cannot be swallowed}}, contents may be {\bf{withdrawn with a parenteral syringe}}, then {\bf{transferred to an oral syringe}} that cannot accept a needle and that can only administer medication orally or via nasogastric tube; **label oral syringes "For Oral Use Only" or "Not for IV Use"; the medication should be drawn up in the pharmacy to reduce medication errors \tn 
% Row Count 23 (+ 15)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}