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\def\citeauthor{~Kamalakar~Likitha,
              ~Shaik~Shafi~Ahamad,
              ~Avula~Sai~Poojitha,
              ~Gundra~Tejaswini,
              ~Kanamala~Arun~Chand~Roby}
\def\citetitle{Long Term Management of Stroke Patients with Drug Associated Problems}
\def\copyrightstmt{This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.}
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\begin{document}


\def\RunningAuthor{Kanamala Arun Chand Roby et al.}
\firstPage{304}
\articleType{Original Article}
\receivedDate{20 Apr 2023}
\acceptedDate{07 May 2023}
\revisedDate{06 May 2023}
\journalVolume{3}
\journalIssue{3}
\journalDoi{fjphs.v3i3.479}
\copyrightYear{2023}
\eISSN{2583-116X}
\journalDoi{fjphs.v3i3.479}
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\title{Long Term Management of Stroke Patients with Drug Associated Problems}
\author{Kamalakar~Likitha\textsuperscript{1},  
            Shaik~Shafi~Ahamad\textsuperscript{1},  
            Avula~Sai~Poojitha\textsuperscript{1},  
            Gundra~Tejaswini\textsuperscript{1}, 
            Kanamala~Arun~Chand~Roby\textsuperscript{*}\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Narayana Pharmacy college, C2H7+X32, Chinthareddy Palem, Nellore-524003, Andhra Pradesh, India}~\\{\textsuperscript{2}Department of Pharmacy Practice, Ratnam Institute of Pharmacy, Pidathapolur (V), Muthukur (M), SPSR Nellore-524 346, Andhra Pradesh, India}}

\begin{abstract}
A focused neurological impairment with a quick onset and a duration of more than 24 hours is referred to as a stroke. Transient ischemia attack, which is described as a focused neurological symptom lasting less than 24 hours, is not included in this classification. Identifies the complication of the patient and how those complications are  addressed. A complication is an adverse event that occurs due to a medical treatment  or  surgical procedure. It is a form of therapy strategy utilised to improve  outcome  of  the  therapy for a  disease  or  condition. An anticipated observational study  carried  out within the division of  neurology  as well as neurosurgery for  a  period  of  6 months. The study was conducted by collecting information from patients  suffering  with stroke  by  using a  patient consent form. It was a prospective observational study carried out in the department of  neurology  and Neurosurgery for  6 months. The total number of participants in the research we conducted  were 150 out of which  male  patients  were  93(60\%)and  females  were  57(38\%)  are  less  likely  present,  the  age  group  of  the people carried out in our study were maximum between {\textgreater}66 that is 39 (24.4\%) and  minimum  between  30-40  that  is  10  (6.2\%), all  are  suffering  with  stroke  and  the  data  is  obtained  and  discussed. Our research showed that the majority of the  patients having difficulty with different types of  stroke was taken into consideration with their treatment modulations and assessment of their  outcomes. Most of the people were recovered from the condition out of which it analyses the  effects  to  make  the  life  better;  our  study  also  estimates  the  complications  and  treatment  to  have  a  better therapeutic  outcome. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Assessment,\newline Complications,\newline Treatment modulation,\newline Neurological impair
\end{keywords}
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\makeatletter{\raggedright{\Large$^\ast$}Corresponding Author\par Name:\ Kanamala~Arun~Chand~Roby~\\ Phone:\ ~\\  Email:\ arunchandroby@gmail.com
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\section{Introduction}
Stroke is In India, a significant non-communicable disease (NCD) is to blame for 3.5\% of the disability-adjusted life years. The occurrence of stroke is on the rise as a result of changes in lifestyle, behaviour, demographics, socio-cultural norms, and technology \unskip~\cite{1986858:28409742,1986858:28409740}. Generally speaking, people can prevent the disease by making little modifications to the way they live. A stroke is a sudden loss of brain function brought on by an interruption in the blood flow to the brain. A stroke is referred to as a "BRAIN ATTACK" when the blood supply to a particular area of the brain is cut off \unskip~\cite{1986858:28409745}. 8, 00,000 primary (first-time) and secondary (recurrent) cases, respectively. Strokes occur annually in the United States, with the majority being primary strokes (about 6, 00,000), 87\% being ischemic violations, 10\% being main haemorrhages, and 3\% subarachnoid  hemorrhages \unskip~\cite{1986858:28409737}. Per  year  17  million  strokes  were  noted.  For  every 2  seconds,  one  stroke was  noted.  For every  Year 6.5  million  deaths were  observed global estimations indicates that primary hemorrhage For 10\% to 25\% of all strokes, people of Asian, African, as well as Latin American ancestry tend to experience primary haemorrhage more frequently than people of European ancestry \unskip~\cite{1986858:28409731}. Additionally, primary haemorrhage causes 10 to 17\% of all strokes, and its prevalence doubles every ten years after age 55. Stroke incidence ranges from 30 to 120 per 100,000 adults aged 35 to 44 and from 670 to 970 per 100,000 adults aged 65 to 74 per year \unskip~\cite{1986858:28409743}. Based on the cause of the stroke, it can be categorised as either ischemic (87\%) or hemorrhagic (13\%).

\textbf{Ischaemic  Stroke:}

It is caused by the blocking of a cerebral artery (50\%) by thrombus or atherosclerotic plaque, 25\% by embolism, and 25\% by micro-artery blockage, or "lacunar stroke") \unskip~\cite{1986858:28409768}. The most frequent type of stroke, an ischemic stroke, occurs when a brain artery is blocked. Ischemic stroke can come in two different forms \unskip~\cite{1986858:28409736}. 

\textbf{Embolic Stroke}

A blood clot or plague fragment usually develops in the heart or the major arteries that supply the brain during an embolic stroke and travels via the arteries to the brain. A stroke results from the clot blocking a blood artery in the brain \unskip~\cite{1986858:28409744}.

\textbf{Thrombotic Stroke}

A blood clot inside an artery that supplies blood to the brain is known as a thrombotic stroke. The clot prevents blood flow, which results in a stroke \unskip~\cite{1986858:28409741}.

\textbf{Transient  Ischemic  Attack:}

Blood flow slows or ceases if a brain artery or one that goes to the brain is temporarily stopped. A brief ischemia attack sometimes referred to as a "MINI STROKE" can result from this. When a TIA occurs, the artery either becomes unblocked quickly or a new channel opens up, restoring normal blood flow \unskip~\cite{1986858:28409739}. The symptoms only stay a short while before going away. A TIA is a severe indication that you could be having a stroke.

\textbf{Hemorrhagic  Stroke:}

When a blood artery in the brain bursts, blood leaks into or around the brain, causing a hemorrhagic stroke. Blood vessels can become weak enough to explode due to aneurysms and high blood pressure \unskip~\cite{1986858:28409734}. There are two types:

\textbf{Intracerebral  Hemorrhage:}

A ruptured blood artery that bleeds into the brain tissue results in this particular type of stroke. As a result of the bleeding, the brain cells die and the damaged area of the brain becomes dysfunctional. The most frequent cause of this kind of stroke is hypertension \unskip~\cite{1986858:28409727}.

\textbf{Subarachnoid  Hemorrhage:}

A blood vessel close to the surface of the brain bursts in this form of stroke, allowing blood to flow into the gap between the brain and the skull. The pressure from the blood that builds up in this area puts strain on the brain's tissue and causes blood vessels to spasm. Aneurysms are typically the cause of this type of stroke \unskip~\cite{1986858:28409728}.

\textbf{Aneurysm:}

It is a weak point of the artery's wall that protrudes into a thin bubble. As it grows, the wall could become weak as well as crack.

The  goals of  treatment of  acute stroke  are

The first is to lessen the ongoing brain damage, as well as to lower death and long-term disability.

Prevent complications brought on by neurological dysfunction and immobility.

\textbf{Prevent stroke reoccurrence }

\textbf{Life  Style  Measures:}

All patients who smoke should be encouraged to give up and to stay away from smoke-filled environments.

Everyone who is able to exercise regularly should be encouraged to do so for at least 30 minutes each day. It should be suggested to them that they begin with low-intensity exercise and build it gradually to moderate levels \unskip~\cite{1986858:28409733}.

All patients should be urged to practise yoga, consume low-fat dairy products, foods made from vegetables, fruits, whole grains and plant oils, cut back on sweets and steer clear of red meat \unskip~\cite{1986858:28409730}.

Diabetes should be checked for in all patients, and treatment should aim for an HbA1C of less than 6.5\%.

It should be suggested to all patients to consume less salt.

\textbf{Intravenous  thrombolysis:}

Poor prognostic indicators include the persistence of proximal arterial blockage following IV thrombolysis, which is frequently observed in patients with baseline NIHSS scores {\textgreater}10. Additionally, the rate of partial or complete recanalization of the occluded proximal middle cerebral artery (MCA) with IV alteplase is only about 25\%, as opposed to the higher rates of 50{\textendash}60\% that are frequently reported following intra-arterial (IA) therapy. In certain patients with acute strokes, IV rt PA showed a definite benefit, according to the National Institute of Neurological Disorders and Stroke (NINDS). In ischemic stroke within three hours of onset, the NINDS research utilised IV rt PA (0.9 kg to a 90 mg max; 10\% as bolus, then the remaining over 60 min). Within 90 minutes, one-half of the patients received care \unskip~\cite{1986858:28409729}.


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\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.121\linewidth-2\tabcolsep}p{\dimexpr.14000000000000002\linewidth-2\tabcolsep}p{\dimexpr.1495\linewidth-2\tabcolsep}p{\dimexpr.1495\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.14\linewidth-2\tabcolsep}p{\dimexpr.16\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor} & 1 & 2 & 3 & 4 & 5 & 6\\
\tblmidrule 
Eye-opening &
  Does  not  open  eyes in  response  to pain &
  Opens  eyes  in  response  to pain &
  Opens  eyes in response  to  commands &
  Opens eyes  spontaneously &
  N/A &
  N/A\\
Verbal &
  Makes  no  sounds &
  Makes  incomprehensible \mbox{}\protect\newline sounds &
  Speaks inappropriate  words &
  Confused \mbox{}\protect\newline , disoriented &
  Oriented \mbox{}\protect\newline , converses normally &
  N/A\\
Motor &
  Makes no movements &
  Extension to painful stimuli &
  Abnormal flexion  to painful stimuli &
  Normal flexion/withdrawal to painful stimuli &
  Localizes to  painful stimuli &
  Obeys commands\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the demographic details of the patient with all the factors of age, sex, educational level, nutritional status, marital status and ethnicity} }
\label{tw-4b431f8b60c8}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3533\linewidth-2\tabcolsep}p{\dimexpr.33\linewidth-2\tabcolsep}p{\dimexpr.3167\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}DEMOGRAPHICS & NO  OF  PATIENTS & PERCENTAGE\\
\tblmidrule 
\textbf{Age} &
   &
  \\
30-40 &
  10 &
  6.2\\
41-50 &
  15 &
  9.4\\
51-60 &
  22 &
  14\\
61-65 &
  32 &
  20\\
66-70 &
  39 &
  24.4\\
{\textgreater}70 &
  32 &
  21.3\\
\textbf{Sex} &
   &
  \\
Male &
  93 &
  60\\
Female &
  57 &
  38\\
\textbf{Marital  Status} &
   &
  \\
Married &
  146 &
  97.3\\
Unmarried &
  14 &
  9.3\\
\textbf{Educational} &
   &
  \\
Primary &
  78 &
  52\\
Secondary  &
  39 &
  26\\
Tertiary &
  33 &
  22\\
\textbf{Nutritional level} &
   &
  \\
Excellent  &
  29 &
  19.3\\
Good &
  48 &
  32\\
Poor &
  73 &
  48.6\\
\textbf{Surrounding} &
   &
  \\
Excellent  &
  35 &
  23.3\\
Good &
  65 &
  43.3\\
Poor &
  50 &
  33.3\\
\textbf{Cleanliness} &
   &
  \\
Excellent  &
  33 &
  22\\
Good &
  68 &
  45.3\\
Poor &
  49 &
  32.6\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the reason for admission in the hospital with primary symptoms} }
\label{tw-61135be0a9be}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3366\linewidth-2\tabcolsep}p{\dimexpr.32339999999999996\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Reason  for  Admission & No  of  patients & Percentage  (\%)\\
\tblmidrule 
Stroke &
  150 &
  100\\
Stroke with Hypertension &
  59 &
  39.3\\
Stroke  with Diabetes Mellitus &
  47 &
  31.3\\
Recurrent  CVA &
  23 &
  15.3\\
Stroke with HTN and DM &
  106 &
  70.6\\
Stroke  with  CAD &
  15 &
  10\\
Stroke  with  UTI, Sepsis,  and  AKI &
  06 &
  04\\
Trauma &
  00 &
  00\\
Post-traumatic  stroke &
  00 &
  00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the symptoms observed during the hospital stay after admission with stroke} }
\label{tw-824c1c08f7af}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3533\linewidth-2\tabcolsep}p{\dimexpr.2801\linewidth-2\tabcolsep}p{\dimexpr.3666\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Symptoms  observed  during hospital  stay & No  of  Patients & Percentage  (\%)\\
\tblmidrule 
Dysarthria &
  48 &
  32\\
Descend &
  34 &
  22.6\\
Not Obeying Commands &
  12 &
  8\\
Facial  asymmetry &
  24 &
  16\\
Fever &
  12 &
  8\\
Constipation &
  16 &
  10.6\\
Mental  Confusion &
  15 &
  10\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the scans performed to the patients to rule out the stroke and type of stroke} }
\label{tw-103276d43eb8}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3433\linewidth-2\tabcolsep}p{\dimexpr.32\linewidth-2\tabcolsep}p{\dimexpr.3367\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Scans  Performed & No  of  Patients & Percentage  (\%)\\
\tblmidrule 
Computed Tomography &
  150 &
  100\\
Magnetic Resonance   Imaging &
  150 &
  100\\
Carotid  Doppler &
  139 &
  86.6\\
Single  Photon Emission  Computed  Tomography &
  00 &
  00\\
Positron  Emission   Tomography &
  00 &
  00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the classes of Drugs Prescribed For The Patientsin the hospital} }
\label{tw-829f47c0f679}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3865\linewidth-2\tabcolsep}p{\dimexpr.2735\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drugs  prescribed & No  of  patients & Percentage\\
\tblmidrule 
Anti-platelet  Activator &
  146 &
  97.3\\
Anti hyperlipidemic agents &
  65 &
  43.3\\
Anti  diabetic  agents &
  47 &
  31.3\\
Anti  hypetensive  drugs &
  59 &
  39.3\\
Thrombolytic agents &
  150 &
  100\\
Anti  ulcer drugs &
  58 &
  38.6\\
Anti coagulants &
  120 &
  80\\
Anti emetics &
  48 &
  32\\
Anti  convulsant &
  138 &
  92\\
Multivitamin  supplements &
  67 &
  44.6\\
Nonsteroidal  anti-inflammatory  drugs &
  54 &
  36\\
Antibiotics &
  87 &
  58\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the symptom sobserved during Admission in ER Department} }
\label{tw-097eba81f07f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3599\linewidth-2\tabcolsep}p{\dimexpr.30\linewidth-2\tabcolsep}p{\dimexpr.3401\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Symptoms  observed  during admission & No  of  Patients & Percentage (\%)\\
\tblmidrule 
Weakness  of  upper limbs, lower limbs  &
  115 &
  72\\
Slurring  of  speech &
  93 &
  58\\
Deviation of angle of mouth &
  78 &
  49\\
Loss  of motor  refluxes &
  24 &
  15\\
Loss of consciousness &
  26 &
  16.2\\
Unresponsiveness to   commands &
  16 &
  10\\
Seizures &
  14 &
  09\\
Headache &
  08 &
  05\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the Lab test performed to the patients after admission} }
\label{tw-93210cca36b1}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3399\linewidth-2\tabcolsep}p{\dimexpr.30690000000000005\linewidth-2\tabcolsep}p{\dimexpr.3531999999999999\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Lab  Investigations & No  of  Patients & Percentage (\%)\\
\tblmidrule 
Complete blood profile  &
  150 &
  100\\
Liver function tests &
  142 &
  89\\
Renal function tests &
  135 &
  84.6\\
Lipid profile tests &
  150 &
  100\\
Electrolytes &
  144 &
  90\\
Urine analysis &
  144 &
  90\\
Glycemic  profile  &
  150 &
  100\\
Thyroid  profile &
  08 &
  05\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows treatment regimen for stroke patients mostly used in all patients} }
\label{tw-2f2f3fc0d2ab}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.3665\linewidth-2\tabcolsep}p{\dimexpr.27680000000000003\linewidth-2\tabcolsep}p{\dimexpr.35669999999999995\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Drugs & No  of  Patients & Percentage (\%)\\
\tblmidrule 
Mannitol &
  150 &
  100\\
Enoxaparin  sodium  &
  150 &
  100\\
Aspirin &
  146 &
  91\\
Clopidogrel &
  62 &
  38.7\\
Cefaparazone + Salbactum  &
  58 &
  36.2\\
Paracetamol &
  45 &
  28\\
Levetiracetam &
  38 &
  24\\
Piperacillin + tazobactum &
  36 &
  22.5\\
Nifedipine &
  33 &
  20.6\\
Insulin R &
  30 &
  18.75\\
Telmisarton &
  25 &
  15.62\\
Hydrochlorthiazide  &
  20 &
  12.5\\
Metformin &
  20 &
  12.5\\
Furosemide &
  20 &
  12.5\\
Amlodipine &
  18 &
  11.2\\
Pantoprazole &
  15 &
  59.37\\
Ondonsetron &
  14 &
  8.7\\
Glimepiride &
  10 &
  6.25\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows complications occurred after stroke during hospital} }
\label{tw-68d4af9920d7}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4197\linewidth-2\tabcolsep}p{\dimexpr.2536\linewidth-2\tabcolsep}p{\dimexpr.32669999999999995\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Complications & No  of  patients & Percentage  (\%)\\
\tblmidrule 
Recurrent seizures &
  05 &
  3.1\\
Epileptic seizure &
  14 &
  8.7\\
Urinary  tract  infections  &
  36 &
  22.5\\
Mobility-related falls &
  76 &
  47.5\\
Pressure sores &
  12 &
  7.5\\
Depression &
  28 &
  17.5\\
Anxiety &
  56 &
  35\\
Emotionalism  &
  28 &
  17.5\\
Confusion &
  90 &
  56.25\\
Pain &
  126 &
  78.7\\
Chest  infections &
  00 &
  00\\
Deep  vein  thrombosis  &
  00 &
  00\\
Pulmonary  embolism &
  00 &
  00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows treatment complications in stroke patients} }
\label{tw-c632ab96b0e2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4097\linewidth-2\tabcolsep}p{\dimexpr.2503\linewidth-2\tabcolsep}p{\dimexpr.34\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Treatment  complications & No  of  patients & Percentage  (\%)\\
\tblmidrule 
Pneumonia  &
  23 &
  14.3\\
Seizures &
  12 &
  7.5\\
Decreased intracranial  pressure &
  10 &
  6.25\\
Intracerebral hemorrhage &
  06 &
  3.7\\
Fibrosis  of  connective  tissue  &
  00 &
  00\\
Cerebral swelling &
  00 &
  00\\
Malnutrition &
  00 &
  00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the drugs Used for Stroke Patients in Long term Therapy} }
\label{tw-186822fdefdf}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4595000000000001\linewidth-2\tabcolsep}p{\dimexpr.24039999999999992\linewidth-2\tabcolsep}p{\dimexpr.30010000000000005\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Long  term  used  Drugs  in stroke  Patients & No  of  Patients & Percentage  (\%)\\
\tblmidrule 
Ecosprin &
  150 &
  100\\
Inj.Alteplase &
  138 &
  92\\
Aspirin &
  146 &
  91\\
Clopidogrel &
  62 &
  38.7\\
Heparin &
  48 &
  32\\
Acenocoumarol &
  24 &
  16\\
Dabigatran &
  15 &
  10\\
Enoxaparin  sodium &
  08 &
  5.3\\
Dipyridamole &
  20 &
  13.3\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows the Duration of drugs used in long-term management} }
\label{tw-565faacac04f}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.32\linewidth-2\tabcolsep}p{\dimexpr.3367\linewidth-2\tabcolsep}p{\dimexpr.3433\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Duration of  drugs  usage & No  of  Patients & Percentage  (\%)\\
\tblmidrule 
Onset  of  stroke  &
  150 &
  100\\
3  weeks &
  150 &
  100\\
3  months &
  120 &
  80\\
6  months &
  68 &
  45.3\\
8  months &
  43 &
  28.6\\
12 months &
  22 &
  14.6\\
Rehabilitation &
  Maximum &
  100\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows treatment outcomes in stroke patients} }
\label{tw-804f1d32250d}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.39650000000000006\linewidth-2\tabcolsep}p{\dimexpr.2868\linewidth-2\tabcolsep}p{\dimexpr.3167\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Treatment  outcome & No  of  patients & Percentage  (\%)\\
\tblmidrule 
Recovered &
  118 &
  73.7\\
Not  recovered &
  21 &
  13.1\\
Economic  burden &
  21 &
  13.1\\
No  change &
  00 &
  00\\
Shifted  to  higher  centers &
  00 &
  00\\
Left  against  to medical \mbox{}\protect\newline Advice (LAMA) &
  00 &
  00\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Shows criteria for diagnosis in the hospital} }
\label{tw-d374261a0613}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.44300000000000004\linewidth-2\tabcolsep}p{\dimexpr.21029999999999998\linewidth-2\tabcolsep}p{\dimexpr.3467\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Condition  at  the  time  of diagnosis & No  of  patients & Percentage  (\%)\\
\tblmidrule 
Can't  remember &
  00 &
  00\\
After  lab  investigations &
  20 &
  12.5\\
By  imaging &
  150 &
  100\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Rehabilitation  of  Stroke  Patients}

A multidisciplinary team approach to stroke rehabilitation involves a doctor, a physiotherapist, an occupational therapist, a nurse, a speech and language therapist, a clinical psychologist, an orthotist, and a social worker \unskip~\cite{1986858:28409735}. 

\textbf{Physiotherapeutic  Management  of  Stroke  Patients}

Physical therapy after a stroke seeks to enhance motor coordination, upper extremity functions, gait, and daily living skills while promoting self-care and social inclusion.

\textbf{General  Recommendations }

The first stroke Within the first 48 hours of admission, patients must be seen and evaluated by a physiotherapist. The assessment must be revisited every two weeks up to the time of discharge, every week for the first month, every month for the first six months, and then every two years after that, until the patient has reached maximum functional recovery \unskip~\cite{1986858:28409738}.

Throughout the healing process, the patient and carers should be involved in choosing the goals and course of treatment.

At all phases of rehabilitation, functional use of the afflicted side should be promoted as much as feasible.

Patients and their carers should get education and encouragement to ensure that the skills they learn in therapy sessions are also practised at home.

Avoid aggressive stretching near joints that are more susceptible to flaccid muscles (shoulder, knee, wrist, as well as hand).

Every stroke patient should receive at least 45 minutes of supervised physical therapy five days a week until the patient meets the assessment's predetermined goals \unskip~\cite{1986858:28409741,1986858:28409738}.
    
\section{Materials and Methods}
\textbf{Place of study}

The  study ``Long  Term  Management  of  Stroke  Patients  With  Drug  Associated  Problems", Which  Was  Carried  out  in  the  Department of Neurology  of a tertiary care teaching hospital.

\textbf{Study  Design}

The research was a prospective observational study carried out in the field of neuroscience  and  Neurosurgery  ward  of territory  care  teaching hospital.

\textbf{Study  Population}

This  study  was done  in  150 Patients  who  are suffering  with  stroke.

\textbf{Study  Duration}

This  study was  conducted for  6  months.

\textbf{Study  Criteria  /Patient  enrollment}

According to the study's inclusion and exclusion criteria, patients are enrolled.

\textbf{Inclusion  Criteria:}


  
  \begin{enumerate}
  \item \relax All  the  patients  suffering with  different  types  of  stroke.
  \item \relax Patients  age  in between  35  {\textendash} 70  years.
  \item \relax Patients  of  both  sexes.
  \item \relax Patients  with  Comorbid  conditions.
  \item \relax Who  are  willing  to  give  Information?
  \item \relax History  of  trauma.
  \item \relax Patient  with  alcohol  and Smoking  habits.
  \end{enumerate}
  \textbf{Exclusion  Criteria:}


  
  \begin{enumerate}
  \item \relax Pregnancy  women.
  \item \relax Lack  of Interest  to  give  information.
  \item \relax Pediatrics.
  \item \relax Whose  verbal  communication was  poor?
  \item \relax Unconsciousness  patients.
  \end{enumerate}
  \textbf{Study  Materials:}


  
  \begin{enumerate}
  \item \relax Patient  informed  consent form.
  \item \relax Patient Information data form.
  \end{enumerate}
  \textbf{Study  Method:}

The  study  will be initiated after obtaining the permission from the Head of the  Institution  and  Head  of  Department  of  Neurology.  Patients  are  considered  into  the  study,  after  taking informed consent form from them or from the attendants. Patients are considered for  the  study based on inclusion and exclusion criteria \unskip~\cite{1986858:28409732}.

The "Chart Review Method" will be used to gather the data for this study, as it is well suited to identifying all the necessary and relevant baseline information. The data will be collected on a specially designed patient data collection proforma, which includes patient demographics like age, socio-economic status, family income, educational level, high-risk factors, past and present medical/medication history, lab investigation data, radiographic data, physician information, and patient demographics like age \unskip~\cite{1986858:28409726}. 
    
\section{Results and Discussion}
Our Study was conducted in the department of neurology and neurosurgery, we  have  collected  the  data  of  the  patients  including  all  the  demographic  details  of  the  stroke patients with inclusion and exclusion criteria of age group 66-70 ( 24.4\%)  having the highest  out of 150 patients and 30-40 (6.2\%) being the lowest, out of  150 (60\%)male and (38\%) female, with marital status of (97.3\%) married and  (9.3\%)unmarried, The educational level of patients (52\%) of primary (26\%) of  secondary and (22\%)of tertiary with hygenic conditions of maximum were poor  73(48.6)  and  minimum  were  good  48(32\%)and  very  less  excellent  29(19.3\%)was  reported  with surrounding environment was almost good and cleanliness is  almost good  65(43.3\%)  was  observed. The  reasons  for  the  admission  were also  analysed  after  collecting  the  data  from  the  stroke patients  150(100\%), hypertension 59(39.3\%), diabetes 47(31.3\%),  recurrent  CVA  23(15.3\%),  both  hypertension  and  diabetes  106(70.6\%),  CAD 15(10\%), UTI sepsis and AKI being(4\%), Trauma  and  post-traumatic  stroke  being  (0\%). The symptoms mostly observed during the treatment and hospital stay were  dysarthria 48(32\%), Facial asymmetry 24 (16\%), descend  34(22.6\%), mental  confusion 15(10\%)and not obeying commands 12(8\%). The symptoms observed  during  the  admission  is  mostly  of  weakness  of  upper limbs  and  lower  limbs  115(72\%), slurring of speech 93(58\%), deviation of mouth angle 78(49\%),  seizures  14(9\%)  including  headache, loss  of  consciousness  reported  the  least (Tables~\ref{tw-a859f633ef36}, \ref{tw-4b431f8b60c8}, \ref{tw-61135be0a9be}, \ref{tw-824c1c08f7af} and~\ref{tw-103276d43eb8}).

The lab parameters performed to the patients in different conditions include complete blood profile,  lipid  profile  and  glycemic  profile  of  150(100\%),  and  liver  function tests, renal function test, urine analysis, thyroid profile and electrolytes  were analysed with the least no of patients. In the study for the final confirmation  differential diagnosis were done of which were mainly scans performed are CT,  MRI  150(100\%),  carotid  doppler  139(86.6\%)  were  performed  for  evaluation  of  stroke (Tables~\ref{tw-829f47c0f679}, \ref{tw-097eba81f07f}, \ref{tw-93210cca36b1}, \ref{tw-2f2f3fc0d2ab} and~\ref{tw-68d4af9920d7}).

The  treatment  regimen  provided  for  the  patients  with  different  class  of  drugs  were mostly of anti platelet drug 146(97.3\%), thrombolytic agents 150(100\%), anti  coagulant 120(80\%), anticonvulsant 138(92\%), antihyperlipidemic agents 65  (43.3\%), anti diabetic drugs 47(31.3\%) and multivitamin tablets are prescribed  for the patients along with NSAIDS and antibiotics. The different types of  treatment provided for stroke patients include mannitol, enoxaparin sodium  150(100\%),  aspirin  146(100\%),  clopidogrel62(38.7\%),  piperacillin  and  tazobactum 36(22.5\%), insulin 30(18.75\%), telmisartan 25 (15.62\%), maximum  use  and  metformin,  amlodipine,  ondansetron,  pantoprazole  were  being  minimum  usage (Tables~\ref{tw-c632ab96b0e2}, \ref{tw-186822fdefdf}, \ref{tw-565faacac04f}, \ref{tw-804f1d32250d} and~\ref{tw-d374261a0613}).

The complications observed after the stroke therapy include recurrent seizures  05(3.1\%), pain 126(78.7\%), confusion 90(56.25\%), anxiety 56(35\%), emotional  28(17.5\%), UTI 36(22.5\%), mobility-related falls 76(47.5\%) and deep vein  thrombosis, chest infections are least  observed. Our study also analysed the  treatment complications in the patients suffering with stroke the maximum was  pneumonia  23(14.3\%),  seizures  12(7.5\%),  decreased  intracranial  pressure  10(6.25\%), and  cerebral swelling,  malnutrition  reported the  least.

The  drugs  that  are  used  for  stroke  in  long-term  therapy  involve  the  maximum  use  of ecosprin 150(100\%), inj.alteplase 138(92\%), aspirin 146(91\%), clopidogrel  62(3.7\%), acenocoumarol 24(16\%) and heparin, dabigatran, dipyridamole and  enoxaparin sodium of minimum usage observed. The duration of therapy in stroke patients include onset of stroke  to  3  weeks  150(100\%),  3 months  120(80\%),  6 months 68(45.3\%), 8 months 43(28.6\%), 12 months 22(14.6\%) and maximum  patients with rehabilitation. The treatment showed better outcome in the patient  suffering  with  stroke, the  maximum  number  of  patients  were  recovered  118(73.7\%), and minimum not recovered 21(13.1\%), and least for economic  burden 21(13.1\%). The overall criteria for the diagnosis in the hospital is by  imaging 150(100\%). Out of 150 patients, 150 are provided with the information  by  continuous  monitoring  of  the  patient  and  the  data  were  analysed  and  evaluated  with long-term complications and  concluded  the  study.
    
\section{Conclusion}
Our study concluded that most of the patients under long-term treatment for  stroke, caused several complications. These complications lead to permanent  systemic complications. Therefore  the long-term management of some drugs  must  be  reviewed  frequently  to  overcome  the  side  effects  in  the  patients.  It  should  be considered that we should provide proper drug therapy to the patients based  on physician advice in a proper mechanism. We the clinical pharmacist should  provide the knowledge to the patient attendants about the drug usage and proper  follow-up.  We  prepare  the  pamphlet  and  brochure  about  medical  management  to  the patients. The healthcare system has to take measures throughout the world for better outcomes and quality of life with increased life expectancy.
    
\section{Acknowledgement}
All thanks and praises to god Almighty or his countless, abundant and never ending blessings in completing this work. It is a proud privileged honor or us to express our hateful thanks and gratefulness to all the persons who backed us directly or indirectly throughout o~this research work as magnitude. Most importantly authors are thankful to patients and health care professionals.

\textbf{Conflict of interest}

Nil. 

\textbf{Funding}

Self.
    

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