36 - Acute Stroke Flashcards Preview

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Flashcards in 36 - Acute Stroke Deck (19):
1

Stroke can either be caused by a block/clot or a bleed. List the 3 types of strokes that can happen

1-cerebral infarction (ischemic stroke) = block
2-intracerebral hemorrhage = bleed
3-subarachnoid hemorrhage = bleed

2

What type of stroke is most common

1-cerebral infarction (ischemic stroke) = block

85% of strokes are this type

3

Warning signs for stroke?

FAST

Face - is it dropping?
Arms - can you lift both of them?
Speech - is it slurred?
Time - time to call 911

4

Non-pharms?

-Endovascular thrombectomy - within 6 hours of onset. May be performed after initiating tx with IV alteplase (TPA) or in patients in whom TPA is CI (after recent surgery, patients on warfarin with INR > 1.7, or on a DOAC)
-Neurosurgical Intervention
-Supportive care (treat fever and hyperglycemia. use oxygen if SaO2 < 95%)
-Swallowing and Nutrition
-Venous Thromboembolism (early mobilization is key, pneumatic compression stockings are recommended as they decrease risk of DVT but graduated compression stockings are NOT recommended)

5

Pharmacologic Tx for Ischemic Stroke: (Clot)
When should thrombolytics (ex. alteplase) be administered?

administer IV ASAP after stroke onset

6

Pharmacologic Tx for Ischemic Stroke: (Clot)
After what amount of time is alteplase of no benefit?

> 4.5 hours after symptom onset

7

Pharmacologic Tx for Ischemic Stroke: (Clot)
Who should get VTE prevention?

Those who had ischemic stroke who cannot move one or both lower limbs or mobilize independently

8

Pharmacologic Tx for Ischemic Stroke: (Clot)
What should they receive as VTE prevention?

in the absence of CIs, use LMWHs or UFH in prophylactic doses

can use ASA

9

Pharmacologic Tx for Ischemic Stroke: (Clot)
If intracranial hemorrhage has been excluded but alteplase is not indicated, what can you give?

ASA 160 mg immediately

follow with ASA 80-325 mg daily

10

Pharmacologic Tx for Ischemic Stroke: (Clot)
If Alteplase is used, what until ___ _____ is excluded 24 hours post-Tx until giving ASA

intracranial hemorrhage

11

Pharmacologic Tx for Ischemic Stroke: (Clot)
If patient was taking ASA prior to their stroke, what agents should you consider?

clopidgrel 75 mg once daily or dipyridamole/ASA 200/25mg BID

12

Pharmacologic Tx for Ischemic Stroke: (Clot)
Should you combine ASA and clopidogrel post stroke?

Combining them in the 1st month after a non-disabling stroke or TIA decreases the risk of major stroke at 3 months w/o increases risk of serious bleeding

This combo is not recommended long-term

13

Pharmacologic Tx for Ischemic Stroke: (Clot)
Options for anticoagulation?

-apixaban, dabigatran, endoxaban, rivaroxaban

If can't be anticoagulated, use ASA

14

Pharmacologic Tx for Ischemic Stroke: (Clot)
Which anticoagulants are CI if CrCl < 30?

dabigatran, endoxaban, rivaroxaban

15

Pharmacologic Tx for Ischemic Stroke: (Clot)
Which anticoagulants are CI if CrCl < 15?

apixaban

16

Pharmacologic Tx for Ischemic Stroke: (Clot)
Need to lower BP: using _____ ______ within 6 hours in those who had SBP = 140-220 showed improvement in functional outcomes

transdermal nitroglycerin

17

Pharmacologic Tx for Ischemic Stroke: (Clot)
When should oral BP-lowering agents be started?

prior to discharge from hospital who have BP > 140/90 (or 130/80 in DM)

18

Pharmacologic Tx for Intracranial Hemorrhage Stroke: (Bleed)

If they have established coagulopathy or hx of warfarin, what options do we have to reverse coagulopathy?

-prothrombin complex concentrate (PCC)
-vitamin K
-fresh frozen plasma (FFP)

*recombinant factor 7a prevents hematoma growth but not used routinely

19

Pharmacologic Tx for Subarachnoid Hemorrhage Stroke: (Bleed)

What do we use for this?

Nimodipine x 3 weeks decreases risk of secondary vasospam and cerebral infarction

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