Medical Treatment Of Stroke

Question 1

Type of seizures seen post-stroke

Answer 1

General, tonic-clonic

Question 2

3 medications to give patients for acute treatment of SAH

Answer 2

1. APAP with codeine for headache
2. Mannitol for cerebral edema
3. Nimodipine for Vasospasms

Question 3

timeframe of when to start anticoagulants after cardiac embolic stroke

Answer 3

If deficit is mild and CT shows no hemorrhage, start immediately. If deficit is severe, wait 3-5 days.

Question 4

What kind of stroke patients do you give anti platelets to?

Answer 4

Patients with noncardioembolic ischemic strokes or TIA

Question 5

Normal CPP

Answer 5

> 60 mmHg

Question 6

What kind of breathing abnormality do people with severe strokes get?

Answer 6

Central Sleep Apnea

Question 7

NIHSS score contraindication with tPA

Answer 7

> 25 (which indicates very severe)

Question 8

FLA for depression treatment in stroke patients

Answer 8

SSRIs

Question 9

Most rapid means of lowering ICP

Answer 9

Hyperventilating to reduce PaCO2 (hypercarbia increases ICP)

Question 10

Who are candidates for hypertension treatment in ischemic stroke patients?

Answer 10

If SBP > 220, DBP > 120 or MAP > 185 in nonthrombolytic patients.
If SBP > 185 or DBP > 110 in thrombolytic patients

Question 11

use of what medications is contraindicated with tPA

Answer 11

1. Warfarin

2. heparin within 48h

Question 12

Candidate for BP mgmt in hemorrhagic stroke

Answer 12

If SBP > 180 or DBP > 105

Question 13

Normal ICP

Answer 13

Less than or equal to 15

Question 14

blood sugar contraindication with tPA

Answer 14

<50 or > 400

Question 15

Favored antihypertensives for BP Mgmt in ischemic stroke

Answer 15

IV labetalol - nonselective Beta-blocker and alpha 1 antagonist
Enalapril - ACE inhibitor

Question 16

age limit for use of tPA

Answer 16

> 18 and <80

Question 17

what patients get a Carotid Endarterectomy

Answer 17

Carotid Stenosis with >70% stenosis

Question 18

What position do you put patient in to lower elevated ICP

Answer 18

Avoid flat and supine positions. Elevate HOB to 30 degrees

Question 19

Equation correlating CPP, MAP and ICP

Answer 19

CPP = MAP - ICP

Question 20

Which stroke has higher mortality rate within 1 month? Ischemic or hemorrhagic?

Answer 20

Hemorrhagic

Question 21

5 inclusion criteria for use of tPA

Answer 21

1. <18 yo
2. <4.5 hours after stroke
3. Head CT negative for blood
4. moderate to severe symptoms of stroke
5. Informed consent

Question 22

How can antihypertensive worsen stroke

Answer 22

Can lower cerebral perfusion

Question 23

Functional assessment tool that measures independence in ADLs on 0-100 scale

Answer 23

Barthel Index

Question 24

What kind of IVF do you want to avoid in stroke patients

Answer 24

Hypotonic solutions because it may worsen brain edema

Question 25

timeframe for use of tPA

Answer 25

<4.5 hours after stroke

Question 26

Agent of choice of BP mgmt in hemorrhagic stroke

Answer 26

IV labetalol

Question 27

BP contraindication for use of tPA

Answer 27

>185/100

Question 28

What is optimal PaCO2

Answer 28

25-30

Question 29

timeframe for intra-arterial thrombolytic therapy

Answer 29

<6 hours

Question 30

Rivaroxaban MOA and brand name

Answer 30

Brand name - Xarelto | MOA - Factor Xa inhibitor

Question 31

Seizures occurring after ________ after stroke have high probability of recurrence

Answer 31

2 weeks

Question 32

Medications that can decrease ICP

Answer 32

Mannitol, furosemide, acetazolamide, high doses of barbiturates.

Question 33

Dabigatran MOA and brand name

Answer 33

Brand name - Pradaxa | MOA - Direct thrombin inhibitor

Question 34

mri finding c/I with tPA

Answer 34

ischemic injury > 1/3 of MCA territory

Question 35

What medication can ASA be combined with for additive benefit

Answer 35

Dipyridamole (ASA + Dipyridamole = Aggrenox)

Question 36

INR contraindication for use of tPA

Answer 36

>1.7

Question 37

First line agent for treating seizures after stroke

Answer 37

IV lorazepam (Ativan) or Diazepam (Valium)

Question 38

When do you start nimodipine for SAH and for how long do you treat and at what dose?

Answer 38

Nimodipine 60mg q4h x 21 days. Start within 96 hours.

Question 39

platelet count contraindication with tPA

Answer 39

<100,000

Question 40

Apixaban MOA and brand name

Answer 40

Brand name - Eliquis | MOA - Factor Xa inhibitor

Question 41

Correlation between intracranial pressure and cerebral blood perfusion pressure

Answer 41

Increased ICP = Decreased CPP

Question 42

PMHx contraindication with tPA

Answer 42

1. stroke or severe head injury in the last 3 months 2. ICH, AVM, aneurysm, GI or GU bleed in the last 3 weeks 3. pregnant or lactating in the last 30 days 4. major surgery in the last 14 days 5. seizure at onset of stroke 6. acute mi 7. Stroke + DM

Question 43

When do you start a stroke patient on ASA

Answer 43

ASA 325 within 24-48 hours after ischemic stroke onset

Question 44

anticoagulant therapy and acute ischemic stroke

Answer 44

Not recommended. No benefit.