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Flashcards in Stroke Deck (23)
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1
Q

What physiologically causes ischemic stroke?

A

A thrombus/clot (like a brain heart attack) causes this.

2
Q

Cardioembolic stroke meaning

A

stroke caused by a embolus in the heart traveling to the brain - usually due to afib

3
Q

non-cardioembolic stroke

A

origin of the disease is the brain not the heart, usually due to athleroschlerosis

4
Q

less serious type of stroke

A

transient ischemic which disappears on its own within a few minutes to hours

5
Q

Symptoms of stroke

A

ACT

Face
Arms
Speech
Time

6
Q

What needs to be done within 20 minutes and why

A

Computed Tomography in order to identify whether stroke is ischemic or hemorrhagic

7
Q

Which fibrinolytic is not indicated for acute stroke but is for MI

A

tenecteplase

8
Q

tpa

A

alteplase/activase

9
Q

Max time you can give tpa after time of stroke

A

3 hours (4.5 not fda approved max)

10
Q

door to needle time to give tpa for stroke

A

60 minutes

11
Q

required bp to give tpa

A

<185/110

12
Q

tpa contraindications

A

active internall bleeding, history of recent stroke, severe uncontrolled hypertensiojn, on any sort of blood thiner within the past 48 hours, ever had a intercerebral hemmorhage

13
Q

the maximum dose in tpa

A

90mg

14
Q

How do you prevent early recurrent stroke?

A

Aspirin 162 - 325 mg PO within 24-48 hours of stroke onset

15
Q

What are the modifiable risk factors for secondary prevention

A

*hypertension, dyslipedemia, diabetes, afib, lifestyle (diet, achohol, exercise)

16
Q

Which hypertensive drugs are best for preventing stroke

A

ace inhibitors and thiazide

17
Q

What can be given to reduce the risk of non-cardioembolic stroke?

A

aspirin 50-325mg po daily or clopidogrel 75mg daily in those with a contraindication to aspirin or aggrenox (dipyridamole/aspirin)

combo therapy of aspirin and clopidogrel only up to 21 days

18
Q

what is dipyridamole moa

A

inhibits the uptake of ademosine into platelets and increases CAMP levels –> vasodilates, causes HA

19
Q

What enzyme converts clopidogrel to active form

A

2c19, beware of inhibitors esomeprazole (dexilant) and

20
Q

warning for clopidogrel

A

Thrombocytopenic purpura (all drugs in its class have this)

21
Q

What the primary complication of intracerebral hemorrhage and how is it treated

A

ICP - hypertonic saline or mannitol injection which withdraws water form the brain and thus is contraindicated in severe renal disease

22
Q

what is a subarachnoic hemmorhage

A

same thing dad had, present with severe headache, nimodepine is used to prevent the cerebral artery vasospasm 3-21 days after the bleed

23
Q

nimodipine moa

A

dhp ccb selective for cerebral arteries due to increased lipophilicity