Stroke Flashcards
Which type of brain matter is harder to have ischemia due to micro-vessel branching?
Grey matter
What does carotid circulation supply?
Anterior, mid, posterior
What does vertebral basilar circulation supply?
Pons, medulla, midbrain
What is a lacunar stroke?
Small vessel infarct in the white matter of the brain
T/F: Your chances of having a stroke after a TIA is statistically the same as having a stroke after a stroke.
TRUE!
Name some treatable stroke risk factors
- HTN
- High cholesterol
- Heart disease (esp. afib)
- Diabetes
- Smoking
- Excessive alcohol
- Obesity
- Inactivity
- Carotid bruit
Name some untreatable stroke risk factors
- Age (>55)
- Sex (male>female)
- Race (Black, Hispanic)
- Prior stroke
- Hereditary
When is the only time you will see an anticoagulant used for stroke prevention?
Atrial fibrillation patients, bilateral shower of emboli present on MRI
MOA of clopidogrel/prasugrel/ticagrelor?
ADP receptor blockade (P2Y12)
MOA of ASA?
Inhibition of COX and thromboxane
MOA of dipyridamole?
Increase plasma adenosine, inhibit platelet phosphodiesterase
What is AGGRENOX?
Low dose aspirin + dipyridamole
Which antiplatelet agent acts reversibly?
Dipyridamole
T/F: Enteric-coated ASA decreases the risk of GI bleeds.
FALSE! It decreases GI discomfort
Which stroke prevention therapy is the most efficacious?
Trick question, there is no evidence that puts one treatment over the other.
What should NOT be used in migraine history?
Dipyridamole
What should be avoided with GI issues (IBS, spastic colon)?
ASA
What should not be used with CCBs?
Clopidogrel/Prasugrel (CYP interaction)
Which drug does not need to be avoided in CYP3A4/CYP2C19 inhibition since it is NOT a prodrug?
Ticagrelor (Brillenta)
Important information during acute stroke
- Home meds
- When onset of stroke was
- When was the patient last seen NORMAL?
tPA time window
<2 hours for reversible deficits
2-6 hours for incomplete recovery
>6 hours for little recovery
tPA drug
Alteplase
- ICH concern
- 0.9 mg/kg, 10% given over 1 minute bolus
- Keep BP <180 mmHg systolic for 24 hours
tPA requirements
- Ischemic stroke causing deficit
- Symptom onset <4.5h (3h for 80+ y/o)
- Age >18
