PHRM 864 > Stroke > Flashcards

Stroke Flashcards

(46 cards)

Study These Flashcards
1
Q

What is a stroke?

A

A stroke is an acute focal injury due to lack of blood/oxygen to the CNS causing neurological deficits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the types of stroke?

A
  • ischemic –> atherosclerotic
  • ischemic –> cardioembolic
  • hemorrhagic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is an ischemic stroke?

A

an infarction of brain tissue resulting from compromised blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is a hemorrhagic stroke?

A

bleeding in the brain due to rupture of a cerebral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the pathophysiology of an atherosclerotic stoke:

A
  1. cholesterol plaque buildup occludes artery
  2. blood clot then completely blocks the artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the main cause of a cardioembolic stroke?

A

atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the pathophysiology of hemorrhagic strokes:

A
  • aneurysm in cerebral artery breaks open –> causing a bleed around the brain
  • pressure of the blood on brain causes brain tissue death

  • aneurysm is a bulge in a blood vessel wall that appears when the vessel wall weakens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the modifiable risk factors for stroke?

A
  • CV disease (afib, valvular disease)
  • diabetes
  • HLD
  • HTN
  • drug/alcohol use
  • obesity/physical inactivity
  • cigarette smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can ischemic strokes be differentiated?

A
  • if atrial fibrillation or valvular abnormalities –> cardioembolic
  • if normal sinus rhythm –> atherosclerotic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the preferred blood glucose range while inpatient and what is used to address hyperglycemia?

A
  • BG < 180 mg/dL
  • treat with SC insulin

Only use an insulin drip if patient is in acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the ischemic blood pressure goals?

A
  • no tPA: < 220/110 mmHg
  • Prior to tPA: < 185/110 mmHg
  • after tPA: < 180/105 mmHg
  • after 48 hours: < 130/90 mmHg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the acute hypertension treatment options?

Could be used if patient’s BP is too high for tPA

A
  • labetalol IV
  • nicardipine IV
  • sodium nitroprusside IV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When can PO HTN management be (re)initiated?

A

after 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which type of stoke would a thrombolytic be used in?

alteplase, tenecteplase

A
  • ischemic - atherosclerotic
  • ischemic - cardioembolic

No impact on mortality, but can improve neurologic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the inclusion and exclusion criteria for using a tPA?

thrombolytics: alteplase, tenecteplase

A

Inclusion:
- diagnosis of ischemic stroke (confirmed with imaging)
- symptom onset <4.5 hours

Exclusion:
- BP >185/110 at time of admin
- BG < 50 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the dosing for alteplase?

thrombolytic

A
  • 0.9 mg/kg IV (max 90 mg)
  • 10% given as bolus over 1 minute
  • 90% infused over 60 minutes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the dosing for tenecteplase?

thrombolytic

A
  • 0.25 mg/kg IV (max 25 mg)
  • full dose given as IV bolus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What drugs should be avoided following thrombolytic administration for ischemic strokes?

A

avoid ALL antiplatelets and anticoagulants for 24 hours after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the antiplatelet options for acute ischemic stroke management?

Study These Flashcards
A
  • aspirin monotherapy
  • aspirin + clopidogrel
  • ticagrelor
  • aspiring + ticagrelor
20
Q

Who gets aspirin for a stroke?

Study These Flashcards
A
  • All ischemic stroke patients unless contraindicated
  • wait 24 hours after tPA admin
  • use immediately if no tPA

  • CI: active bleeding or high bleed risk

21
Q

When would each of the antiplatelet options be utilized?

Study These Flashcards
A
  • aspirin: first line option!
  • aspirin + clopidogrel: second line option ONLY in minor strokes
  • ticagrelor: second line, maybe for true aspirin allergy
22
Q

Are anticoagulants used in the acute treatment of ischemic strokes?

Study These Flashcards
A
  • no
  • if patient came in on anticoag, d/c it and transition to aspirin. Patient will not be given tPA

Patient can resume anticoag 2-14 days after stroke

23
Q

What is the distinguishing symptom of a hemorrhagic stroke?

Study These Flashcards
A

severe headache

24
Q

What agents are used to reverse causative medications of a hemorrhagic stroke?

Study These Flashcards
A
  • IV vitamin K –> warfarin
  • protamine –> heparin products
  • idarucizumab (Praxabind) –> dabigatran
  • recombinant coagulation factor Xa (Andexxa) –> other DOACs
  • no antidote for antiplatelets
25
What are the blood pressure goals for hemorrhagic stroke?
- first 24 hours: < 180/110 mmHg - after 24 hours: < 160/90 mmHg - after 48 hours: < 130/80 mmHg
26
When is nimodipine indicated?
- after a subarachnoid hemorrhagic stroke in order to minimize complications from cerebral vasospasm
27
What is the dosing for nimodipine?
60 mg PO Q4H for 21 days after subarachnoid hemorrhage
28
When should anticonvulsants be used?
Only is a hemorrhagic stroke patient has a documented seizure history
29
When are antiplatelets indicated indefinitely for secondary stroke prevention?
Ischemic atherosclerotic
30
When are anticoags indicated indefinitely for secondary stroke prevention?
ischemic cardioembolic
31
When should atorvastatin 80 mg be initiated as secondary stroke prevention?
ischemic atherosclerotic
32
When are SSRIs indicated?
- evaluate need after any kind of stroke
33
What are the first line antiplatelet options for secondary stroke prevention? | ischemic atherosclerotic
- aspirin - dipyridamole/aspirin - clopidogrel + aspirin (only in minor) ##Footnote - aspirin - high dose for 2-4 weeks, then low dose thereafter - aggrenox - start after 2-4 weeks of high dose aspirin following stroke - aggrenox - dipyridamole 200 mg/ aspirin 25 mg PO BID - aggrenox - headache !
34
What is the second-line option for antiplatelets for secondary stroke prevention? | ischemic atherosclerotic
- clopidogrel ##Footnote - for aspirin intolerant patients - 75 mg PO QD
35
Which antiplatelet is contraindicated for secondary stroke prevention?
prasugrel
36
When should anticoagulants be initiated for secondary stroke prevention?
2-14 days following a cardioembolic stroke
37
What anticoagulants can be used for secondary stroke prevention?
- apixaban 5 mg PO BID - dabigatran 150 mg PO BID - edoxaban 60 mg PO QD - rivaroxaban 20 mg PO QD - warfarin (INR goal 2-3 or 2.5-3.5)
38
Which anticoagulants should be used for secondary stroke prevention if the patient has mechanical mitral valve or LV thrombus? | ischemic cardioembolic
- warfarin - rivaroxaban
39
What are the first line antihypertensives for black patients?
CCB, thiazides
40
What are the first line antihypertensives for CKD patients?
ACEI, ARB
41
What are the first line antihypertensives for CAD patients?
BB + ACEI (or ARB)
42
What are the first line antihypertensives for diabetes patients?
ACEI, ARB
43
What are the first line antihypertensives for HFrEF patients?
- neprilysin inhibitor/ARB, ACEI, ARB + BB + AA
44
What are the first line antihypertensives for atrial fibrillation patients?
BB or non-DHP CCB
45
What are the high intensity statin options that should be initiated after an atherosclerotic stroke?
- atorvastatin 80 mg - rosuvastatin 20-40 mg ##Footnote LDL goal < 70 mg/dL
46
What antidepressants can be used following a stroke?
- sertraline - fluoxetine - escitalopram - citalopram ##Footnote AVOID: paroxetine, tricyclics
PHRM 864
flashcards
Decks in class (36)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions