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Flashcards in Stroke Deck (39):
0

What's stroke?

Stroke or cerebrovascular accident (CVA) occurs when blood flow to an area of the brain is interrupted by ischemia due to a clot (thrombus or emboli) or a ruptured blood vessel (hemorrhage)

1

Risk factors for stroke?

HTN - most common cause (risk increases above 120/80mmHg)

A. Fib

Gender (males > females)

Ethnicity (AAs at highest risk by ethnicity)

Age (55 and older)

Atherosclerosis

DM

Transient ischemic attack (TIA)

Prior hx of stroke

Smoking

Hypercholesterolemia

Patent foramen Ovale (PFO)

SCD

2

Howz type of stroke determined?

Via brain imaging (either ischemic - more common or hemorrhagic)

3

Sx of stroke?

FAST

Face
Arms
Speech
Time

4

Prevention of venous thromboembolism in hemorrhagic stroke?

Use intermittent pneumatic compression

5

Tx of Intracerebral Hemorrhage?

Elevate bed by 30 degrees

Use Mannitol

6

MOA of Mannitol (used IM Intracerebral hemorrhage - ICH)?

Increases osmotic pressure to reduce intracranial pressure (ICP) ass with cerebral edema

7

Brand name of Mannitol?

Osmitrol

8

SEs of Mannitol (Osmitrol)?

Fluid and electrolyte loss

Dehydration

Hyperosmolar-induced hyperkalemia

Acidosis

Increased osmolar gap

9

What's Subarachnoid hemorrhage?

SAH is bleeding in the space btw the brain and the surrounding membrane (subarachnoid space)

10

Role of Oral Nimodipine in SAH?

Prevents vasospasm associated with delayed ischemia

11

BBW of Nimodipine (Nymalize) - used in SAH?

Don't admin IV....use oral route ONLY

To prevent severe cardiovascular adverse events including death

12

How should syringes with Nimodipine (Nymalize) - used in SAH - be labeled?

"For oral use only"

13

Pharmacologic management of Acute Ischemic Stroke?

Alteplase (recombinant tissue plasminogen activator (rt-PA) causes fibrinolysis by binding to fibrin in thrombus (clot) and converse entrapped plasminogen to plasmin

14

Brand name of Atleplase - used in acute ischemic stroke?

Activase

rt-PA

15

What must be done b4 using Atleplase (Activase; rt-PA) - used in acute ischemic stroke?

Must confirm clot on brain imaging (head CT scan) b4 use

16

Dosing of Atleplase (Activase; rt-PA) - used in acute ischemic stroke? Max dose?

Infuse 0.9 mg/kg IV over 60 min
10% of dose given as bolus

Max dose: 90mg

17

SEs of Atleplase (Activase; rt-PA) - used in acute ischemic stroke?

Major bleeding e.g ICH

Hypotension

Angioedema

18

When should tx of Atleplase (Activase; rt-PA) - used in acute ischemic stroke - be initiated?

Must be initiated within 3 hrs of sx onset


(guidelines - up to 4.5hrs, but this isn't FDA approved)

19

Additional therapies in mgt of acute ischemic stroke?

Aspirin therapy

HTN mgt

Hyperglycemia mgt

DVT prevention

(Modifiable risk factors should be corrected)

20

Role of Aspirin in Acute Ischemic Stroke?

Prevention of early recurrent stroke (secondary prevention)

21

Dose of Aspirin in Acute Ischemic Stroke?

81 mg PO daily

22

When should Aspirin be initiated in Acute Ischemic Stroke?

W/in 24-48 hrs after stroke onset

23

When should Aspirin NOT be initiated in Acute Ischemic Stroke?

W/in 24 hrs of fibrinolytic therapy

24

Role of HTN management in Acute Ischemic Stroke?

Qualifies patients for rt-PA or reduce BP

Use ACEIs or ARBs

25

When should Atleplase (Activase; rt-PA) NOT be initiated as part of HTN management?

If BP is not =< 185/110 mmHg

Don't give rt-PA

26

Hyperglycemia management in Acute Ischemic Stroke?

Maintain BG levels bye 140-180 mg/dL

27

When should DVT prevention NOT be initiated in management of Acute Ischemic Stroke?

Don't use anticoagulant therapy within 24 hrs of receiving rt-PA therapy

28

List lifestyle changes used in ischemic stroke prevention

Increased physical exercise (at least 30 mins most days of the wk)

Weight reduction if necessary (maintain BMI 18.5-24.9 kg/m^2)

Women Waist circumference < 35 inches
Men waist circumference < 40 inches

Women alcohol, limit =< 1 drink/day
Men alcohol, limit =< 2 drinks/day

29

When's primary prevention of ischemic stroke recommended?

Only for A. Fib pts

30

Secondary prevention for patients with previous cardioembolic stroke?

Anticoagulant therapy

31

Secondary prevention for patients with previous non-cardioembolic ischemic stroke or TIA?

Antiplatelets, (aspirin, Clopidogrel) rather than oral anticoagulant

32

List Antiplatelet agents used in patients with previous noncardioembolic ischemic stroke or TIA?

Aspirin

Clopidogrel (Plavix)

Dipyridamole ER/Aspirin (Aggrenox)

33

Brand name of Asprin (used in patients with previous non-cardioembolic ischemic stroke or TIA)?

Ascriptin

Bayer Aspirin

Bufferin

Bufferin Extra Strength

Ecotrin

St. Joseph Adult Aspirin

Others

34

Brand name of Clopidogrel (used in patients with previous non-cardioembolic ischemic stroke or TIA)?

Plavix

35

Dose of Clopidogrel (Plavix) - (used in patients with previous non-cardioembolic ischemic stroke or TIA)?

75mg daily

36

BBW of Clopidogrel (Plavix)?

Effectiveness depends on the activation to an active metabolite mainly by CYP 2C19.

Poor metabolizers exhibit higher cardiovascular events than patients with normal 2C19 fxn

CYP2C19*1 allele = fully fxnal metabolism
CYP2C19*2 and *3 alleles = nonfxnal

37

SEs of Clopidogrel (Plavix)?

Bleeding

Bruising

Rash

Thrombotic Thrombocytopenia Purpura - TTP - (rare)

38

SEs of Dipyridamole ER/Aspirin (Aggrenox)?

HA (> 10%)

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