Stroke and coagulants

Question 1

What procedures call for use of coagulants?

Answer 1

oral anticoagulant overdoses, CABG, orthopedic procedures

Question 2

What are 2 ways to enforce clotting?

Answer 2

Facilitate clot cascade, Prevent fibrinolysis

Question 3

Factors given to hemophiliacs?

Answer 3

Hemophilia A- Factor 8, Hemophilia B- Factor 9

Question 4

What drugs can prevent coagulopathies?

Answer 4

FEIBA, Novoseven, Prothrombin complex concentrate, Cryoprecipitate

Question 5

what are uses for anti-inhibitors?

Answer 5

Hemophilia A and B patients for surgery, Pradaxa antidote

Question 6

ADR for anti-inhibitors

Answer 6

Allergy, Thrombotic events- stroke

Question 7

What is the MOA for anti-inhibitors?

Answer 7

precursor and activated forms of factors 2,7, 9, 10

Question 8

Prothrombin complex mechanism?

Answer 8

contains factors 2, 7, 9, 10, protein C and S

Question 9

Use of prothrombin?

Answer 9

warfarin reversal

Question 10

how does factor VIIa work?

Answer 10

activates factors 9 and 10, injectable until bleeding stops

Question 11

Indications for factor VIIa use?

Answer 11

hemophilia A and B, unapproved uses (bleeding from trauma or surgery, intracranial bleeds, warfarin reversal)

Question 12

what drugs stop fibrinolysis?

Answer 12

aminocaproic acid, tranexamic acid

Question 13

MOA of aminocaproic acid

Answer 13

binds with plasminogen so it can’t convert to plasmin and plasmin can’t breakdown fibrin

Question 14

uses of aminocaproic acid

Answer 14

acute bleeding in a surgical setting

Question 15

MOA of tranexamic acid

Answer 15

displaces plasminogen from fibrin and inhibits fibrinolysis inhibiting the proteolytic activity of plasmin

Question 16

uses of tranexamic acid

Answer 16

hemophillia to reduce or prevent hemorrhage following tooth extraction, treatment of heavy menstrual bleeding

Question 17

MOA of topical thrombin

Answer 17

activates platelets and converts fibrinogen to fibrin

Question 18

MOA of cellulose (oxidized), ferric subsulfate, and gelatin absorbable

Answer 18

aids in clot formation

Question 19

What is tisseal

Answer 19

fibrin sealant, combination of fibrinogen, fibrin and aprotinin used at surgical sites

Question 20

uses for desmopressin?

Answer 20

hemophilia and hemostasis

Question 21

how does desmopressin come as dosage forms?

Answer 21

IV infusion or nasal spray

Question 22

What does desmopressin increase?

Answer 22

VWF

Question 23

what are the risk factors for stroke?

Answer 23

HTN, hyperlipidemia, DM, smoking, unhealthy diet, lack of physical activity, obesity

Question 24

What are the types of hemorrhagic stroke?

Answer 24

intracerebral, subarachnoid hemorrhage, intracerebral aneurysm, arteriovenous malformation (AVMs)

Question 25

FAST

Answer 25

face, arm, speech, time

Question 26

etiology of intracerebral hemorrhage

Answer 26

spontaneous rupture of small vessel damage by chronic HTN

Question 27

Etiology of SAH?

Answer 27

underlying cerebrovascular malformation in an otherwise normal patient

Question 28

what type of stroke is most common?

Answer 28

ischemic

Question 29

etiology of intracerebral aneurysm

Answer 29

vessel rupture

Question 30

Etiology of AVM

Answer 30

congenital vascular anomaly

Question 31

how is intracerebral hemorrhage controlled and treated?

Answer 31

ABCs, BP control (not too low), analgesia, sedation

Question 32

How is SAH treated?

Answer 32

prophylactic antiseizure drugs, do NOT lower BP!, CCB (Nimodipine oral liquid)

Question 33

ADR of Nimodipine

Answer 33

HOTN, HA - greater effects on cerebral arteries than other arteries

Question 34

treatment goals of ischemic stroke?

Answer 34

prevent/reverse brain injury - ABCs, watch glucose, STAT non-contrast head CT, IV thrombolysis, antithrombotic treatments

Question 35

How soon do pts with ischemic stroke need to be treated?

Answer 35

3-4.5 hours from onset of sxs, must dx and treat within an hour of presentation, brain tissue not salvageable after 4.5 hours

Question 36

what gender is mor elikely to have stroke?

Answer 36

women

Question 37

Treatment of ischemic stroke (drug)?

Answer 37

alteplase (thrombolysis)

Question 38

what antiplatelet is used in stroke?

Answer 38

clopidogrel

Question 39

What LDL is it necessary to use atilipemics after stroke?

Answer 39

\>120 - want to get it down to 70

Question 40

when is combination therapy of ASA and clopidogrel after stroke appropriate?

Answer 40

TIAs

Question 41

what stroke severity score is it not necessary to use alteplase?

Answer 41

\<5 - use neuro opinion

Question 42

what is the oral liquid preparation of CCB for stroke?

Answer 42

Nymalize

Question 43

how long does it take brain cells to die from ischemia?

Answer 43

4-10 minutes

Question 44

what is considered high, caution, and low-risk on the stroke risk scorecard?

Answer 44

\>3 from high risk, 4-6 from caution, 6-8 from low-risk

Question 45

what type of stroke has a better prognosis?

Answer 45

ischemic

Question 46

What coagulant is used in cervical bx?

Answer 46

ferric subsulfate