Stroke (edited) Flashcards
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
Prior Stroke or Transient ischemic attack (TIA)
Smoking
Dyslipidemia
Patent foramen Ovale (PFO)
Sickle Cell Disease
How is type of stroke determined?
Via brain imaging-CT (either ischemic - more common or hemorrhagic)
Sx of stroke?
FAST
Face
Arms
Speech
Time
Prevention of venous thromboembolism in hemorrhagic stroke?
Use intermittent pneumatic compression
Tx of Intracerebral Hemorrhage?
Elevate bed by 30 degrees
Use Mannitol
MOA of Mannitol (used IM Intracerebral hemorrhage - ICH)?
Increases osmotic pressure to reduce intracranial pressure (ICP) ass with cerebral edema
Brand name of Mannitol?
Osmitrol
CI-renal disease
SEs of Mannitol (Osmitrol)?
Fluid and electrolyte loss
Dehydration
Hyperosmolar-induced hyperkalemia
Acidosis
Increased osmolar gap
What’s Subarachnoid hemorrhage?
SAH is bleeding in the space btw the brain and the surrounding membrane (subarachnoid space)-after aneurysm rupture
Role of Oral Nimodipine in SAH?
Prevents artery vasospasm that can occur 3-21 days post aneurysm rupture associated with delayed ischemia
Box: Nimodipine (Nymalize) - used in SAH?
Don’t admin IV….use oral route ONLY-comes in an capsule or oral solution only
To prevent severe cardiovascular adverse events including death that has occurred by inadvertently injecting peripherally
How should syringes with Nimodipine (Nymalize) - used in SAH - be labeled?
“For oral use only” OR “Not for IV Use” and put in a syringe that can’t accept a needle
Pharmacologic management of Acute Ischemic Stroke?
Alteplase (recombinant tissue plasminogen activator (rt-PA) causes fibrinolysis by binding to fibrin in thrombus (clot) and converts the plasminogen to plasmin
Brand name of Atleplase - used in acute ischemic stroke?
Activase
rt-PA
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
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
SEs of Atleplase (Activase; rt-PA) - used in acute ischemic stroke?
Major bleeding e.g ICH
Hypotension
Angioedema
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)
Must be administered within 60 minutes of hospital arrival
Additional therapies in mgt of acute ischemic stroke?
Aspirin therapy
HTN mgt
Hyperglycemia mgt
DVT prevention
(Modifiable risk factors should be corrected)
Role of Aspirin in Acute Ischemic Stroke?
Prevention of early recurrent stroke (secondary prevention)
Dose of Aspirin in Acute Ischemic Stroke?
162-325 mg PO within 24-48 hr of stroke onset
NOT within 24 hr of fibrinolytic tx (alteplase)
When should Aspirin be initiated in Acute Ischemic Stroke?
W/in 24-48 hrs after stroke onset
NOT within 24 hr of fibrinolytic tx (alteplase)
Role of HTN management in Acute Ischemic Stroke?
IV labetalol, nicardipine, or clevidipine
to decrease BP<185/110 so alteplase can be administered
AND to maintain BP < 180/105 for at least 24 hr after alteplase
PTs not getting alteplase may not require BP treatment unless >= 220/120
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
