Therapeutics - Stroke Prevention and Treatment Flashcards
(73 cards)
stroke vs TIA
TIA is a deficit that lasts less than 24 hrs with complete resolution of symptoms. typically lasts less than an hour
a lot of patients with a TIA will eventually have a stroke
we don’t ignore TIA, just like we don’t ignore ischemia!
a ___ diet can help to limit stroke
mediterranean (fruits and veggies, whole grains, fish)
most strokes are ischemic or hemorrhagic
ischemic
as mentioned, most strokes are ischemic
name 2 general causes
cerebrovascular disease (disease in vessels)
cardiogenic embolism due to things like afib, valvular heart disease, or infective endocarditis
TIA clinical presentation
temporary blindness, slurred speech, dizziness, 1 side weakness
stroke symptoms
depends on location
aphasia, dysphagia – choking concern, hemiparesis or plegia
what is the ABCD2 score
explain the categories
estimating the risk of stroke after a patient gets a TIA
0-3 is low risk
4-5 is moderate risk
6-7 is high risk
if the stroke was suspected to be of a cardiogenic source, what is used to diagnose
echocardiogram
what tests are done to rule out a hemorrhagic stroke?
why do we want to rule out that it’s not hemorrhagic?
CAT scan or MRI
bc before we give thrombolytics we have to make sure that the patient isn’t bleeding
why is malnutrition a consequence to stroke
bc of the dysphagia - trouble swallowing
pt may need a feeding tube
what is aphasia
language disorder
consequence of stroke
a consequence of stroke is transient HTN
explain why this may actually be desirable
may want to keep the BP a lil high at first to keep the perfusion
role of antiplatelet therapy in prevention
NOT USED FOR PRIMARY PREVENTION
most studies are on secondary
differentiate between primary and secondary prevention for stroke
primary - patient never had an event. all we want to focus on is lifestyle modification, control BP and weight
secondary - patient already had a TIA or another event. want to prevent another
true or false
in patients with CVD, anticoagulation is NOT routinely used for prevention
true
true or false
a patient is over 60 years old with no risk factors for stroke. it WOULD NOT BE beneficial for them to take aspirin daily
true
DO NOT GIVE ASPIRIN!!
if they have risk factors, it’s a different story
patients who have a history of non-cardioembolic stroke or TIA
(non cardioembolic indicates NOT DUE TO AFIB)
what can they be given for prevention
this is considered SECONDARY prevention - so we give antiplatelets
low dose aspirin daily
or
clopidogrel 75mg QD
or
aspirin/ER dyprimidamole 25/100 BID
or
cilostazol 100mg BID (not in US)
The 2 preferred ones are clopidogrel or aspirin/dipyidamole
for secondary prevention from non-cardioembolic cause, what do we use if the patient is allergic to aspirin
use clopidogrel
true or false
increasing aspirin dose to 325mg provides more benefit for secondary prevention
FALSE - no benefit over 81mg
just increased bleeding risk
after a stroke, does DAPT show any benefit?
start aspirin + clopidogrel within 24 hours of a minor ischemic stroke or TIA and continue for 21 days
if had a recent stroke or TIA due to SEVERE stenosis, clopidogrel + aspirin for 90 days, then single agent after that
pt had NONCARDIOGENIC (not afib) ischemic stroke
do we use dual or single antiplatelet therapy?
if EARLY ischemic and NIHSS is 3 or less, DUAL for 0-90 days, then single after that
if NOT early, or if NIHSS is more than 3, single antiplaaltet
patient had non-cardiogenic TIA
dual or single antiplateleet
if high risk - dual for 0-90 days, then single after that
if nit high risk - just do single
aspirin toxicity
GI - take with food
when we use dipyridamole with aspirin, which form do we use
ER! NO IR
