Kristellar Stroke Cardio Test 2

Front 1

what are the two ways a stroke can happen?

what is the result of this?

Back 1

thrombus formation starting from atherosclerosis or embolism that gets lodged in a cerebral artery

hypoperfusion, hypoxia, and cell death

Front 2

where do the embololism usually come from?

Back 2

in left atrium, if this clot gets lodged in a cerebral artery it is called cardioembolic stroke

Front 3

why is it important to establish perfusion quickly?

Back 3

to prevent cell death and neurological deficits

Front 4

what causes a hemorhagic stroke?

Back 4

the presence of blood in the brain tissue or surrounding space that results in an increase in intracranial pressure

Front 5

what are some sign and symptoms of a stroke?

Back 5

hemiparesis- weakness on 1 side of body

monoparesis- weakness in single extremity

aphasia- impaired communication

dysarthria-disturbance of speech

headache, visual defects

Front 6

what is the short term goal?

what is the long term goal?

Back 6

prevent brain damage by resotring perfusion

prevent recurrent stroke

Front 7

how soon should treatment of alteplase be started from symptom onset?

Back 7

within 4.5 hours

Front 8

what are the supportive measures that should be taken if a patient has an ischemic stroke?

Back 8

maintain 02 saturation

treat hyper/hypo perfusion

treat fever with apap

BP control within first 48 hrs of stroke

Front 9

what should you give a patient if they are not candidates for alteplase?

Back 9

UFH or LMWH

Front 10

if patients do get alteplase, how soon can you start VTE prophylaxis?

Back 10

24 hours after alteplase

Front 11

if your not eligible for alteplase and your BP is less than 220/1120 what should you do?

what if your BP is above that?

Back 11

observe unless end organ involvement

treat with IV antihypertensiveto bring BP below 220//120

Front 12

if you are eligilbe for alteplase what should you BP be before treatment

during or after treatment?

what should you use to get the BP to this?

Back 12

before greater than 185/110

after/during 180/105

IV antihypertensives

Front 13

what is an important factor to remember when lowering blood pressure for a stroke patient?

Back 13

do it gently and slowly in the first 24 hours

Front 14

Best time to get thrombolytics for ischemic stroke?

Back 14

within 3 hours of symptom onset but not beyond 4.5 hours

Front 15

what did the NINDS trial show an improvement in? what major risk was shown from ateplase use in this trial?

how is this risk reduced?

Back 15

disability

increase risk or intracranial hemorrhage

adherence to inclusion/exclusion criteria and management of BP

Front 16

what is the dose of alteplase?

Back 16

0.9mg/kg

Front 17

how does time relate in the use of alteplase?

Back 17

the sooner, the better

Front 18

what two drug classes should be avoided for 24 hours after alteplase use? what are they used for?

Back 18

antplatelets and anticoagulants

VTE prophylaxis

Front 19

what is the name of the stroke scale to gauge neurological function?

Back 19

NIHSS

Front 20

how often should you be monitoring neurological function?

Back 20

every 15 minutes during infusion, every 30 minutes every 6 hours after infusion, then every hour after 24 hours of alteplase use

Front 21

symptoms of intracranial hemorrhage include?

Back 21

mental status change, headache, N/V, photophobia

Front 22

what should be monitored if using alteplase?

Back 22

hemoglobin and hemotocrit

Front 23

when would anticoagulation might be used during ischemic stroke?

is LMWH ever recomended?

Back 23

if the patient has chronic atrial fibrillation

never

Front 24

what is the difference between full dose anticoag UFH with prophylaxis dose UFH?

Back 24

full dose is continuous IV infusion

prophylaxis is subcutaneous every 8-12 hours

Front 25

how soon should you give aspirin for ischemic stroke? what does should you use for this time period?

what does should be used long term?

Back 25

24-48 hours of onset of stroke symptoms

150-325mg

81mg

remember this is all 24 hours after alteplase

Front 26

should aspirin be used for primary prevention of stroke?

Back 26

ckd pad Cv risk greater than or equal to 10%

Front 27

what is the most important modifiable risk stroke risk factor?

Back 27

htn

Front 28

what are the two surgieres are options for secondary prevention of stroke?

Back 28

carotid endarectomy or carotid angioplasty

Front 29

when should you consider carotid endarectomy?

Back 29

if carotid artery stenosis is occluding 60-99% of carotid artery

Front 30

what drugs should be considered for secondary prevention of stroke?

Back 30

aspirin, clopidogrel, aggrenox, acei, thiazide, statin

Front 31

what drugs are better than aspirin for secondary prevention?

Back 31

clopidogrel and aggrenox which are equivalent in benefit

Front 32

should you recieve antihypertensive meds for secondary prevention?

Back 32

yes regardless if you have HTN or not, use an ACE and thiazide

Front 33

if a patient has a stroke while on a anti platelet, what should you do?

Back 33

change the antiplatelet

Front 34

how should you monitor a ischemic stroke patient?

Back 34

BP, neurologic function, bleeding, Hgb/Hct, platelets

Front 35

name some of the roles a pharmacist can play in strokes

Back 35

counsel patients on symptoms of stroke and 911

develop hospital stroke protocal

watch dysphagia and oral meds

participate in stroke team

look for issues during stroke rehab fro med issues in MTM

Front 36

modifiable risk factors for stroke?

Back 36

MOHHAS

migraine, oral contraceptive, hyperhomocystinnemia, high hematocrit, asymptomatic carotid stenosis, sickle cell

Front 37

what are non-modifiable risk factors for stroke?

Back 37

age greater than 55, gender male, genetics, race hispanic, low birth weight

Front 38

what is the difference between TIA and stroke?

Back 38

TIA symptoms lasts less than 30 minutes but has no deficits after, stroke symptoms last around an hour and deficits remain

Front 39

what usually causes cardiembolic stroke?

Back 39

afib

Front 40

what are some exclusions for alteplase?

Back 40

ICH, improving symptoms, internal bleeding, Gi bleed in 21 days, aneurysm, surgery in 14 days

Front 41

what should you know about how hypertension and normal MAP relate on that graph thing?

Back 41

normal BP would actually be very bad for a hypertensive patient because it would decrease cerebal blood flow to an already ishhemic area of the brain

Front 42

what is the main risk of using anticoagulation during an ischemic stroke?

Back 42

potentially can cause a hemorrhagic stroke

Front 43

would you ever use coumadin after a stroke?

Back 43

yes if they cause of the stroke was related to coumadin for secondary prevention

Front 44

what should you monitor for a statin?

Back 44

LFTs and muscle pain

Front 45

two things should be always be included with patients before discharge?

Back 45

life style modifications (diet exercise weight loss) flu shot