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72 Cards in this Set
- Front
- Back
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What are the 2 types of stroke?
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ischemic and hemorrhagic
ischemic more common |
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How early does tissue plasminogen activator (t-PA) need to be given?
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within 3 hours of onset
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What is the cornerstone of antithrombotic therapy for secondary prevention of ischemic stroke?
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antiplatelet therapy
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What is the drug of choice for secondary prevention of cardioembolic stroke?
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Warfarin
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Is BP lowering effective in stroke prevention?
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effective in both primary and secondary prevention of ischemic and hemorrhagic stroke
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Is BP lowering effective in acute stroke period (first 7 days)?
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no, can decrease cerebral blood flow and worsen symptoms
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When is statin therapy recommended for stroke?
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all ischemic stroke pts regardless of baseline cholesterol
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Is ischemic or hemorrhagic stroke more lethal?
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hemorrhagic
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What causes ischemic stroke?
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local thrombus formation or embolic phenomenon resulting in occlusion of a cerebral artery
atherosclerosis causes most ischemic strokes |
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What is cause of stroke if have AF?
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cardiogenic embolism
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What risk factors are targeted for risk factor reduction?
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modifiable, well-documented
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How does age affect risk for stroke?
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for each decade over 55 your risk doubles
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What race has more death from stroke?
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african american, asian-pacific islanders, hispanics
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What sex is at a higher risk of stroke?
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men
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What sex is more likely to die from stroke if they have one?
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women
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What are the most common modifiable well-documented risk factors for stroke?
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HTN, cigarette smoking, diabetes, AF, dyslipidemia
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What hemorrhage volum is associated with 71-90% death at 30 days?
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>60mL
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What is an abrupt-onset focal neurologic deficit that lasts at least 24 hours and is of presumed vascular origin?
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stroke
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What is an abrupt-onset focal neurologic deficit that last less than 24 hours and usually less than 30 minutes?
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TIA
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What symptom is present with hemorrhagic stroke but not usually present with ischemic stroke?
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severe HA
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What are the symptoms of stroke?
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weakness on one side of the body
inability to speak loss of vision vertigo falling |
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What is hemiparesis?
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weakness on one side of the body
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If pt has vertigo and double vision, where is stroke located?
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posterior circulation
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If pt has aphasia where is stroke located?
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anterior circulation
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When do you test for stroke, and what tests do you use?
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Test only if the cause of the stroke can't be determined by presence of risk factors.
Protein C, protein S, antithrombin III |
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What test can reveal the infarct within minutes?
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DWI (diffusion weighted imaging)
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What is used to determine if stroke is ischemic of hemorrhagic?
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CT
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Should stoke pt be treated if they have high BP?
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only if it is over 220/120
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What drugs are used to treat BP in acute ischemic stroke?
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labetalol, nicardipine, nitroprusside
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How long is the acute phase of the stroke?
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first week
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What is MOA of tPA?
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initiates fibrinolysis by binding to fibrin and converting plasminogen to plasmin
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What type of stroke is tPA used for?
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ischemic
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What age for use of tPA?
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18 years
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When do you have to use tPA by?
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within 3 hours of onset
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When can you not use tPA?
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any type of bleeding disorder/hemorrhage
intracranial surgery within 3 months major surgery or trauma within 14 days lumbar puncture within 7 days seizure with stroke recent acute MI SBP >185, DBP >110 |
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What are the 2 most recommended agents for stroke?
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tPA and aspirin
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When should aspirin be given?
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within 48 hrs of onset
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How is tPA given?
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0.9mg/kg over 1 hr, 10% in first 10 minutes
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How long should antithrombotic be avoided when giving tPA?
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24 hours
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Can you give aspirin with tPA?
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never, must wait 24 hours after tPA before giving asprin
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What is the cornerstone for secondary prevention of stroke?
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antiplatelet
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What are the first line antiplatelet agents?
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aspirin, clopidogrel, and ERDP-ASA (extended release dipyridamole pluse aspirin)
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What is antithrombotic first choice?
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warfarin
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Who get a statin after stroke?
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everyone
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Who gets HTN med, and which one?
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previous HTN or normotensive
ACEI + diuretic |
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What is a risk when using tPA?
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intracerebral hemorrhage
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Which pts receive secondary antiplatelet therapy?
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pt with noncardioembolic stroke
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What is a SE of ERDP?
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HA
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What is the most effective tx for the prevention of stroke in AF pt?
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warfarin
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What is INR target for prevention of stroke?
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2.5
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If pt has stroke or TIA, what is LDL goal?
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<100
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What is used to prevent DVT after stroke?
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low molecular weight heparin or unfractionated heparin
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What is MOA of LMW heparins for prevention DVT?
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inhibit factor Xa
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What is MOA of unfractionated heparin?
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potentiates action of antithrombin III and inactivates thrombin
prevents conversion of fibrinogen to fibrin stimulates release of lipoprotein lipase |
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What is AE of aspirin and clopidogrel combo?
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increased bleeding
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When should aspirin and clopidogrel be used?
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recent MI or coronary stent placement
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When should ARB be considered for stroke?
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If ACEI is not tolerated
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How does aspirin work?
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inhibits COX that prevents conversion of arachidonic acid to thromboxane A2
inhibits PGI2 that inhibits platelet aggregation |
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How is dose of aspirin decided?
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want dose that inhibits thromboxane A2 the most, with the least amount of PGI2 inhibition
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How should aspirin and ibuprofen be given?
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aspirin 2 hours before or 4 hours after ibuprofen
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How does dipyridamole work?
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inhibits platelet aggregation by inhibiting PDE, leading to accumulation of cAMP and cGMP that prevent platelet activation
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What is the most common AE of dipyridamole?
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HA
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How does clopidogrel work?
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inhibit ADP pathway of platelet aggregation leading to blocking of glycoprotein IIb/IIIa receptor
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How long before antiplatelet effect is max for plavix?
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3-7 days
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What is better in clopidogrel compared to ASA?
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less GI bleeding
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What SE from clopidogrel?
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diarrhea and rash
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How is clopidogrel activated to active form?
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cyp3A4
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What is a possible nonpharm technique for neuroprotection?
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hypothermia
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What agent is used in aubarachnoid hemorrhage to reduce incidence and severity of neurologic deficits?
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nimodipine
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What do you monitor for tPA and how often in hostpital setting?
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BP, neurologic function, bleeding
q15min x 1 hr, q30min x 6 hr, q60min x 17 hr, qshift |
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What do you monitor in aspirin, clopidogrel, erdp/asa and how often in hospital?
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bleeding, daily
HA in ERDP/ASA |
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What to you monitor in warfarin and how often in hospital?
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bleeding, INR, Hb/Hct
INR daily x 3 days, weekly until stable, monthly |
