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Phar 505 > Acute Ischemic Stroke > Flashcards

Acute Ischemic Stroke Flashcards

1
Q

What fibrinolytic is the only FDA-approved for acute ischemic stroke

A

Altepase

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2
Q

What is a stroke, how is it diagnosed

A

CNS infarction involving cell death due to ischemia/ imaging/pathology OR clinical symptoms lasting greater than 24 hours or until death

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3
Q

What is ischemic stroke

A

an episode of neurological dysfunction caused by focal CNS infarction

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4
Q

What is intracerebral hemorrhage

A

Rapidly developing clinical signs of neurological dysfunction due to a non-traumatic focal collection of blood in the brain tissue or ventricular system that rapidly results in clinical sign of neurological dysfunction

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5
Q

What are the signs and symptoms of stroke

A

Sudden weakness, dizzines or difficulty walking/ sudden confusion or difficulty speaking/ sudden changes in vision/ sudden facial droop or numbness/ sudden severe headache

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6
Q

If a person is suspected to have a stroke what is acronymn used to identify and treat them

A

F: Face drooping after trying to smile
A: Arm weakness after trying to raise their arms
S: Speech difficulty
T: Time to call 911

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7
Q

What is a trans ischemic attack and how does it connect to a stroke

A

A brief period of neurological dyfunction caused by a focal distubance of brain or retinal ischemia with clincal symptoms lasting less than 1 hour and no evidence of of infarction while self resolving, major determinant of future stroke

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8
Q

What are the three prominent types of ischemic strokes

A

Thrombotic, Embolic, and cryptogenic

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9
Q

What are the stroke classifications based on location and what are their connected symptoms

A

Anterior cerebral artery (ACA): more weakness in the legs, confusion, mutism, poor judement
Middle cerebral artery (MCA): more weakness in the arms, dysarthria, aphasia, monocular vision loss
Posterior cerebral artery (PCA): 50% vision loss, CNIII palsy, memory loss
Vertebrobasilar system: cannot move but conscious, coma, blindness/vision changes, ataxia

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10
Q

What are the goals of therapy

A

Restore blood flow, Limit the area of ischemia. reverse neurological deficit, prevent complications, salvage the pneumbra

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11
Q

What are the initial managment treatments for stroke

A

Stabilized airway, breathing and circulation/ cardiac monitoring/ intravenous access/oxygen/ check for hypoglycemia/ history

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12
Q

What is time zero

A

The last time the patient did not have any symptoms of their stroke

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13
Q

What comorbid conditions increase the risk of stroke, what medications should be known about

A

Hypertension and diabetes/ anticoagulants, insulin, antihypertensives

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14
Q

What must be given before a person receives alteplase

A

CT scan to rule out hemorrhage and blood glucose

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15
Q

What is the NIH stroke scale, what are the prognostic value

A

a standardized and validated assesment tool for judging the severity of the stroke, 60-70% favorable outcomes in one year if score is less than 10 but 4-16% favorable outcomes in one year if score is greater than 20

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16
Q

What types of drug class is Alteplase, what is the dose

A

Recombinant tissue plasminogen activator, 0.9mg/kg IV for a max dose of 90 mg with 10% of the dose given over 1 minute while the remainder is infused over 1 hour

17
Q

What are the contraindications of using alteplase to treat stroke

A

Onset of symptoms greater than 3 hours, improving symptoms, blood glucose less than 50 mg/dl, thrombocytopenia (less than 100,000), active bleeding or trauma

18
Q

What are contraindications in the patient’s history that would not allow for alteplase use

A

Stroke, MI, or head trauma in the past 3 months/ GI bleed or urinary tract bleed in the last 21 days/ Surgery within 2 weeks, presence or history of intercranial hemorrhage

19
Q

What are medication contraindications that can cause no alteplase use

A

Warfarin with INR greater than 1.7, Heparin with elevated PTT

20
Q

What are neurological monitoring parameters for alteplase use

A

Every 15 minutes durign alteplase infusion, every 30 minutes thereafter for 6 hours, every 1 hour until 24 hours have passed

21
Q

What blood pressure monitoring parameters for alteplase use, what must the blood pressure be below

A

Every 15 minutes during alteplase infusion for 2 hours, every 30 minutes after for 6 hours, every hour until 24 hours have passed/ less than 180/105

22
Q

T/F: A CT scan must be done after 12 hours before starting any antithrombotic or anticoagulant

A

False: A CT scan after 24 hours before starting any antithrombotic or anticoagulant

23
Q

T/F: Angioedmea and airway obstruction should be monitored for alteplase use

A

True

24
Q

If alteplase cannot be used how high will the blood pressure be allowed to go, what can be given to lower the BP as intermittent therapy, continuous infusion

A

Up to 220/120, Labetalol and Hydralazine, Nitroprusside and Nicardipine

25
Q

What stroke complication causes a sudden worsening of neurological exam, headache, nausea/vomiting, and acute HTN, what is done to treat it

A

Intracranial Hemorrhage/ STOP the alteplase infusion, START CT scan, SEND labs, Administer blood products 6-8 units of FFP or platelets if less than 100,000

26
Q

What are characteristics of angioedmea after alteplase, what are the treatment options

A

acute swelling of the tongoue, lips with potential for airway compromise/ Antihistamines: Diphenhydramine AND Famotidine or Ranitidine, Corticosteroids: Methylprednisolone or Hydrocortisone, Epinephrine

27
Q

T/F: Alteplase does not reduce mortality

A

True

28
Q

What are procedures that can be done if a patient cannot be given alteplase

A

Intra-arterial thrombolysis, cerberal angioplasty, stent retriever

29
Q

T/F: Urgent Heparin anticoagulation is recommended if stroke is present

A

False: Urgent anticoagulation is nOT recommedned if stroke is present

30
Q

What are benefits of using asprin if they have had a stroke, when is given after alteplase use

A

less death, less recurrent stroke, no change in bleeding/ Asprin 325 mg can be started within 24-48 hours of stroke onset but Asprin should be for at least 24 hours after administering alteplase

31
Q

What can be changed to make a patient eligible for alteplase

A

Blood pressure and blood glucose

32
Q

What is the ABCD2, what are its parameters

A

Severitly of a TIA,
Age greater than 60
Blood Pressure greater than 140/90
Clinical features (unilateral weaknes and speech difficulty without weakness)
Duration greater than 60 minutes, 10-59 minutes
Diabetes
For a max of 7 points

33
Q

What are the two parameters that have scores of 2, what is considered low risk, medium risk, high risk

A

Unilateral weakness and duration of TIA greater than one hour/ Low risk: 0-3, Medium risk: 4-5, High risk: 6-7

Phar 505 (33 decks)

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