Acute Ischemic Stroke Flashcards

1
Q

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

A

Altepase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is ischemic stroke

A

an episode of neurological dysfunction caused by focal CNS infarction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the three prominent types of ischemic strokes

A

Thrombotic, Embolic, and cryptogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is time zero

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

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

A

Hypertension and diabetes/ anticoagulants, insulin, antihypertensives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What must be given before a person receives alteplase

A

CT scan to rule out hemorrhage and blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

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
What stroke complication causes a sudden worsening of neurological exam, headache, nausea/vomiting, and acute HTN, what is done to treat it
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
What are characteristics of angioedmea after alteplase, what are the treatment options
acute swelling of the tongoue, lips with potential for airway compromise/ Antihistamines: Diphenhydramine AND Famotidine or Ranitidine, Corticosteroids: Methylprednisolone or Hydrocortisone, Epinephrine
27
T/F: Alteplase does not reduce mortality
True
28
What are procedures that can be done if a patient cannot be given alteplase
Intra-arterial thrombolysis, cerberal angioplasty, stent retriever
29
T/F: Urgent Heparin anticoagulation is recommended if stroke is present
False: Urgent anticoagulation is nOT recommedned if stroke is present
30
What are benefits of using asprin if they have had a stroke, when is given after alteplase use
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
What can be changed to make a patient eligible for alteplase
Blood pressure and blood glucose
32
What is the ABCD2, what are its parameters
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
What are the two parameters that have scores of 2, what is considered low risk, medium risk, high risk
Unilateral weakness and duration of TIA greater than one hour/ Low risk: 0-3, Medium risk: 4-5, High risk: 6-7