Acute stroke Flashcards
MOA of tPA
converts plasminogen to plasmin
What treatments are available for acute stroke?
ONLY tPA
Dose of tPA?
.9 mg/kg up to a max of 90 mg. 10% bolus and 90% over 1 hour
A patient’s BP must be under what to give tPA?
185/110
A patients blood pressure must be maintained less than ___ after administering tPA.
180/105
What is the most important side effect of tPA?
bleeding
If you do not treat tPA, when do we need to treat elevated BP?
220/120 (if you lower patient’s bp, you may lower perfusion to the brain and enlarge ischemic size.)
What is the second most important side effect of tPA, and how do you treat it?
Angioedema, methylprednisolone and benedryl
Which agent is most preferred for the treatment of elevated bp in acute stroke?
Nicardipine (it is a continuous infusion and you can titrate it) hydralazine and labatelol are also in guidelines.
What are the 4 extra criteria to consider when giving tPA in the 3- 4.5 hours
- Age < 80
- Severe stroke (NHSS > 25)
- Taking an oral anticoag regardless of INR
- History of both diabetes and prior ischemic stroke
Inclusion critera for tPA
- Diagnosis of ischemic stroke causing measurable neurological deficit (MRI shows it a lot faster, CT may take longer to show stroke, but is a faster procedure), 2. Onset of symptoms < 3 hours before beginning treatment, 3. aged > or = 18
What is the MOA of clopidogrel?
irreversibly blocks the P2Y12 component of AP rceptors
which side effect limits the clinical use of Aggrenox?
Headache
What oral anticoags are indicated for the prevention of stroke in nonvalvular afib?
Dabigatran, Edoxaban, Apixaban, Rivaroxaban
What are the high intensity statins?
Atorvastatin 40mg, Rosuvastatin 20 mg (40 mg)
