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Advanced Pharmacy Practice > AF and Stroke Workshop > Flashcards

AF and Stroke Workshop Flashcards

1
Q

Why is AFib a risk factor for stroke?

A

AFib is an irregular heartbeat which increases stroke risk as it allows blood to pool in the heart and when blood pools it tends to form clots which can travel to the brain and cause stroke.

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2
Q

Patients with AF are _____ more likely to have a cardioembolic stroke.

A

Patients with AF are 5x more likely to have a cardioembolic stroke.

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3
Q

Name of a scoring system used to calculate the risk of a patient with AF having a stroke.

A

CHADS2-VASc scoring system.

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4
Q

Name of a scoring system to calculate the risks of bleeds.

A

HASBLED

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5
Q

CHADS2-VASc stands for

A 
Congestive hf
Hypertension
Age >75
Diabetes mellitus
S2: prior stroke/tia/thromboembolism
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6
Q

Scoring system for the risk of a stroke occuring following TIA

A

ABCD2

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7
Q

What does HAS-BLED stand for?

A

Hypertension
Abnromal renal function/dialysis, transplant or Abnromal liver
Stroke, prior history.
Bleeding.
Labile INR (unstable/high)
Elderly: >65
Drugs: prior alcohol/drugs usage. Antiplatelet agents/NSAIDS

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8
Q

First line treatment of established AF

A

Beta blocker - cardioselective - bisoprolol.

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9
Q

Why do we use beta blockers in AF treatment?

A

By reducing the heart rate the patient may go back into sinus.

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10
Q

How soon post acute stroke should atleplase be given?

A

Within 4 hours. Need to have established that not heamorrhagic stroke and need to have the BG and BP controlled (below 160/90).

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11
Q

What five drugs should someone be on within 12 months of ACS?

A

Dual antiplatelets.
Statin: Atorvastatin 80mg. (ASAP).
ACEI
Beta blocker.

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12
Q

What is the target blood pressure of someone with t2 diabetes?

A

130/80

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13
Q

What is the target blood pressure of someone with a history of stroke?

A

130/80

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14
Q

Can lmwh be used for VTE prophylaxis in stroke patients?

A

No, no stockings or lmwh.
Only pneumatic leg thing.

If they have risk of bleeding / transformative haemorhhagic.

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15
Q

What are the two main types of stroke?

A

Ischemic (80%, blocked blood vessel, less oxygen)

Haemorrhagic (20%, burst blood vessel)

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16
Q

What are TIAs

A

Transient Ischemic Attacks - mini strokes. Warning sign of future stroke risk.

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17
Q

Why is high cholesterol a risk factor for stroke?

A

Athersclerosis - blocked blood vessels, plaques. clots etc.

18
Q

What is the number one risk factor for stroke?

A

High blood pressure

19
Q

What is FMD?

A

(Fibromuscular dysplasia) disorder where some of the arteries that carry blood throughout the body do not develop as they should. Fibrous tissue grows in the wall of the arteries causing them to narrow.

20
Q

What is Patent foramen ovale (PFO)?

A

Can cause strokes/TIAs without any other risk factors present due to a “hole” in the heart

21
Q

FAST

A

Face
Arms
Speech
Time

22
Q

Primary prevention of stroke consists of

A 
Hypertension management. 
Smoking cessation.
Weight loss
Cholesterol control
Diabetes management
Warfarin/ AF management.
23
Q

What has a lower bleeding risk of the DOACs?

A

Apixaban

24
Q

What must be considered when choosing between the DOACs?

A

Renal function
Ability to swallow
Compliance aid- some moisture liable cannot be removed from packaging.
Dosing frequency.

25
Q

What is the second line treatment for patients with established AF?

A

CCB
Rate limiting - diltiazem has less side effects.
If they were on amlodipine for other reasons consider keeping on it.

26
Q

What would be the third drug added to AF mangement?

A

Digoxin.

27
Q

How can new onset AF be treated?

A

Electrical shocking?
DC convert - could lead to clots that are in the pooling blood so we need to rule the presence of these clots out before shocking the heart. If more than 24 hours since onset they will need to be anticoagulated due to likelihood of presence of clots in pooling blood in the heart.

28
Q

When is amiodarone used in AF management?

A

Pre and post DC conversion, short term use of no longer than a year has been shown to keep the heart in normal rythym - only of use if they have previously had DC conversion and then gone back into AF.

29
Q

How is flecanide used in AF management?

A

In the management of paroxysmal AF - patient must carry the flecanide with them at all times. Theu learn to recognise the symptoms and then take when needed.

30
Q

How should a patient with an ABCD2 score of 3 be managed?

A

1% risk of event in next two days.

Consider further imaging to rule out haemorrhagic attack.

31
Q

If a patient’s ABCD2 score is 4 or above, what acute interventions are of proven benefit?

A

Once a haemorrhage is ruled out, and if the patients BP is controlled: agents with a rapid onset such as LMWH or an oral direct thrombin or factor Xa inhibitor can be used.

32
Q

What strategies are there for the prevention of recurrent stroke?

A

Dual antiplatelet therapy:

Anticoagulation therapy for those with AF.

33
Q

What are the contraindications of atleplase in acute stroke?

A

Uncontrolled diabetes, uncontrolled blood pressure.

34
Q

What does of atleplase should be given for acute stroke?

A

Within 4.5 hours:

By IV over 60 mins, 900 micrograms/kg (max. 90mg), inital 10% dose by IV inj, rest by infusion.

35
Q

In what patients would H2 antagonist be offered instead of omprazole?

A

Omeprazole interacts with clopidogrel.

Give ranitidine instead.

36
Q

If a patient already on antiplatelet drugs has had a suspected stroke what should we do?

A

Stop the antiplatelets until haemorrhagic cause of stroke is ruled out.

37
Q

In patients being treated with Alteplase for acute stroke when should aspirin be given?

A

Aspiring 300mg 14/7, 24 hours after alteplase.

38
Q

Why is ACEi a better choice in diabetic hypertensive patients?

A

It is nephroprotective - it would be first line in over 55 instead of CCB plus it can be used for ACS treatment (AF).

39
Q

In stroke patients, blood glucose must be between

A

5-15 as per guidelines.

40
Q

If a patient already on clopidogrel has a stroke what should happen?

A

Stop the clopidogrel for 14/7 then restart it if still within the 12 months duration of diagnosis of AF.

Advanced Pharmacy Practice (29 decks)

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