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PR3154: Haematological & Musculoskeletal Systems > AIS and ACS > Flashcards

AIS and ACS Flashcards

1
Q

What is FAST for stroke?

A

Face drooping
Arm weakness
Speech/slurring
Time to call ambulance

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2
Q

What labs suggests a MI?

A
  • Troponin levels +++
  • ST elevation
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3
Q

What are the 2 types of stroke and explain them?

A

Ischaemic stroke: blocked artery, when blood clot blocks the blood flow in an artery within brain, brain tissues die

Haemorrhagic stroke: ruptured artery -> intracranial haemorrhage, a blood vessel bursts within the brain. The bleeding compress other tissues and cause another infarction/tissue death (stop blood flow in another part)

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4
Q

Which type of stroke is more common?

A

Ischaemic stroke

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5
Q

What is TIA?

A

Sudden symptom onset for stroke but is temporary and goes away on its own. It is usually a pre-cursor to stroke.

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6
Q

Criteria of ABCD2

A

Age:
>=60y/o: 1

BP elevation when first assessed after TIA:
SBP >=140 or diastolic >=90: 1

Clinical features:
- Unilateral weakness: 2
- Isolated speed disturbance: 1

Duration of TIA smx:
- >=60mins: 2
- 10-59mins: 1

Diabetes: 1

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7
Q

What is NIHSS?

A

Determines if is minor stroke

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8
Q

What is ABCD2 score for?

A

Determine TIA risk

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9
Q

When is r-TPA eligible?

A

If AIS present within 3-4.5hrs

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10
Q

If pt is eligible for r-TPA, what should be given?

A

Start SAPT after 24hrs, within 48hrs

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11
Q

What NIHSS score suggests minor stroke?

A

0-3

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12
Q

What ABCD2 score suggests high risk TIA?

A

> =4

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13
Q

If pt is not eligible for rTPA, what should be given?

A

Minor stroke or high risk TIA: DAPT asap for 21d
Not minor stroke or high risk TIA: SAPT asap

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14
Q

What labs are done to evaluate stroke mechanism?

A

MRI: determine which vessel is affected
24h Holter: ambulatory ver of ECG
TTE: check heart func and if clot is present in heart
US carotids: evaluate carotid vessels
Lipid panel, TFT, HbA1c

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15
Q

If the stroke mechanism is cardioembolic, what should be done?

A

Stop antiplatelet as it suggests underlying AF so start OAC

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16
Q

If the stroke mechanism is non-cardioembolic, what to consider next?

A

If severe major ICAS (70-99%): add clopidogrel to aspirin x 90d. After that, lifelong SAPT
No severe major ICAS (70-99%): lifelong SAPT

17
Q

What antiplatelet is not commonly used for SPAF?

A

Dipyridamole

18
Q

What is the dose of aspirin?

A

Load 300mg (unless alr on aspirin) f/b 100mg OM lifelong

19
Q

What is the dose of clopidogrel?

A

Load 300mg (onset within 6hr) or 600mg (onset within 2hr) f/b 75mg OM

20
Q

Which CYP enzyme coverts clopidogrel to its active metabolite?

A

CYP2C19

21
Q

How does CYP2C19 LoF affect clopidogrel?

A

Reduce clopidogrel active metabolite so increases risk of MACCE (major advere CV and cerebrovascular events)

22
Q

What is the dose for dipyridamole IR?

A

25-150mg TDS

23
Q

What is the dose for ticagrelor?

A

Load 180mg f/b 90mg BD up to 12m then 60mg BD (for extended therapy)

24
Q

Dipyridamole SE

A

Flushing, dizziness, abdominal distress

25
Q

Ticagrelor SE

A

Dyspnea, bleeding, bradycardia

26
Q

Clopidogrel or ticagrelor preferred for ACS?

A

Ticagrelor as not subject to CYP2C19 polymorphism
Bleeding risk is higher than clopidogrel.
For CCS, clopidogrel is preferred

27
Q

Ticagrelor or clopidogrel shorter t1/2?

A

Ticagrelor as it inhibits P2Y12 ADP receptor REVERSIBLY.

Clopidogrel is IReversibly.

28
Q

What should be given after PCI procedure and why?

A

DAPT to prevent In-Stent Thrombosis (IST) or In-Stent Restenosis (ISR)

29
Q

What should be given before PCI procedure?

A

UFH bolus

30
Q

What other medications should be started for AIS?

A

High intensity statin if no CI:

Atorva 40-80mg QD
Rosuva 20-40mg QD

31
Q

Is aspirin recommended for primary prevention of ASCVD?

A

No, unless atherosclerosis then SAPT

32
Q

Which CYP2C19 alleles suggests LoF

A

*2 , *3 alleles

PR3154: Haematological & Musculoskeletal Systems (10 decks)

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