Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics II Exam 3 > Cerebrovascular Dz > Flashcards

Cerebrovascular Dz Flashcards

1
Q

How is an ischemic CVA caused?

A

Reduction of blood supply to different areas of the brain due to obstruction of blood vessel

Obstruction can be d/t:

  • Atherosclerosis
  • Vessel injury
  • Plaque rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 types of ischemic CVA? Definition?

A

Thrombotic–local vessel obstruction

Embolic–clot travels from somewhere else to the brain & obstruct a cerebro-vessel

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

Definition of Transient Ischemic Attack (TIA)?

A

Pre-CVA

  • brief episode of neurological dysfunction caused by focal brain or retinal ischemia w/ clinical sx lasting <1hr
  • w/o residual neurological dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition Ischemic CVA

A

Cerebrovascular infarct
IRREVERSIBLE damage occurs
w/ residual neurological defect

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

Risk Factors for Ischemic CVA

A
  • HTN (uncontrolled)
  • uncontrolled DM
  • Hyperlipidemia
  • Carotid Stenosis
  • High homocysteine
  • Hx non-cardioembolic stroke
  • Smoking
  • A-fib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which of the following is a risk factor specific for EMBOLIC stroke?

a. Hyperlipidemia
b. Carotid Stenosis
c. A-fib
d. HTN

A

A-fib!

Risk factor for cardio-EMBOLIC stroke only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of Ischemic CVA

A
  • may vary depending on parts of brain involved
  • hemiparesis
  • face asymmetry
  • gaze deviation
  • dysphasia/aphasia
  • dysarthria
  • limb incoordination
  • ataxia (+/- vertigo)
  • one sided sensory sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which of the following is NOT a sx of ischemic CVA?

a. dysarthria
b. loss of vision
c. ataxia
d. hemiparesis

A

B. loss of vision

pt may have gaze deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What therapeutic class drugs are appropriate 1st choice therapy for a Non-Cardioembolic stroke (not from a-fib)?

a. NSAID
b. antiplatelet
c. anticoagulant
d. thrombolytic

A

B. Antiplatelet therapy

Aspirin 50-325mg/day**
Aggrenox (ASA +dipyridamole) BID
Clopidogrel (Plavix) 75mg/day
Ticagrelor 90mg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When would you give ticagrelor in a pt with a non-cardioembolic stroke?

A

If they have an aspirin allergy

Not inferior to aspirin, can be used as alternative option–can cause more bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which antiplatelet drug would you to start a pt on with noncardioembolic stroke that isn’t being treated with a thrombolytic?

A

ASPIRIN

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

What therapeutic class of drugs are appropriate therapy for cardio-embolic stroke (from a-fib)?

A

Anticoagulants

Warfarin (INR 2-3)
Dabigatran (150mg BID)
Rivaroxaban (20mg daily)
Apixaban (5mg BID)
Edoxaban (60mg daily)
Aspirin (81mg)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What pathway of the clotting cascade do anticoagulant affect?

A

Intrinsic pathway

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

What is CHA2DS2-VASC used for?

A

Determines risk of a cardioembolic stroke for pt w/ a-fib ONLY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does CHA2DS2-VASC stand for?

A 
Congestive HF
Hypertension
Age >75yo / 65-74yo
Diabetes
Stroke
Vascular Dz (MI, PAD)
Female
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which 2 risk factors from CHA2DS2-VASC counts for 2points

A

Age >75yo

Stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a pt has no risk factors for thromboemoblism, what drug therapy should they be on?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If a pt has 1 risk factor for thromboembolism which drugs could they be on?

A 
Warfarin
Dabigatran
Apixaban
Rivarxaban
Edoxaban
Aspirin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a pt has 2 or more risk factors for thromboembolism, which drugs could they be on?

A 
Warfarin
Dabigatran
Apixaban
Rivarxaban
Edoxaban
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Whether the pt had a thrombotic or embolic stroke, what other class of drugs should the pt be on?

A

STATIN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What statin should the pt be on and what dose?

A

Atorvastatin 80mg once a day

REGARDLESS of cholesterol profile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Aspirin (Dose/ADR)

A

50-325mg

GI bleed, stomach upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dipyridamole (Dose/ADR)

A

ASA 25mg + Dipyridamole 200mg (aggrenox)

BLEEDING

24
Q

Clopidogrel (Dose/ADR)

A

75mg/day

THROMBOCYTOPENIA, bleeding

25
Ticagrelor (Dose/ADR)
90mg BID BRADYCARDIA, bleeding
26
Warfarin (Dose/monitor)
Dose to INR 2-3 indefinitely INR, consistent vit K intake, DDI
27
Direct Anti-Xa inhibitors Monitor
Bleeding | Renal function
28
Statins (monitor/ADR)
LFT | Muscle pain
29
What are the direct oral anticoagulants (DOA)?
Dabigatran Rivaroxaban Apixaban Edoxaban
30
Which of the DOA are dosed BID?
Dabigatran | Apixaban
31
Which DOA are MORE EFFECTIVE than warfarin?
Dabigatran | Apixaban
32
Which DOA is a direct thrombin inhibitor?
Dabigatran
33
Which of the following drugs are eligible for a pt w/ cardioembolic stroke & CKD? a. dabigatran b. apixaban c. warfarin d. rivaroxaban
Warfarin
34
What is the initial approach for a pt coming in with a CVA
- IV fluid - eval for eligibility for thrombolytic therapy - plan on initiating/re-initiating antiplatelet, antithrombotic therapy - conservative HTN mgmt - Mgmt underlying etiologies for stroke - other supportive care
35
What does thrombolytic therapy do?
Dissolve clots
36
What are pt at high risk for if on thrombolytic therapy?
BLEEDING
37
What is time frame allows for admin of thrombolytic therapy after a stroke? a. 2.0-3.5hrs b. 3.0-4.5hrs c. 3.5-5.0hrs d. any time
B. 3.0-4.5 hrs after stroke given over 1hr
38
Once a thrombolytic has been administered, what is the following steps of their mgmt?
- IVF NS at 75-100mL/hr - No blood thinners for 24hrs (heparin, warfarin, ASA, clopidogrel or dipyridamole) - get brain CT/MRI at 24hrs
39
If pt wasn't eligible for thrombolytic, how should they be managed?
- IVF NS at 75-100mL/hr - Aspirin 325mg w/i 1st 24hrs of hospital admission - Anticoagulants (heparin/warfarin) in cardioembolic stroke AFTER 24hrs & pt is STABLE - Repeat brain CT/MRI 24-48hrs after stroke or prn
40
If pt is given tpA at 2pm, can they take their aspirin at 10am the next day?
NO. they can't restart any blood thinner within 24hrs after admin of tpA
41
Pt started experiencing dysarthria, hemiparesis, and face asymmetry, at 4pm and arrived at the ER at 10pm. No a-fib, They're on aspirin 81mg, labetolol 10mg and simvastatin 15mg. How would manage this pt?
Pt isn't eligible for tpA bc they arrived over >4.5hrs after the stroke occurred. - Give them higher dose aspirin (325mg) within 24hrs of admission - give them intensive statin therapy (atorvastatin 80mg)
42
Can pt be on anticoagulants for DVT/PE prophylaxis within 24hr of stroke?
YES - bleeding risk is small bc dose is tiny - used to prevent DVT as complication of stroke bc pt will be bed bound; NOT used to tx the stroke Low dose heparin (5000units sc BID or TID) LMWH (Enoxaparin 30 or 40mg QD) Fonadaparinux (2.5mg SC QD)
43
Complications Post Acute Ischemic Stroke
- cerebral hemorrhage - cerebral edema - DVT/PE - Seizure
44
What BP lvl is the cut off for thrombolytic therapy?
Systolic 220 | Diastolic 140
45
What can be given to pt w/ BP >220/140
Labetalol or Nicardipine Can add Nitroprusside if uncontrolled
46
What % reduction of BP are you aiming for?
10-15% reduction
47
Is BP 210/140 eligible for thrombolytic therapy?
Yes! just need to lower it to be <185/110 | w/ antihypertensive therapy (BB or CCB)
48
How would you manage a pt w/ BP 185/110
- Check BP q15min for 2hr, then q30min for 6hrs, then q1hr for 16hrs - Labetalol (may repeat or give nitropaste) or - Nicardipine drip - if uncontrolled, add Nitroprusside - Aim for 10-15% reduction of BP
49
IV Heparin, monitor?
aPTT 1.5-2.5x baseline | platelets
50
LMWH, monitor?
Platelets
51
Labetolol, monitor?
BP
52
Nicardipine, monitor?
BP
53
Nitroprusside, monitor?
BP Cyanide toxicity Renal fucntion
54
Nitroglycerin, monitor?
BP HA sign of tachyphylaxis (when used for >2-3 days continuously)
55
Which BP lowering drug should you monitor for cyanide toxicity? A. Labetolol B. Nicardipine C. Nitroprusside D. Nitroglycerine
C. Nitroprusside also monitor BP and renal function!

Therapeutics II Exam 3 (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions