Cerebrovascular (stroke) Flashcards
What drug is used for initial treatment of ischaemic stroke
Alteplase (rt-PA)
What drugs are used for post-stroke care
Anti-platelets, anticoagulants, antihypertensives, statins
E.g. of anti-platelets
Aspirin and clopidogrel
What do anti-platelets do
Prevent the adherence of platelets to the wall of the injured vessel
When should aspirin be given post-stroke
After 48 hours. It should be started as soon as possible but should wait 24 hours after using rt-PA
E.g. of anticoagulants
Warfarin, apixaban, dabigatran, rivaroxiban
If the pt has AF oral anticoagulants are…
More effective in preventing recurrent stroke than antiplatelet drugs, and they carry a similar risk of bleeding
When can you start anticoagulants post-stroke?
Cannot be started until at least a few days (up to 14 days) after ischaemic stroke cos risk of bleeding (including intracranial haemorrhage)
How do antihypertensives help in ischaemic stroke
Lowering the BP reduces the risk of recurrent stroke by approximately 25%. Lowering the BP is more important than the type of antihypertensive used.
How do statins help in ischaemic stroke
Statins can slightly reduce the risk of any stroke, in people with a history of TIA or ischaemic stroke. Statins also increases the risk slightly of haemorrhagic stroke.
Medication for hemorrhagic stroke:
Nimodipine
What does nimodipine do
MOA is unclear, may reduce influx of calcium into neurones and vascular smooth muscle cells. Prevents ischaemic damage from cerebral spasm
Drugs that can help with hemorrhagic stroke
Analgesia, stool softeners, anti-emetics, anti-epileptic meds
Alteplase stuff
It’s a serine protease which binds to fibrin in a clot and the plasminogen that is part of the structure is activated and becomes plasmin. The plasmin further aids in the breakdown of fibrin, and Alteplase only works in its full capacity when there is fibrin present, which minimises systemic effects. After four hours, fibrinogen and plasminogen levels are approximately halved, but increases to about 80% after 24 hours. Contraindicated in patients who have an increased risk of haemorrhaging.
