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NAPLEX 2023 > Chapter 33: Stroke > Flashcards

Chapter 33: Stroke Flashcards

1
Q

How is acute ischemic stroke (aka, a non-cardioembolic stroke) caused

A

By a thrombus that forms during a cerebral atherosclerotic infarction

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2
Q

How does a cardioembolic stroke occur

A

when an embolus forms in the heart and travels to the brain

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3
Q

A common cause of cardioembolic stroke

A

AFib

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4
Q

Risk factors for stroke

A 
HTN (most important)
AFib
Gender (F > M)
Ethnicity (↑risk in AA)
Age > 55 years
Atherosclerosis
Diabetes
Prior stroke or TIA
Smoking
Dyslipidemia
Patent Foramen Ovale (PFO)
Sickle Cell Disease
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5
Q

What is a TIA

A

caused by a temporary clot, or block of blood flow, in the brain. Symptoms are the same as stroke, but disappear on their own within minutes to a few hrs; there is NO permanent damage
-Seek immediate medical attention: TIAs are often a warning for a future full stroke

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6
Q

Signs and symptoms of stroke

A
  • remember: act F.A.S.T*
  • Face: ask the person to smile. Does one side of the face droop or is it numb? Is the smile uneven?
  • Arms: ask the person to raise both arms. Does one arm drift downward?
  • Speech: ask the person to repeat a simple sentence. Are the words slurred? Is the sentence repeated correctly?
  • Time: if the person shows any of these sx, even if they go away, call 911 immediately
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7
Q

What is performed in stroke patients within 20 min of arrival to ED

A

Brain imaging, using CT

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8
Q

Immediate goal for ischemic stroke

A

Restore blood flow to the ischemic area of the brain to obtain complete neurological recovery

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9
Q

MOA of alteplase

A

recombinant tissue plasminogen activator (tPA) that binds to fibrin in a thrombus and converts plasminogen to plasmin, resulting in fibrinolysis

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10
Q

What is the ONLY fibrinolytic drug that is used in acute ischemic stroke

A

Alteplase

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11
Q

Patients are candidates for alteplase if a clot is confirmed on brain imaging and the following criteria for timing are met:

A
  • Can be administered within 3 hours of symptom onset
  • It can be administered within 4.5 hours of symptom onset in select patients (not FDA-approved)
  • It can be administered within 60 min of hospital arrival (door-to-needle time)
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12
Q

Alteplase CI

A
  • Active bleed (e.g., internal bleed, ICH)
  • Conditions or labs that increase risk of bleed (e.g., severe HTN, INR > 1.7)
  • Drug interactions with bleeding risk (e.g., anticoagulants)
  • Severe, uncontrolled HTN (BP > 185/110 mmHg)
  • History of recent stroke
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13
Q

Alteplase brand name

A

Activase

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14
Q

Max dose of alteplase in ischemic stroke

A

90 mg

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15
Q

What must be excluded before using alteplase

A

intracranial hemorrhage

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16
Q

Alteplase SE

A

Major bleeding (e.g., ICH)

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17
Q

ASA __-__ mg PO within __-__ hrs after stroke onset is recommended to prevent early recurrent stroke

A

162 – 325

24-48

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18
Q

Which antihypertensive drug classes have the best evidence for stroke risk reduction

A

ACEi and thiazide diuretics

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19
Q

What is the goal BP for ischemic stroke

A

< 130/80 mmHg

20
Q

What statin intensity should be used in secondary prevention of stroke

A

High-intensity

21
Q

For patients with non-cardioembolic ischemic stroke or TIA, what drug is recommended to reduce the risk of recurrent stroke

A

ASA (or clopidogrel if ASA is CI)

22
Q

Combo of ASA and clopidogrel can be initiated within 24 hrs of a minor ischemic stroke & continued for 21 days. This combination should not be used long-term for secondary prevention of stroke or TIA as it increases the risk of ____

A

hemorrhage (NOTE: this is different for ACS - in ACS, DAPT is used for 12 months & can be continued if the pt is tolerating and are not high risk for bleeding following stent placement)

23
Q

T/F: In patients who have an ischemic stroke or TIA while taking ASA, there is an added benefit to increase the ASA dose

A

False - there is no added benefit

24
Q

What is the MOA of dipyridamole

A

inhibits the uptake of adenosine into platelets and increases cAMP levels, which inhibits platelet aggregation

25
Q

Aspirin dosing in stroke

A

50-325 mg daily

26
Q

Aspirin ER capsule brand name

A

Durlaza

27
Q

Aspirin DR tablet brand name

A

Yosprala

28
Q

ER dipyridamole/aspirin brand name

A

Aggrenox

29
Q

ER dipyridamole/aspirin warnings

A

hypotension

30
Q

ER dipyridamole/aspirin SE

A

headache

31
Q

Clopidogrel dosing in stroke

A

75 mg daily

32
Q

Clopidogrel should be stopped __ days prior to elective surgery

A

5

33
Q

Clopidogrel should be avoided with which 2 drugs

A

omeprazole and esomeprazole

34
Q

What should be done in patients with intracranial hemorrhage who are anticoagulated

A

reversal of the anticoagulant should be considered

35
Q

What should be done in ICH if there is clinical evidence of seizures

A

They should be treated but ppx anticonvulsant meds should not be used

36
Q

How is ICH treated

A

elevate the head by 30 degrees and use mannitol or hypertonic saline

37
Q

MOA of mannitol

A

Produces osmotic diuresis. Reduces ICP by withdrawing water from the brain

38
Q

Mannitol formulation

A

injection

39
Q

Mannitol CI

A

severe renal disease

40
Q

How does acute subarachnoid hemorrhage present

A

Severe headache

41
Q

Cerebral artery vasospasm can occur __=__ days after the bleed in SAH, causing delayed cerebral ischemia

A

3-21

42
Q

Which drug & route is used to prevent vasospasm in SAH

A

oral nimodipine

43
Q

Nimodipine MOA

A

DHP CCB that is more selective for cerebral arteries d/t increased lipophilicity

44
Q

Nimodipine BW

A

Do not administer IV or by any other parenteral routes; death and serious life-threatening AE have occurred when contents of the capsules have been injected parenterally

45
Q

Nimodipine SE

A

Hypotension

46
Q

If nimodipine capsules cannot be swallowed, what can be done

A

contents can be withdrawn with a parenteral syringe, then transferred to an oral syringe that cannot accept a needle; label oral syringes “For Oral Use Only” or “Not for IV Use”

NAPLEX 2023 (88 decks)

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