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PHRM 864 > E4 Stroke (pause) > Flashcards

E4 Stroke (pause) Flashcards

1
Q

2 classes of stroke we talk about

A

ischemic and hemorrhagic

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2
Q

where do atheroscletoric and cardioembolic strokes fall?

A

under ischemic

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3
Q

which type of stroke has headache as a clinical presentation more often?

A

hemorrhagic (cause its the brain duh)

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4
Q

what scale is used for sx evaluation

A

National Institutes of Health Stroke Scale (NIHSS)
has a score 0-42

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5
Q

if ischemic stroke with _______ or _______ usually cardioembolic

A

Afib, valvular abnormalities

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6
Q

if ischemic stroke with _______ usually atherosclerotic

A

normal sinus rhythm

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7
Q

what two tests are used to assess stroke

A

ECG
echocardiogram

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8
Q

what 4 labs are used in assessment of stroke

A

BG
BMP
CBC
INR/aPTT

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9
Q

what two vital signs are used in assessment of stroke

A

BP
o2 sat

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10
Q

what two imaging things are used for assessment of stroke

A

Head CT
MRI

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11
Q

can cause neurological changes mimicking a stroke
A. Hypoglycemia
B. Hyperglycemia

A

A

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12
Q

treat with carbs
A. Hypoglycemia
B. Hyperglycemia

A

A

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13
Q

if hyperglycemic when presenting treat with insulin in BG > ___

A

180

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14
Q

when to use insulin drip in pts presenting with hyperglycemia and stroke

A

only if patient is in acidosis *

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15
Q

acute BP goals:
check BP how often?

A

q15 min x 2h, then q30 min x 6h, then q1 h for 16 hours
damn

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16
Q

BP goals within first 48 hours:*****
no tPA:
tPA admin:

A

<220/110
<180/105

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17
Q

do i need to know the details from slide 31? ( i think its 31 but its the flow chart)

A

spencer pls

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18
Q

3 drugs for acute htn tx options in acute ischemic stroke

A

labetalol
nicardipine
sodium nitroprusside
all are quick onset
dont need doses

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19
Q

htn management after 48 hours:
if BP elevated after 48 hrs, do what

A

start po meds if able to take OR resume home antihypertensives

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20
Q

2 tPA drugs

A

alteplase
tenecteplase

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21
Q

what do tPAs activate and what does that do

A

plasminogen -> breaks clots

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22
Q

T or F:
thrombolytics (tPAs) improve mortality and neurologic function

A

false, no impact on mortality

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22
Q

what are the 3 inclusion criteria for tPA eligibility

A

diagnosis of ischemic stroke
sx onset of <4.5 hours*
age >18 yo

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22
Q

Based on the mechanism of action, which type of stroke would you use a thrombolytic? Select all that apply.
A. Hemorrhagic
B. Ischemic – atherosclerotic
C. Ischemic - cardioembolic

A

B and C

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23
Q

what BG level is considered hypoglycemic

A

<50

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23
Q

for tPA eligibility you need to meet ALL inclusion and NO exclusion criteria

A

yes

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24
Q

what BP value is in exclusion criteria for tPA eligibility ***

A

BP >185/110 at time of admin

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25
Q

what are some of the tPA exclusion criteria things that might pop up based on his practice questions

A

active internal bleed
MI in last 3 months
platelets <100k
any current anticoag use

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26
Q

alteplase dose and max

A

0.9mg/kg
max 90mg

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27
Q

tenecteplase dose and max

A

0.25mg/kg
max 25 mg

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28
Q

alteplase dosing regimen (ignore actual dose for this)

A

10% given as bolus
90% given over 1 hour

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29
Q

tenecteplase dosing regimen (ignore actual dose for this)

A

all IV bolus

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30
Q

2 SEs of tPA agents

A

bleeding duh
cerebral edema

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31
Q

after giving tPA keep BP at what value to reduce risk of bleeding/hemorrhagic stroke***

A

<180/105

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32
Q

what should you avoid for 24 hours after tPA admin *

A

ALL antiplatelets and anticoags

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33
Q

antiplatelets decrease activation of?

A

P2Y12

34
Q

4 antiplatelet options for acute ischemic stroke management

A

aspirin mono
aspirin+clopid
ticagrelor
aspirin +ticag

35
Q

T or F:
aspirins inhibition of COX is reversible

A

false, irreversible

36
Q

inhibiting COX reduces formation of ?

A

thromboxane A2 -> reduces platelet agg

37
Q

aspirin utility:
- __ line for acute mgmt of ischemic stroke
- studies show a decrease in early recurrent ischemic stroke with ?

A

1st
high dose aspirin for 2-4 weeks*

38
Q

2 monitoring for aspiri

A

bleeding
stroke

39
Q

who gets aspirin for a stroke

A

ALL ischemic stroke pts unless CI’d

40
Q

what are 2 CI’s of aspirin use

A

active bleeding or high bleeding risk

41
Q

when to give aspirin if tPA administered and if not administered

A

> 24 hours with tPA
immediately if not*

42
Q

use aspirin+clopid ONLY in ?

A

minor strokes (NIHHS <4)

43
Q

how long to use aspirin + clopid combo

A

3 weeks or 90 days but 90 days increases bleed risk

44
Q

ticagrelor only used in?

A

minor strokes (NIHHS <5)

45
Q

T or F:
aspirin + ticagrelor is better than ticagrelor alone

A

true

46
Q

if pt has a true aspirin allergy what do you use?

A

ticagrelor (yes even over clopid)

47
Q

what do we do if a pt came in on anticoags already when they came for ischemic stroke

A

d/c and transition to aspirin

48
Q

if cardioembolic ischemic stroke or other indication for anticoag, start > __-__ days after stroke *(quiz question)

A

2-14 days but his quiz said after 7 so just use that range

49
Q

distinguishing sx of hemorrhagic stroke

A

severe headache

50
Q

T or F:
worse prognosis with hemorrhagic stroke

A

true duh

51
Q

warfarin reversal agent

A

IV vitamin K

52
Q

heparin products reversal agent

A

protamine

53
Q

dabigatran (DOAC) reversal agent

A

idarucizumab

54
Q

other DOAC reversal agent

A

Andexxa

55
Q

antiplatelet reversal agent

A

none

56
Q

management is mostly surgical
A. cardioembolic
B. Atherosclerotic
C. Hemorrhagic

A

C

57
Q

stroke guidelines recommend to treat with IV antihtn if SBP > ___

A

180

58
Q

goa BP in first 24 hours for hemorrhagic stroke

A

<180/100*

59
Q

goal BP in hospital AFTER 24 hours for hemorrhagic stroke

A

<160/90

60
Q

outpatient BP goal for hemorrhagic stroke

A

<140/90

61
Q

what type of stroke gives pts a risk of cerebral vasospasm

A

subarachnoid hemorrhagic stroke

62
Q

what to give to minimize complications from cerebral vasospasm

A

nimodipine (DHP CCB)

63
Q

T or F:
prophylactic anticonvulsants are recommended by stroke guidelines after a hemorrhagic stroke

A

false, lack of benefit

64
Q

anticonvulsants only used if pt has?

A

documented seizure history

65
Q

atherosclerotic stroke pts receive what to prevent future strokes

A

antiplatelets

66
Q

cardioembolic stroke pts receive what to prevent future strokes

A

anticoag

67
Q

1st line for secondary stroke prevention in atherosclerotic stroke

A

aspirin, high dose 2-4 weeks then 81 indefinitely

68
Q

my bad theres another 1st line for secondary stroke prevention in atherosclerotic stroke what is it

A

dipyridamole + aspirin

69
Q

dipyridamole inhibits ?

A

adenosine phosphodiesterase

70
Q

1 niche side effect for dipyridamole aspirin combo

A

headache

71
Q

2nd line for secondary stroke prevention in non-embolic ischemic stroke (mod/sev)

A

clopidogrel + aspirin

72
Q

1st line for secondary stroke prevention in non-embolic ischemic stroke (minor)

A

clopid+aspirin

73
Q

drug that is CI’d in secondary prevention

A

prasugrel

74
Q

when to give warfarin/rivaroxaban in cardioembolic stroke

A

if mechanical mitral valve/LV thrombus

75
Q

high dose aspirin for >2 days
A. Atherosclreotic
B. Cardioembolic

A

B, A is 2-4 weeks

76
Q

long term BP goal for all pts w/ hx of stroke

A

<130/80

77
Q

first line antihypertensives:
black people

A

CCB, thiazide

78
Q

first line antihypertensives:
CKD

A

ACE/ARb

79
Q

first line antihypertensives:
CAD

A

BB + ACE (or ARB)

80
Q

first line antihypertensives:
diabetes

A

ACE or ARB

81
Q

first line antihypertensives:
HF

A

ARNI, ACE, ARB + BB + spiro (duh)

82
Q

first line antihypertensives:
Afib

A

BB or non-DHP CCB

83
Q

after an atherosclerotic stroke, all pts should be initiated on ?

A

high intensity statin

84
Q

LDL goal

A

<70

85
Q

do not use a statin if what or what?

A

cardioembolic or hemorrhagic stroke

86
Q

? have been shown to improve neurological functioning after a stroke

A

SSRis, just avoid paroxetine

PHRM 864 (28 decks)

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