Exam 3 Cerebrovascular Dz Management

Question 1

Goals of stroke therapy? (3)

Answer 1

Address acute event
Prevent toxic cascade
Prevent recurrence

Question 2

Stroke studies? (6)

Answer 2

Angio
Carotid US
Cranial CT
ECG
Echo
MRI/MRA

Question 3

Acute mgmt of CVA?

Answer 3

ABC
Control BP
Avoid hypotonic fluids (D5W)
ASA 325mg/day

Question 4

Management of BP during CVA, when?

How?

Want how much of a drop?

What med is contraindicated?

Answer 4

if >200/100

DOC = IV Labatolol

NOT more than 20%

SL procardia

Question 5

Cranial CT done why?

Answer 5

MANDATORY to r/o hemorr stroke

Question 6

Rapid assessment of stroke/CVA should include?

What studies? (4)

Answer 6

Focused hx/physical

Pulse Ox
ECG
CXR
Cranial CT

Question 7

Rapid assessment of stroke/CVA labs should include? (7)

Answer 7

CBC/platelets
CMP
PT/PTT
ESR
Tox screen w/ blood etoh
Preggo test
Blood type

Question 8

Stroke/CVA coagulation addressed how?

Answer 8

Assess for recombinant tissue-type plasminogen activator (rt-PA)

If not rt-PA ok, Heparin/Warfarin

Question 9

rt-PA contraindicated when? (7)

Answer 9

Uncontrolled HTN (>185-110)
Head trauma w/i 3 mo
Intracranial hemorr hx
Gi or GU hemorr w.i 3 wks
Major surgery w/i 2 wks
Anticoag therapy or coagulopathy hx
Preggos

Question 10

Heparin loading dose?

Goal?

Answer 10

5000 units

Maintain PTT @ 1.5 x control

Question 11

Warfarin dosing?

Goal?

Answer 11

2-10 mg/day

INR 2-3

Question 12

Anti-platelet meds used when? (2)

Answer 12

Small vessel dz

Hx of Transient Ischaemic Attack (TIA)

Question 13

Anti-platelet meds? (4)

Answer 13

ASA
Ticlopidine (Ticlid)
Clopidogrel (Plavix)
Warfarin if others fail

Question 14

Statins used when?

Answer 14

Acute phase of stroke after IV thrombolysis

Question 15

Tx for Intra-arterial Thrombolysis?

Answer 15

Small dose of rt-PA into clot

Question 16

Carotid Dz indications for surgery?

Surgery type?

Goal?

Answer 16

Lesions causing >70% stenosis

Carotid Endarterectomy

↓ risk of stoke

Question 17

Carotid Angioplasty/Stents indicated when? (5)

Answer 17

High-risk pts:

High lesion
Prior neck dissection
Unstable angina
Recent MI
HF