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Clin Therapeutics II (Spring 2018) > Exam 3: TIA, CVA > Flashcards

Exam 3: TIA, CVA Flashcards

1
Q

Does this class cause a person to have a severe CVA?

A

Yes

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2
Q

Define brief episode of neurological dysfunction caused by focal brain or retinal ischemia, with clinical symptoms typically lasting less than one hour and without evidence of acute infarct with major improvement within one hour of onset?

A

TIA

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3
Q

When does major improvement occur in a TIA?

A

Within 1 hour of onset

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4
Q

How is TIA like angina?

A

Transient and reversible

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5
Q

Define: Cerebrovascular infarct where irreversible damage has occurred and residual neurological dysfunction caused by reduction of blood supply to different areas of the brain causing ischemic injury

A

Ischemic CVA

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6
Q

How is Ischemic CVA like NSTEMI/STEMI?

A

Real damage, not reversible.

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7
Q

2 types of Ischemic CVA?

A
  1. Thrombotic

2. Embolic

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8
Q

Thrombotic CVA aka

A

“Non-cardio embolic stroke”

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9
Q

Thrombotic stroke local or traveling?

A

Local

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10
Q

Embolic stroke local or traveling?

A

Traveling

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11
Q

Embolic from brain or elsewhere?

A

Outside brain. Traveling clot which goes to brain and causes cerebro-vessel occlusion.

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12
Q

Major condition which causes embolic/cardioembolic stroke?

A

AFib

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13
Q

Signs and sx of stroke?

A

Hemiparesis, face asymmetry, gaze deviation, dysphagia/aphagia, limb incoordination, ataxia +/- vertigo, one-sided sensory sx

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14
Q

Which tx does thrombotic/non-cardioembolic stroke best respond to?

A

Anti-platelet

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15
Q

How to determine risk and prevent for Embolic/Cardioembolic stroke from AFib?

A

Use CHA2DS2-VASc score

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16
Q

C in CHA2DS2-VASc score means and score?

A

CHF. 1

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17
Q

H in CHA2DS2-VASc means and score?

A

HTN. 1.

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18
Q

A in CHA2DS2-VASc means and score?

A

Age.
65-74=1
≥75=2

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19
Q

D in CHA2DS2-VASc means and score?

A

DM. 1.

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20
Q

S in CHA2DS2-VASc means and score?

A

Prior stroke. 2.

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21
Q

V in CHA2DS2-VASc means and score?

A

Vascular dz (MI, PAD). 1.

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22
Q

Sc in CHA2DS2-VASc score means and score?

A

Sex.
Female=1
Male=0

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23
Q

Tx if CHA2DS2-VASc score ≥2

A

Warfarin or DOAC (not ASA)

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24
Q

Tx if CHA2DS2-VASc score = 1

A

Warfarin, DOAC, or ASA

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25
Q

Tx if CHA2DS2-VASc score = 0

A

ASA only

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26
Q

ASA tx for thrombotic/non-cardioembolic stroke?

A

ASA 50-325mg

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27
Q

Tx is PT allergic to ASA in thrombotic/non-cardioembolic stroke?

A

Ticagrelor

28
Q

Is Ticagrelor more effective than ASA?

A

Nope

29
Q

Aggrenox is a combo of which 2 anti-platelet meds?

A
  1. ASA 25mg

2. Dipyridamole 200mg

30
Q

Aggrenox more effective than ASA alone?

A

Yes

31
Q

Clopidogrel used instead of what?

A

ASA

32
Q

Anticoagulants used to treat which type of stroke?

A

Embolic/Cardioembolic from AFib

33
Q

If PT on warfarin what is goal INR?

A

2-3

34
Q

4 DOACs used for Embolic/Cardioembolic stoke from AFib?

A
  1. Apixiban
  2. Edoxaban
  3. Rivoroxaban
  4. Dabigatran
35
Q

MOA of DOACs ending in “-tran”?

A

Direct Thrombin-inhibitor

36
Q

MOA of DOACs ending in “-xaban”?

A

Direct anti-Xa inhibitor

37
Q

Which 2 DOAC are more effective than Warfarin?

A
  1. Apixaban

2. Dabigatran

38
Q

Which 2 DOAC are similarly effective to Warfarin?

A
  1. Edoxaban

2. Rivaroxaban

39
Q

DOACs and bleeding compared to Warfarin?

A

Similar bleeding risk

40
Q

Do all DOACs require renal dosing?

A

Yes

41
Q

Which DOAC to avoid is CrCl >95?

A

Edoxaban

42
Q

CHA2DS2-VASc score used to determine risk and what else?

A

Prevent embolic/cardioembolic stroke from AFib

43
Q

PT with full vessel occlusion can receive what tx to bust the clot?

A

Thrombolytic

44
Q

Which is only Thrombolytic can be used in ischemic CVA?

A

rt-PA ONLY!

There are other thrombolytics but can’t use them in ischemic CVA.

45
Q

Time frame for rt-PA

A

3-4.5hr

46
Q

rt-PA timeframe if intra-arterial delivery at an experienced stroke center?

A

6h

47
Q

CIs for rt-PA?

A

CVA or head trauma w/n 3 months, SAH, PLT <100k, INR >1.7, Heparin w/n 48h, BP >220/>140

48
Q

When can give heparin, warfarin, clipidogrel, or dipyridamole after giving rt-PA?

A

24h+

49
Q

When to do brain CT/MR after rt-PA?

A

After 24h

50
Q

If PT has ischemic CVA and doesn’t get rt-PA what to give?

A

325mg ASA w/n 24-48h of hospital admission

51
Q

When to give THERAPEUTIC anticoagulants after embolic/cardioembolic stroke?

A

24h+

52
Q

Can give anticoagulants for DVT/PE prophylaxis within 24h or embolic/cardioembolic stroke?

A

Yes. Very low dose=low disk of bleeding

53
Q

What BP is absolute CI for rt-PA?

A

> 220/>140

54
Q

Cannot give rt-PA if BP above what until lowered?

A

> 185/>110 until lowered

55
Q

How to lower BP to make patient eligibile for rt-PA?

A

Labetolol x2 or Labetolol x1 + Nitropaste x1

56
Q

What can be used in place of Labetolol?

A

Nicardipine drip

57
Q

What to add if BP is uncontrolled?

A

Nitroprusside

58
Q

When to start ASA after rt-PA?

A

24h later

59
Q

BP above what makes rt-PA contraindicated?

A

> 220/>140

60
Q

If lower BP >220/>140 can make eligible for rt-PA?

A

Nope!

61
Q

Percent goal for reducing BP?

A

10-15%

62
Q

When to check BP?

A

q15min for 2 hours, then q30min for 6h, then q1h for 16h

63
Q

If PT not eligible for rt-PA what to give w/n 24h? What not to give w/n 24h?

A

Give=ASA 325mg

Don’t give=anticoagulants

64
Q

When to consider anticoagulants in PT not eligible for rt-PA?

A

24h after ASA

65
Q

What type of statin to give all PTs with TIA or CVA?

A

High-intensity statin (Atorvastatin or Rosuvastatin)

66
Q

How to treat high homocysteine levels?

A

Folic acid

67
Q

What percent block to do carotid endarectomy?

A

Stenotic lesion ≥60%

Clin Therapeutics II (Spring 2018) (11 decks)

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