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CDM 2 Exam 1 > Lecture 10 - Stroke 1 > Flashcards

Lecture 10 - Stroke 1 Flashcards

1
Q

Stroke is….

A

sudden loss of neurological function caused by vascular injury to the brain that lasts > 24hrs and is associated with neurological deficit

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2
Q

Transient ischemic attack…..

A

sudden focal loss of neurological function that lasts < 24hrs and is not associated with neurological deficit

risk factor for stroke

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3
Q

Ischemic vs Hemorrhagic Stroke

A

Ischemic = block

Hemorrhagic = most serious, cant give meds, vessel in brain burst

majority are ischemic (87% vs 13% hemorrhagic)

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4
Q

Collagen pathway for stroke

A
  1. adhesion
  2. activation of platelets
  3. aggregation of platelets
  4. platelet plug
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5
Q

Tissue Factor Pathway stroke

A

Thrombin activates Fibrinogen, causes Crosslinked fibrin leading to clot

Thrombin can also cause inflammation and activate platelets

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6
Q

Ischemic Penumbra

A

Normal Cerebral Blood flow = 50ml/100g/min

Core infarct = area of dead tissue, <8mL/100g/min

Penumbra is area around core = 8-35ml/100g/min…use therapy to hopefully reflow flow

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7
Q

Non-modifiable Risk Factors Stroke

A

Age
Gender (M>F)
FH
Race (AA>Hispanics> Asians)

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8
Q

Modifiable Risk Factors Stroke

A 
HTN
AFib/ CVD
Hyperlipidemia
Prior TIA/CVA
DM
Cartoid Stenosis
CKD
Lifestyle = Obesity, diety, heavy booze, smoking, inactivity
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9
Q

Single most modifiable risk factor for stroke?

A

HTN

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10
Q

Most important concept for determine if a patient is having a stroke?

A

History, When was the patient last seen normal

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11
Q

NIHSS scale

A 
0 = no stroke
1-4 = minor stroke
5-15 = moderate stroke
15-20 =moderate/sever stroke
21-41 = severe stroke
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12
Q

Outcomes that NINDS study looked for?

A

Mortality
Safety
Neurologic deficit after 24hrs and 3 months

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13
Q

NINDS Study dosing

A

0.9mg/kg (90mg max) alteplase

10% bolus, 90% infusion

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14
Q

NINDS Study Inclusion Criteria for rt-PA

A

> 18 yr old

Clinical diagnosis of stroke with measurable defect

time of onset of stroke known and < 3hr

no evidence of intracranial hemorrhage on CT

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15
Q

Results of NINDS Study

A

Benefit:
No Difference in mortality/short term deficity
32% inc in # of pt returning to normal or minimal deficit in 90 days

Harm:
inc incidence of intracerebral hemorrhage (6.4% v 0.6%) in 1st 36hrs

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16
Q

Tenecteplase Vs Alteplase

A

Tenecteplase could be considered as an alternative in select patients with acute ischemic stroke with minor neurological I,pariment and no major intracranial occlusion

study shows tenecteplase is atleast non inferior, real world data shows the same…maybe some benefits

17
Q

Tenecteplase Dose

A

0.25 mg/kg, max of 25 mg

same CI as alteplase

push over 5 seconds

18
Q

Alteplase window extended to….

A

4.5hrs form originally 3 hrs

19
Q

Heparin used for Ischemic Stroke?

A

Nah, no benefit shown

only in vertebrobasilar stroke

20
Q

Heparin DVT prophylaxis after stroke

A
  1. Pt not receiving thrombolytics, usually started >24hr after stroke onset
  2. Pt receiving thrombolytics, wait 24hr after admin of it

Enoxaparin 40mg SubQ or Heparin 5000 unit SubQ TID

21
Q

Is aspirin efficacious for acute treatment of stroke?

A

Overall, shows a small but significant benefit

22
Q

Aspirin uses

A

should be started in 24-48hr after stroke onset in pt not receiving thrombolyics

Dose is 325mg po QD in acute setting

23
Q

Blood pressure changes issues

A

Increasing too much can….

Inc brain edema
Inc hemorrhagic transformation
Inc vascular damage

If you go too low….may reduce perfusion to ischemic area and expand infarct size

24
Q

1st line therapies for BP in stroke

A

Nicardipine
Labetalol
Clevidipine
Nitroprusside

25
Q

If Non Thrombolytic Therapy, SBP >220 or DBP > 120 then treatment is…

A

Clevidipine gtt
Labetalol IVP
Nicardipine gtt

Goal: 15% reduction w/in 1st day

26
Q

If Thrombolytic Therapy, Pre period treatment if…

A

SBP > 185 or DBP >110

Clevidipine gtt
Labetalol IVP
Nicardipine gtt

27
Q

If Thrombolytic Therapy, During/Post period treatment if…

A

SBP > 180 or DBP >105

Clevidipine gtt
Labetalol IVP or gtt
Nicardine gtt

28
Q

When is nitroprusside used?

A

If other agents cant control BP, and DBP > 140

CDM 2 Exam 1 (12 decks)

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