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Stroke > Medical Treatment Of Stroke > Flashcards

Medical Treatment Of Stroke Flashcards

1
Q

Type of seizures seen post-stroke

A

General, tonic-clonic

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2
Q

3 medications to give patients for acute treatment of SAH

A
  1. APAP with codeine for headache
  2. Mannitol for cerebral edema
  3. Nimodipine for Vasospasms
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3
Q

timeframe of when to start anticoagulants after cardiac embolic stroke

A

If deficit is mild and CT shows no hemorrhage, start immediately. If deficit is severe, wait 3-5 days.

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4
Q

What kind of stroke patients do you give anti platelets to?

A

Patients with noncardioembolic ischemic strokes or TIA

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5
Q

Normal CPP

A

> 60 mmHg

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6
Q

What kind of breathing abnormality do people with severe strokes get?

A

Central Sleep Apnea

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7
Q

NIHSS score contraindication with tPA

A

> 25 (which indicates very severe)

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8
Q

FLA for depression treatment in stroke patients

A

SSRIs

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9
Q

Most rapid means of lowering ICP

A

Hyperventilating to reduce PaCO2 (hypercarbia increases ICP)

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10
Q

Who are candidates for hypertension treatment in ischemic stroke patients?

A

If SBP > 220, DBP > 120 or MAP > 185 in nonthrombolytic patients.
If SBP > 185 or DBP > 110 in thrombolytic patients

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11
Q

use of what medications is contraindicated with tPA

A
  1. Warfarin

2. heparin within 48h

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12
Q

Candidate for BP mgmt in hemorrhagic stroke

A

If SBP > 180 or DBP > 105

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13
Q

Normal ICP

A

Less than or equal to 15

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14
Q

blood sugar contraindication with tPA

A

<50 or > 400

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15
Q

Favored antihypertensives for BP Mgmt in ischemic stroke

A

IV labetalol - nonselective Beta-blocker and alpha 1 antagonist
Enalapril - ACE inhibitor

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16
Q

age limit for use of tPA

A

> 18 and <80

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17
Q

what patients get a Carotid Endarterectomy

A

Carotid Stenosis with >70% stenosis

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18
Q

What position do you put patient in to lower elevated ICP

A

Avoid flat and supine positions. Elevate HOB to 30 degrees

19
Q

Equation correlating CPP, MAP and ICP

A

CPP = MAP - ICP

20
Q

Which stroke has higher mortality rate within 1 month? Ischemic or hemorrhagic?

A

Hemorrhagic

21
Q

5 inclusion criteria for use of tPA

A
  1. <18 yo
  2. <4.5 hours after stroke
  3. Head CT negative for blood
  4. moderate to severe symptoms of stroke
  5. Informed consent
22
Q

How can antihypertensive worsen stroke

A

Can lower cerebral perfusion

23
Q

Functional assessment tool that measures independence in ADLs on 0-100 scale

A

Barthel Index

24
Q

What kind of IVF do you want to avoid in stroke patients

A

Hypotonic solutions because it may worsen brain edema

25
Q

timeframe for use of tPA

A

<4.5 hours after stroke

26
Q

Agent of choice of BP mgmt in hemorrhagic stroke

A

IV labetalol

27
Q

BP contraindication for use of tPA

A

> 185/100

28
Q

What is optimal PaCO2

A

25-30

29
Q

timeframe for intra-arterial thrombolytic therapy

A

<6 hours

30
Q

Rivaroxaban MOA and brand name

A

Brand name - Xarelto

MOA - Factor Xa inhibitor

31
Q

Seizures occurring after ________ after stroke have high probability of recurrence

A

2 weeks

32
Q

Medications that can decrease ICP

A

Mannitol, furosemide, acetazolamide, high doses of barbiturates.

33
Q

Dabigatran MOA and brand name

A

Brand name - Pradaxa

MOA - Direct thrombin inhibitor

34
Q

mri finding c/I with tPA

A

ischemic injury > 1/3 of MCA territory

35
Q

What medication can ASA be combined with for additive benefit

A

Dipyridamole (ASA + Dipyridamole = Aggrenox)

36
Q

INR contraindication for use of tPA

A

> 1.7

37
Q

First line agent for treating seizures after stroke

A

IV lorazepam (Ativan) or Diazepam (Valium)

38
Q

When do you start nimodipine for SAH and for how long do you treat and at what dose?

A

Nimodipine 60mg q4h x 21 days. Start within 96 hours.

39
Q

platelet count contraindication with tPA

A

<100,000

40
Q

Apixaban MOA and brand name

A

Brand name - Eliquis

MOA - Factor Xa inhibitor

41
Q

Correlation between intracranial pressure and cerebral blood perfusion pressure

A

Increased ICP = Decreased CPP

42
Q

PMHx contraindication with tPA

A
  1. stroke or severe head injury in the last 3 months
  2. ICH, AVM, aneurysm, GI or GU bleed in the last 3 weeks
  3. pregnant or lactating in the last 30 days
  4. major surgery in the last 14 days
  5. seizure at onset of stroke
  6. acute mi
  7. Stroke + DM
43
Q

When do you start a stroke patient on ASA

A

ASA 325 within 24-48 hours after ischemic stroke onset

44
Q

anticoagulant therapy and acute ischemic stroke

A

Not recommended. No benefit.

Stroke (11 decks)

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