Medical Treatment Of Stroke Flashcards
Type of seizures seen post-stroke
General, tonic-clonic
3 medications to give patients for acute treatment of SAH
- APAP with codeine for headache
- Mannitol for cerebral edema
- Nimodipine for Vasospasms
timeframe of when to start anticoagulants after cardiac embolic stroke
If deficit is mild and CT shows no hemorrhage, start immediately. If deficit is severe, wait 3-5 days.
What kind of stroke patients do you give anti platelets to?
Patients with noncardioembolic ischemic strokes or TIA
Normal CPP
> 60 mmHg
What kind of breathing abnormality do people with severe strokes get?
Central Sleep Apnea
NIHSS score contraindication with tPA
> 25 (which indicates very severe)
FLA for depression treatment in stroke patients
SSRIs
Most rapid means of lowering ICP
Hyperventilating to reduce PaCO2 (hypercarbia increases ICP)
Who are candidates for hypertension treatment in ischemic stroke patients?
If SBP > 220, DBP > 120 or MAP > 185 in nonthrombolytic patients.
If SBP > 185 or DBP > 110 in thrombolytic patients
use of what medications is contraindicated with tPA
- Warfarin
2. heparin within 48h
Candidate for BP mgmt in hemorrhagic stroke
If SBP > 180 or DBP > 105
Normal ICP
Less than or equal to 15
blood sugar contraindication with tPA
<50 or > 400
Favored antihypertensives for BP Mgmt in ischemic stroke
IV labetalol - nonselective Beta-blocker and alpha 1 antagonist
Enalapril - ACE inhibitor
age limit for use of tPA
> 18 and <80
what patients get a Carotid Endarterectomy
Carotid Stenosis with >70% stenosis
What position do you put patient in to lower elevated ICP
Avoid flat and supine positions. Elevate HOB to 30 degrees
Equation correlating CPP, MAP and ICP
CPP = MAP - ICP
Which stroke has higher mortality rate within 1 month? Ischemic or hemorrhagic?
Hemorrhagic
5 inclusion criteria for use of tPA
- <18 yo
- <4.5 hours after stroke
- Head CT negative for blood
- moderate to severe symptoms of stroke
- Informed consent
How can antihypertensive worsen stroke
Can lower cerebral perfusion
Functional assessment tool that measures independence in ADLs on 0-100 scale
Barthel Index
What kind of IVF do you want to avoid in stroke patients
Hypotonic solutions because it may worsen brain edema
timeframe for use of tPA
<4.5 hours after stroke
Agent of choice of BP mgmt in hemorrhagic stroke
IV labetalol
BP contraindication for use of tPA
> 185/100
What is optimal PaCO2
25-30
timeframe for intra-arterial thrombolytic therapy
<6 hours
Rivaroxaban MOA and brand name
Brand name - Xarelto
MOA - Factor Xa inhibitor
Seizures occurring after ________ after stroke have high probability of recurrence
2 weeks
Medications that can decrease ICP
Mannitol, furosemide, acetazolamide, high doses of barbiturates.
Dabigatran MOA and brand name
Brand name - Pradaxa
MOA - Direct thrombin inhibitor
mri finding c/I with tPA
ischemic injury > 1/3 of MCA territory
What medication can ASA be combined with for additive benefit
Dipyridamole (ASA + Dipyridamole = Aggrenox)
INR contraindication for use of tPA
> 1.7
First line agent for treating seizures after stroke
IV lorazepam (Ativan) or Diazepam (Valium)
When do you start nimodipine for SAH and for how long do you treat and at what dose?
Nimodipine 60mg q4h x 21 days. Start within 96 hours.
platelet count contraindication with tPA
<100,000
Apixaban MOA and brand name
Brand name - Eliquis
MOA - Factor Xa inhibitor
Correlation between intracranial pressure and cerebral blood perfusion pressure
Increased ICP = Decreased CPP
PMHx contraindication with tPA
- stroke or severe head injury in the last 3 months
- ICH, AVM, aneurysm, GI or GU bleed in the last 3 weeks
- pregnant or lactating in the last 30 days
- major surgery in the last 14 days
- seizure at onset of stroke
- acute mi
- Stroke + DM
When do you start a stroke patient on ASA
ASA 325 within 24-48 hours after ischemic stroke onset
anticoagulant therapy and acute ischemic stroke
Not recommended. No benefit.
