MY STROKE

Question 1

What are the three main types of strokes

Answer 1

Haemorrhaging strokes - manage BP AND AVOID STATINS
Ischaemic - blood clot is moving
TIA- transient ischaemic stroke

Question 2

Stroke is associated with the risk of??? What do we do with patients

Answer 2

• Stroke is associated with the risk of morbidity and mortality
  
  • Transfer patients urgently to hospital to determine the type of stroke and initiate treatment

Question 3

What are the symptoms:

Answer 3

• BE FAST!!!!!!!
  
  • BALANCE
  • EYES - Droopy
  • FACE- drops
  • ARMS - weak and floppy
  • SPEECH- slow and slurred
  • TIME - call 999 quick

Question 4

Initially we start stroke patients on

Answer 4

• Initially start off on 300mg of ASPIRIN
  
  • Clopidogrel immediately if Aspirin is not tolerated
  • Following a confirmed diagnosis, patients should receive treatment for secondary prevention immediately

Question 5

Initially atleplase 4.5…….
And what else???

Answer 5

Initially, Aleplase - within 4.5 hours for 24 hours
- Aspirin 300mg/clopidogrel 75mg OD for 14 days

Question 6

How do we manage it long term? Not associated with AF:
Anti-platelets (non AF patients):
What is first lin,second line and third line???

Answer 6

1ST LINE- CLOPIDOGREL 75MG OD
2ND LINE - MR Dipyramidole and ASPIRIN
3RD LINE - MR Dipyramidole OR ASPIRIN

Question 7

Anti coagulants for stroke associated with AF:

Answer 7

• Warfarin - anticoagulant for AF patients

Question 8

Long term management:
ASAAAAP- how long after stroke do we initiate statin (obvs not haemo.)what is our target by?? What are all pts advised on

Answer 8

• Initiate a statin 48 hours after stroke
  
  • Monitor blood pressure, target <130/80 mmHg and treat hypertension
  • All pts advised on life style changes - modifying diet, weight, alcohol intake and smoking

Question 9

AntiPlatelet vs Anti Coagulant

Answer 9

Anti platelet agents inhibit clot formation by preventing platelet activation and aggregation
Anti coagulants primarily inhibit the coagulation cascade and fibrin formation

Question 10

When a patient has a suspected TIAAAA

Answer 10

1) Aspirin immediately - unless contraindicated (300mg)
2)Clopidogrel or other anti platelet
3) Dual anti platelet therapy for low bleeding risk patients - Clopidogrel and Aspirin or Ticagrelor and Aspirin
4) mono therapy unsuitable

Question 11

Interactions OF PPI and CLOPIDOGREL

Answer 11

• Concurrent use of PPI may make clopidogrel less effective
  
  • Evidence still shows that omeprazole and esomeprazole still a cause for concern
  • Lansoprazole and other should be okay

Question 12

Troponin elevated when

Answer 12

Stemi and nstemi