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Block 8 Week 4 Colt > Primary Stroke Prevention - Lopez > Flashcards

Primary Stroke Prevention - Lopez Flashcards

1
Q

how long does a TIA normally last?

A

15 minutes

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2
Q

If TIA Sx last hours, more likely than not there will be (blank) tissue

A

infarcted

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3
Q

At what point in time does the chance of a positive diffusion weighted image exceed 50% with TIA sx?

A

Sx for 3-6 hours

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4
Q

Where can a stroke occur?

A

Brain, spinal cord, or retinal cell death due to ischemia

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5
Q

T/F: you can have an infarction and not have symptoms

A

true; aka silent infarction

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6
Q

what are the non-modifiable risk factors for stroke?

A
  1. age
  2. low birth weight
  3. black and hispanics
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7
Q

What is the correlation between blacks/hispanics and stroke?

A

higher incidence of all stroke types

higher mortality rates

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8
Q

FHx of stroke increases the risk of stroke by what percent?

A

30%

Also Hx of ischemic stroke before 65 is risk factor

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9
Q

What are the correlations between stroke and aneurysm?

A

8% of of people with AD PKD

7% of individuals with cervical fibromuscular dysplasia

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10
Q

When should you do non-invasive screening for aneurysm?

A

1.>2 first degree relatives with SAH/intracranial hemorrhage
pts with AD PKD and SAH or
2.>1 relative with AD PKD and intracranial hemorrhage

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11
Q

What are the modifiable risk factors for stroke?

A 
Physical inactivity
Dyslipidemia
HTN
DM
Diet
Obesity
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12
Q

How does exercise reduce the risk of stroke?

A

Reduces plasma fibrinogen
Reduces platelet activity
Elevates t-PA activity
Elevates HDL

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13
Q

The beneficial effects of statins are greater with greater (blank) lowering

A

lipid

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14
Q

each 1% decreases in total cholesterol is associated with a 0.8% decrease in the risk of…

A

stroke, duh

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15
Q

Do statins increase the risk of ICH?

A

nipe

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16
Q

Can statins change the characteristics of plaques?

A

yes; can improve them

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17
Q

What two things are advised for the primary prevention of ischemic stroke in pts. with a high 10 year risk or CV events?

A

change in lifestyle

statins

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18
Q

What is the only drug that is useful in reducing the risk of stroke?

A

statins
niacin not established
fibric acid not established

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19
Q

What are the dietary changes that help reduce the risk of stroke?

A 
reduce Na
increase K
EAT YOUR VEGGIES
blacks especially sensitive to BP raising effects of salt
reduce red meat intake
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20
Q

What are the components of a DASH/Mediterranean diet that help reduce the risk of stroke?

A

lots of fruits, veggies, and nuts
low fat dairy
reduced saturated fats

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21
Q

What is the single greatest risk factor for stroke?

A

HTN

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22
Q

(blank) is Strong, continuous, graded, consistent, independent, and predictive of stroke

A

HTN

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23
Q

T/F: most people over 55 will at some point develop HTN

A

true

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24
Q

What fraction of people oer 65 have HTN?

A

2/3

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25
Q

How many drugs does it take on average to control HTN?

A

more than 1

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26
Q

T/F: treating HTN only reduces the risk of ischemic stroke

A

false; ischemic and hemorrhagic

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27
Q

what is the target BP?

A

<140/90

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28
Q

Which ethnic groups are more obese?

A

blacks, mexican-americans, and all hispanics

lowest rates in whites

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29
Q

what is the recommended tx in obese pts to lower BP?

A

lose weight; it also reduces the risk of stroke

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30
Q

by what fold does DM increase the risk of stroke

A

doubles it

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31
Q

what percent of pts with DM will die of stroke?

A

20%

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32
Q

Hyperglycemia reduces PLT sensitivity to (blank)

A

aspirin

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33
Q

what is the Tx for adults with DM to reduce the risk of stroke

A

statin

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34
Q

Besides stroke, what else does smoking increase the risk of/

A

SAH

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35
Q

There is a synergisitic effect between the use (blank) and smoking on the risk of stroke

A

the pill

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36
Q

2nd hand smoke is a risk factor for….

A

heart disease

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37
Q

is the exposure to tobacco dose-dependent?

A

no, exposure threshold

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38
Q

what are the effects of smoking a single cigarette?

A

increases HR and BP and decreases arterial distensibility

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39
Q

Active and passive cigarette exposure is assc’d with….

A

atherosclerosis

40
Q

What drug do you use to help in smoking cessation?

A

Chantix aka vareniciline; more effective than nicotine replacement

41
Q

A fib has a how many fold increase in the risk of ischemic stroke from embolism?

A

4-5 fold

42
Q

A fib accounts for what percent of all ischemic strokes?

A

10%

43
Q

What are the criteria for CHADS2/

A 
Score 0-6
1 point each given for
CHF
HTN
Age >75
DM
2 points for
Prior stroke or TIA
44
Q

What are the point value sfor low, moderate, and high risk for CHADS2?

A

low: 0
moderate: 1
high: >1

45
Q

In CHA2DS2VASc, what is the age criteria?

A

1 pt for 56-74

2 pts for >75

46
Q

What is the VASc portion of CHA2DS2VASc?

A 
Vascular disease, such as
Peripheral artery disease
MI
Aortic plaque
Female sex
47
Q

A score >2 on HAS-BLED is associated with…

A

increased risk of major bleeding

48
Q

What do you do to reduce the risk of stroke in A fib?

A

Warfarin to INR of 2-3
reduces all-cause mortality
reduces stroke severity and post-stroke mortality
reduces stroke by 39% compared to aspirin

49
Q

What are the major NOACs?

A

Dabigatran
Rivaroxaban
Apixaban
Edoxaban

50
Q

What is the only direct thrombin inhibitor?

A

dabigatran

51
Q

What is the clearance of dabigatran?

A

80% renal

52
Q

What are the three factor Xa inhibitors?

A

Rivaroxaban
Apixaban
Edoxaban

53
Q

In descending order, list the factor Xa inhibitors in order of most to least renal clearance

A

Edoxaban
rivaroxaban
Apaxiban

54
Q

T/F: factor Xa inhibitors are cleared through the kidney

A

true

55
Q

What are the benefits of using an NOAC?

A

Fixed dose
No blood monitoring
Fewer drug interactions than warfarin
Lower risk of ICH

56
Q

t/f: Despite having a reversing agent, warfarin related ICH mortality is high

A

true

57
Q

does warfarin or NOACs have a shorter half life?

A

NOACs

58
Q

T/F: Warfarin and ASA is recommneding for AF and stable CAD

A

false

59
Q

between plavix combos, what are the best options?

A

ASA and plavix better than ASA alone

warfarin better than plavix and ASA

60
Q

T/f: cardioversion, rate control, and rhythm control protect AF patients against stroke

A

false

61
Q

At what CHA2DS2VASc score is an anticoag recommended?

A

> 1

62
Q

Can you suggest ASA tx at CHA2DS2VASc score of 0?

A

yes

63
Q

what cardiac conditions increase the risk of stroke?

A 
Acute MI
Cardiomyopathy
Valvular heart disease
PFO
Cardiac tumors
Aortic atherosclerosis
64
Q

When is anticoag therapy used post acute MI?

A

pts. with STEMI and asymptomatic L ventricular mural thrombi or apical hypokinesis

65
Q

Warfarin is used to lower the risk of ischemic stroke when the EF is less than…

A

35%

66
Q

Risk of embolism is higher in valvular heart disease whn..

A

pts have rheumatic heart disease (even without AF) or prosthetic valves

67
Q

When is anticoagulation recommended in valvular disease?

A
  1. mitral stenosis + prior embolic event, even if sinus rhythm
  2. mitral stenosis with L atrial thrombus
68
Q

When do you use ASA in valvular disease?

A

mitral valve prolapse with TIA

69
Q

When do you use warfarin in valvular disease?

A

if stroke and:
mitral regurg
AF
L atrial thrombus

70
Q

The risk of stroke is greatest in what time period after insertion of prosthetic valves?

A

first three months
higher with mitral valves
use warfarin then switch to ASA if no other risks

71
Q

T/f: anticoags reduce the risk of stroke in endocarditis

A

false; just increases the risk of ICH

72
Q

What is the Tx for PFO to reduce stroke?

A

none; no tx necessary

73
Q

What is the most common type of cardiac tumor that emoblizes/

A

myxoma

74
Q

50% of pts with fibroelastoma present with what?

A

stroke/TIA

75
Q

what size of plaque is associated with increased risk of stroke?

A

> 4mm

76
Q

Is anticoagulation recommended in mitral stenosis even if sinus rhtymn and L atrial thrombus?

A

yes

77
Q

What two drugs are indicated in all mitral valve replacements?

A

ASA and warfarin

78
Q

what one simple drug do you use for aortic or mitral bioprosthesis?

A

ASA

79
Q

What is the tx for myxomas?

A

surgical excision

80
Q

Warfarin is used in STEMI with what two other risk factors?

A

asymptomatic L ventricular mural thrombus and anterior apical hypokinesis

81
Q

What do you do in asymptomati carotid stenosis/

A

statins; carotid stenting also is equal to endarterectomy

daily ASA and stain

82
Q

what age group with SCD is most likely to have a stroke?

A

kids!!

83
Q

Velocity greater than what is assocated with 10%/y risk of stroke in SCD?

A

200cm/sec via TCD

84
Q

what is the only way to reduce stroke in SCD?

A

RBC transfusion

85
Q

What percent do you want to keep HbS under to prevent stroke?

A

<30%

86
Q

What are the other risk factors for stroke?

A 
Migraine
Metabolic Syndrome
Alcohol consumption
Drug abuse
Sleep-disordered breathing
Hyperhomocystenemia
Hypercoagulability
Inflammation and infection
Antiplatelet agents/aspirin
87
Q

What are criteria for migraine with aura to be assc’d with stroke?

A 
<45 years old
smokers
use of OC
frequency correlated with stroke
also increases risk of ICH
88
Q

there is a linear correlation between alcohol consumption and…;

A

ICH

89
Q

All sympathomimetics, cannabis, and heroin are associated with increased risk of..

A 
stroke via:
BP elevations
Cerebral vasospasm
Vasculitis
Endothelial dysfunction
Increased blood viscosity
Platelet aggregation
90
Q

sleep apnea is an independent risk factor for…

A

stroke; treat with CPAP; use of CPAP lowers stroke rate

91
Q

Lowering the levels of what metabolite in the blood lowers the risk of stroke?

A

homocysteinemia

92
Q

What are the two most common genetic reasons for thrombophilia

A

Factor V leiden

G202010A prothrombin mutation

93
Q

Are thrombophilias associated with stroke?

A

noooope

94
Q

Chronic infammatory conditions such as (blank and blank) should be considered at risk for stroke

A

RA or SLE

95
Q

T/f: there is benefit for using ASA to reduce first stroke in general population

A

false; only useful for MI

Block 8 Week 4 Colt (7 decks)

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