Stroke Flashcards
What physiologically causes ischemic stroke?
A thrombus/clot (like a brain heart attack) causes this.
Cardioembolic stroke meaning
stroke caused by a embolus in the heart traveling to the brain - usually due to afib
non-cardioembolic stroke
origin of the disease is the brain not the heart, usually due to athleroschlerosis
less serious type of stroke
transient ischemic which disappears on its own within a few minutes to hours
Symptoms of stroke
ACT
Face
Arms
Speech
Time
What needs to be done within 20 minutes and why
Computed Tomography in order to identify whether stroke is ischemic or hemorrhagic
Which fibrinolytic is not indicated for acute stroke but is for MI
tenecteplase
tpa
alteplase/activase
Max time you can give tpa after time of stroke
3 hours (4.5 not fda approved max)
door to needle time to give tpa for stroke
60 minutes
required bp to give tpa
<185/110
tpa contraindications
active internall bleeding, history of recent stroke, severe uncontrolled hypertensiojn, on any sort of blood thiner within the past 48 hours, ever had a intercerebral hemmorhage
the maximum dose in tpa
90mg
How do you prevent early recurrent stroke?
Aspirin 162 - 325 mg PO within 24-48 hours of stroke onset
What are the modifiable risk factors for secondary prevention
*hypertension, dyslipedemia, diabetes, afib, lifestyle (diet, achohol, exercise)
Which hypertensive drugs are best for preventing stroke
ace inhibitors and thiazide
What can be given to reduce the risk of non-cardioembolic stroke?
aspirin 50-325mg po daily or clopidogrel 75mg daily in those with a contraindication to aspirin or aggrenox (dipyridamole/aspirin)
combo therapy of aspirin and clopidogrel only up to 21 days
what is dipyridamole moa
inhibits the uptake of ademosine into platelets and increases CAMP levels –> vasodilates, causes HA
What enzyme converts clopidogrel to active form
2c19, beware of inhibitors esomeprazole (dexilant) and
warning for clopidogrel
Thrombocytopenic purpura (all drugs in its class have this)
What the primary complication of intracerebral hemorrhage and how is it treated
ICP - hypertonic saline or mannitol injection which withdraws water form the brain and thus is contraindicated in severe renal disease
what is a subarachnoic hemmorhage
same thing dad had, present with severe headache, nimodepine is used to prevent the cerebral artery vasospasm 3-21 days after the bleed
nimodipine moa
dhp ccb selective for cerebral arteries due to increased lipophilicity
