Stroke

Question 1

What physiologically causes ischemic stroke?

Answer 1

A thrombus/clot (like a brain heart attack) causes this.

Question 2

Cardioembolic stroke meaning

Answer 2

stroke caused by a embolus in the heart traveling to the brain - usually due to afib

Question 3

non-cardioembolic stroke

Answer 3

origin of the disease is the brain not the heart, usually due to athleroschlerosis

Question 4

less serious type of stroke

Answer 4

transient ischemic which disappears on its own within a few minutes to hours

Question 5

Symptoms of stroke

Answer 5

ACT

Face
Arms
Speech
Time

Question 6

What needs to be done within 20 minutes and why

Answer 6

Computed Tomography in order to identify whether stroke is ischemic or hemorrhagic

Question 7

Which fibrinolytic is not indicated for acute stroke but is for MI

Answer 7

tenecteplase

Question 8

tpa

Answer 8

alteplase/activase

Question 9

Max time you can give tpa after time of stroke

Answer 9

3 hours (4.5 not fda approved max)

Question 10

door to needle time to give tpa for stroke

Answer 10

60 minutes

Question 11

required bp to give tpa

Answer 11

<185/110

Question 12

tpa contraindications

Answer 12

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

Question 13

the maximum dose in tpa

Answer 13

90mg

Question 14

How do you prevent early recurrent stroke?

Answer 14

Aspirin 162 - 325 mg PO within 24-48 hours of stroke onset

Question 15

What are the modifiable risk factors for secondary prevention

Answer 15

*hypertension, dyslipedemia, diabetes, afib, lifestyle (diet, achohol, exercise)

Question 16

Which hypertensive drugs are best for preventing stroke

Answer 16

ace inhibitors and thiazide

Question 17

What can be given to reduce the risk of non-cardioembolic stroke?

Answer 17

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

Question 18

what is dipyridamole moa

Answer 18

inhibits the uptake of ademosine into platelets and increases CAMP levels –> vasodilates, causes HA

Question 19

What enzyme converts clopidogrel to active form

Answer 19

2c19, beware of inhibitors esomeprazole (dexilant) and

Question 20

warning for clopidogrel

Answer 20

Thrombocytopenic purpura (all drugs in its class have this)

Question 21

What the primary complication of intracerebral hemorrhage and how is it treated

Answer 21

ICP - hypertonic saline or mannitol injection which withdraws water form the brain and thus is contraindicated in severe renal disease

Question 22

what is a subarachnoic hemmorhage

Answer 22

same thing dad had, present with severe headache, nimodepine is used to prevent the cerebral artery vasospasm 3-21 days after the bleed

Question 23

nimodipine moa

Answer 23

dhp ccb selective for cerebral arteries due to increased lipophilicity