Stroke

Question 1

What is the definition of a stroke?

Answer 1

sudden onset of focal neurologic deficit resulting from the interruption of blood flow to an area in the brain

Question 2

What word should you know for stroke?

Answer 2

FAST
face
arms
speech
time

Question 3

List some symptoms after a stroke

Answer 3

weakness or paralysis
problems with balance or coordination
problems using language
pain, numbness or odd sensations
problems with memory, thinking, attention or learning

Question 4

What are the two main types of stroke?

Answer 4

hemorrhagic
ischemic

Question 5

What are some facts and risk associated with hemorrhagic stroke?

Answer 5

higher death rate
higher morbidity

Risk
-aneurysm
-hypertension
-medication

Question 6

List the types of ischemic stroke

Answer 6

atherosclerosis
cryptogenic
cardioembolic
lacunar
other causes

Question 7

Define cardioembolic stroke

Answer 7

certain conditions can result in thrombus generation
this breaks off and gets stuck in small cerebral vessels

Question 8

What is the focus of prevention for cardioembolic stroke?

Answer 8

use of anticoagulant

Question 9

What condition will show on ECG for stroke?

Answer 9

it will be a cardioembolic stroke as it is caused by A fib or mechanical heart valves

Question 10

What will be used to diagnosis cardioembolic stroke?

Answer 10

ECG will show A Fib
Left atrial thrombus will be seen on echocardiogram

absence of sign. atherosclerosis on imaging

Question 11

What will happen at the ER if there are signs of Stroke?

Answer 11

Imaging to see if it is ischemia and hemorrhage
look at ECG
see what is decided based on results

Question 12

When do you use thrombolysis?

Answer 12

before 4.5 hours after first symptoms and it is ischemic

Question 13

What are fibrinolytics?

Answer 13

plasminogen activators
breaks up clots

Question 14

What is alteplase?

Answer 14

extract human sequence of tPA
requires 1 hour infusion time

Question 15

What is tenecteplase?

Answer 15

longer acting fibrinolytic
can be administered with a single IV bolus dose
more convenient

Question 16

What are the two types of fibrinolytics

Answer 16

alteplase (tPA)
tenecteplase

Question 17

Why is it important to use fibrinolytic therapy within 3 hours?

Answer 17

it will decrease the risk for poor stroke outcomes

Question 18

What are CI for tPA

Answer 18

rapidly improving
hemorrhage on CT
seizures
recent stroke (3 months)
recent GI/UTI bleed (3 wks)
low platelets
recent anticoag (2 days)
history of ICH

Question 19

What to do if not eligible for TPA and not hemorrhage?

Answer 19

antiplatelet therapy

Question 20

When is anticoagulation used?

Answer 20

cardioembolic strokes
-A Fib
Mechanical heart valves
Severe HF

Question 21

LIst the Antiplatelet agents

Answer 21

COX inhibitors
ADP receptors antagonists
inference with cyclic AMP
GP IIb/IIIa antagonists

Question 22

What is the first line antiplatelet?

Answer 22

ASA

Question 23

When is it CI to use ASA as secondary prevention of stroke?

Answer 23

certain pt with AFIB / cardioembolic risks
hemorrhagic stroke

Question 24

Non cardioembolic stroke 1st line agents

Answer 24

ASA or Aggrenox
clopidogrel
for the first 21 days then ASA alone

Question 25

What does dipyridamole do?

Answer 25

MOA - PDE inhibitor poor absorption from regular dosage forms BID

Question 26

Role of DAPT after stroke used in

Answer 26

non disabling stroke high risk TIA

Question 27

DVT/PE prophylaxis during a stroke

Answer 27

stroke pt are at risk for VTE due to paralysis all pt with reduced mobility are given preventative therapy

Question 28

What are alternatives for DVT?

Answer 28

low dose heparin LMWH IPC or ES

Question 29

What can DVT lead to?

Answer 29

pulmonary embolism

Question 30

What is the first line BP control after a stroke?

Answer 30

ACE + TZD

Question 31

What does the progress study show?

Answer 31

decrease the chances of a second stroke after ACEi and TZD

Question 32

What are some secondary stroke prevention?

Answer 32

BP Antiplatelet therapy Cholesterol reduction smoking cessation

Question 33

In the comparison between anticoagulants vs ASA in Non cardioembolic stroke what is the takeaways?

Answer 33

ASA vs warfarin Warfarin did not reduce events compared to ASA bleeding was also slightly higher in warfarin groups

Question 34

What is the preferred therapy for atherosclerotic stroke management?

Answer 34

antiplatelet is preferred over anticoagulant warfarin is only recommended for cardioembolic stroke

Question 35

What are the factors in the CHADS-65?

Answer 35

Heart Failure (CHF) hypertension age Diabetes stroke (prior)

Question 36

What is done for everyone who have atrial fibrillation?

Answer 36

they will get stroke prevention even if they have never had a stroke

Question 37

What the major catergories that are used in stroke management?

Answer 37

thrmbolysis (if pt fits criteria) antiplatelet therapy BP reduction Statins

Question 38

What did the study show about taking ASA everyday?

Answer 38

it will reduce CV outcomes increase major bleeding it should only be used for secondary not primary prevention

Question 39

What are the major risk for bleeding?

Answer 39

no previous history of bleeding no history of ulcers no anticoagulant therapy normal platelet level BP under control not frail