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CV PHAR 152 > Stroke > Flashcards

Stroke Flashcards

1
Q

What is the definition of a stroke?

A

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

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2
Q

What word should you know for stroke?

A

FAST
face
arms
speech
time

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3
Q

List some symptoms after a stroke

A

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

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4
Q

What are the two main types of stroke?

A

hemorrhagic
ischemic

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5
Q

What are some facts and risk associated with hemorrhagic stroke?

A

higher death rate
higher morbidity

Risk
-aneurysm
-hypertension
-medication

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6
Q

List the types of ischemic stroke

A

atherosclerosis
cryptogenic
cardioembolic
lacunar
other causes

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7
Q

Define cardioembolic stroke

A

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

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8
Q

What is the focus of prevention for cardioembolic stroke?

A

use of anticoagulant

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9
Q

What condition will show on ECG for stroke?

A

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

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10
Q

What will be used to diagnosis cardioembolic stroke?

A

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

absence of sign. atherosclerosis on imaging

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11
Q

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

A

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

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12
Q

When do you use thrombolysis?

A

before 4.5 hours after first symptoms and it is ischemic

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13
Q

What are fibrinolytics?

A

plasminogen activators
breaks up clots

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14
Q

What is alteplase?

A

extract human sequence of tPA
requires 1 hour infusion time

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15
Q

What is tenecteplase?

A

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

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16
Q

What are the two types of fibrinolytics

A

alteplase (tPA)
tenecteplase

17
Q

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

A

it will decrease the risk for poor stroke outcomes

18
Q

What are CI for tPA

A

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

19
Q

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

A

antiplatelet therapy

20
Q

When is anticoagulation used?

A

cardioembolic strokes
-A Fib
Mechanical heart valves
Severe HF

21
Q

LIst the Antiplatelet agents

A

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

22
Q

What is the first line antiplatelet?

A

ASA

23
Q

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

A

certain pt with AFIB / cardioembolic risks
hemorrhagic stroke

24
Q

Non cardioembolic stroke 1st line agents

A

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

25
Q

What does dipyridamole do?

A

MOA - PDE inhibitor
poor absorption from regular dosage forms
BID

26
Q

Role of DAPT after stroke used in

A

non disabling stroke
high risk TIA

27
Q

DVT/PE prophylaxis during a stroke

A

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

28
Q

What are alternatives for DVT?

A

low dose heparin
LMWH
IPC or ES

29
Q

What can DVT lead to?

A

pulmonary embolism

30
Q

What is the first line BP control after a stroke?

A

ACE + TZD

31
Q

What does the progress study show?

A

decrease the chances of a second stroke
after ACEi and TZD

32
Q

What are some secondary stroke prevention?

A

BP
Antiplatelet therapy
Cholesterol reduction
smoking cessation

33
Q

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

A

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

34
Q

What is the preferred therapy for atherosclerotic stroke management?

A

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

35
Q

What are the factors in the CHADS-65?

A

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

36
Q

What is done for everyone who have atrial fibrillation?

A

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

37
Q

What the major catergories that are used in stroke management?

A

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

38
Q

What did the study show about taking ASA everyday?

A

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

39
Q

What are the major risk for bleeding?

A

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

CV PHAR 152 (4 decks)

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