Stroke Flashcards
What is the definition of a stroke?
sudden onset of focal neurologic deficit resulting from the interruption of blood flow to an area in the brain
What word should you know for stroke?
FAST
face
arms
speech
time
List some symptoms after a stroke
weakness or paralysis
problems with balance or coordination
problems using language
pain, numbness or odd sensations
problems with memory, thinking, attention or learning
What are the two main types of stroke?
hemorrhagic
ischemic
What are some facts and risk associated with hemorrhagic stroke?
higher death rate
higher morbidity
Risk
-aneurysm
-hypertension
-medication
List the types of ischemic stroke
atherosclerosis
cryptogenic
cardioembolic
lacunar
other causes
Define cardioembolic stroke
certain conditions can result in thrombus generation
this breaks off and gets stuck in small cerebral vessels
What is the focus of prevention for cardioembolic stroke?
use of anticoagulant
What condition will show on ECG for stroke?
it will be a cardioembolic stroke as it is caused by A fib or mechanical heart valves
What will be used to diagnosis cardioembolic stroke?
ECG will show A Fib
Left atrial thrombus will be seen on echocardiogram
absence of sign. atherosclerosis on imaging
What will happen at the ER if there are signs of Stroke?
Imaging to see if it is ischemia and hemorrhage
look at ECG
see what is decided based on results
When do you use thrombolysis?
before 4.5 hours after first symptoms and it is ischemic
What are fibrinolytics?
plasminogen activators
breaks up clots
What is alteplase?
extract human sequence of tPA
requires 1 hour infusion time
What is tenecteplase?
longer acting fibrinolytic
can be administered with a single IV bolus dose
more convenient
What are the two types of fibrinolytics
alteplase (tPA)
tenecteplase
Why is it important to use fibrinolytic therapy within 3 hours?
it will decrease the risk for poor stroke outcomes
What are CI for tPA
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
What to do if not eligible for TPA and not hemorrhage?
antiplatelet therapy
When is anticoagulation used?
cardioembolic strokes
-A Fib
Mechanical heart valves
Severe HF
LIst the Antiplatelet agents
COX inhibitors
ADP receptors antagonists
inference with cyclic AMP
GP IIb/IIIa antagonists
What is the first line antiplatelet?
ASA
When is it CI to use ASA as secondary prevention of stroke?
certain pt with AFIB / cardioembolic risks
hemorrhagic stroke
Non cardioembolic stroke 1st line agents
ASA or Aggrenox
clopidogrel
for the first 21 days then ASA alone
What does dipyridamole do?
MOA - PDE inhibitor
poor absorption from regular dosage forms
BID
Role of DAPT after stroke used in
non disabling stroke
high risk TIA
DVT/PE prophylaxis during a stroke
stroke pt are at risk for VTE due to paralysis
all pt with reduced mobility are given preventative therapy
What are alternatives for DVT?
low dose heparin
LMWH
IPC or ES
What can DVT lead to?
pulmonary embolism
What is the first line BP control after a stroke?
ACE + TZD
What does the progress study show?
decrease the chances of a second stroke
after ACEi and TZD
What are some secondary stroke prevention?
BP
Antiplatelet therapy
Cholesterol reduction
smoking cessation
In the comparison between anticoagulants vs ASA in Non cardioembolic stroke what is the takeaways?
ASA vs warfarin
Warfarin did not reduce events compared to ASA
bleeding was also slightly higher in warfarin groups
What is the preferred therapy for atherosclerotic stroke management?
antiplatelet is preferred over anticoagulant
warfarin is only recommended for cardioembolic stroke
What are the factors in the CHADS-65?
Heart Failure (CHF)
hypertension
age
Diabetes
stroke (prior)
What is done for everyone who have atrial fibrillation?
they will get stroke prevention even if they have never had a stroke
What the major catergories that are used in stroke management?
thrmbolysis (if pt fits criteria)
antiplatelet therapy
BP reduction
Statins
What did the study show about taking ASA everyday?
it will reduce CV outcomes
increase major bleeding
it should only be used for secondary not primary prevention
What are the major risk for bleeding?
no previous history of bleeding
no history of ulcers
no anticoagulant therapy
normal platelet level
BP under control
not frail
