Stroke

Question 1

What are the risk factors of stroke?

Answer 1

Smoking
Diabetes
Prior TIA or stroke
HTN - MOST IMPORTANT
Afib
Sex ( F> M)
African American
Age >/=55 years
Atherosclerosis
DLD
Sickle Cell Disease :(
Physical inactivity

Question 2

Types of Ischemic stroke

Answer 2

Non-cardioembolic - caused by a thrombus formed outside of the heart

Cardioembolic - most common cause Afib formed within the heart

Question 3

What is a TIA?

Answer 3

Transient Ischemic Attack - the same symptoms of a stroke but goes away within a few hours because the clor was temporary = no permanent damage!

Question 4

What are the symptoms of a stroke?

Answer 4

FAST
Face drooping
Arm down
Speech slurred
Time to call

Question 5

When is it appropriate to treat a stroke with Alteplase?

Answer 5

stroke must be ISCHEMIC
- within 3 hours of symptoms
or
- within 4.5 hours of symptoms in select patients

BP should be < 185/110

MUST NOT be:
-actively bleeding
- have high bleeding risk (severe HTN, INR >1.7)
-on anticoagulation

**rule out hemorrhagic stroke 1st!!!!!!

Question 6

Alteplase (Activase) dosing

Answer 6

0.9 mg/kg (Max 90 mg) give 10% as a bolus, than 90% as a 60 minute infusion

Question 7

Activase CI

Answer 7

CI: active bleed, recent stroke (within 3 months), uncontrolled HTN (>185/110), hx of ICH, INR >1.7
-treatment with LMWH within 24 hours
-treatment with direct thrombin inhibitor or direct factor Xa inhitor within 48 hours

Question 8

After an ischemic stroke how would you prophylaxis?

Answer 8

• High intensity statin
• HTN management
• DM control
• Antiplatelet therapy (non-cardioembolic)
  -Anticoagulation (cardioembolic) + afib control if necessary

Question 9

Dipyridamole use

Answer 9

inhibits the uptake od adenosine into platelets and increases cAMP to inhibit platelet aggregation
- use in combination with ASA (Aggrenox)

Question 10

When would you add on anti-platelet therapy for stroke?

Answer 10

For non-cardioembolic ischemic stroke

Question 11

When would you add on anticoagulation therapy for stroke?

Answer 11

For cardioembolic ischemic stroke

Question 12

Mannitol MOA

Answer 12

produces osmotic diuresis to increase urinary output of fluid and reduces the intracranial pressure by withdrawing water from the brain

Question 13

Use of Mannitol (Osmitrol, Resectisol)

Answer 13

Treatment of intracranial pressure in a intracerebral hemorrhage (ICH)

CI: severe renal disease
***inspect injection for crystals before use!

Question 14

Use of Nimodipine

Answer 14

prevent vasospam in Subarachnoid hemorrhage (SAH)

DDH CCB more selective for cerebral arteries

Warning: DO NOT ADMINISTER IV!!!!