Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Cardiovascular System > Stroke > Flashcards

Stroke Flashcards

1
Q

What are the different types of strokes?

A
  • Haemorrhagic stroke (Intracerebral haemorrhage)
  • Ischaemic stroke
  • Transient ischaemic stroke (TIA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the common symptoms of a stroke?

A

Acronym ‘Think FAST’

  • Face drops
  • Arm weakness
  • Slurred speech
  • Time to dial 999
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the initial management for TIA (also known as mini stroke)?

A
  • Aspirin 300mg (only when haemorrhagic stroke has been excluded)
  • Clopidogrel can be given if intolerant to aspirin
  • After a confirmed diagnosis, patients should receive treatment for secondary prevention immediately
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the initial management for Ischaemic stroke?

A
  • Alteplase if patient present within 4.5 hours of stroke onset
    IF intracranial haemorrhage has been excluded

Then within 24 or asap, start them on:
* Aspirin 300mg or clopidogrel 75mg OD for 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the long term management of TIA and Ischaemic stroke?

A

If stroke is NOT associated with AF, treat with antiplatelets:
* Clopidogrel 75mg daily is recommended.

If contraindicated:
* Dipyridamole MR 200mg + aspirin (if clopidogrel is contraindicated)

If clopidogrel and aspirin are contraindicated:
* Dipyridamole MR 200mg alone

If clopidogrel and dipyridamole are contraindicated:
* Aspirin alone

If stroke IS associated with AF, treat with anticoagulants:
* Warfarin, or other anticoagulant
(same thing if patient has embolism or venous thrombosis)

Initiate high intensity statin (e.g. atorv 20-80mg) 48 hours after stroke

Advice on lifestyle changes (diet, exercise, weight, alcohol and smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What needs to be monitored with long term management of ischaemic stroke and T.I.A?

A

Monitor BP.
Target is less than 130/80mmHg.

If higher, treat with antihypertensive drugs.
But avoid beta blockers (unless indicated for co-existing condition)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the initial management of Intracerebral haemorrhage?

A
  • Surgery
  • AVOID ALL MEDICATIONS

Long term management is treat hypertension but avoid all other drugs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are Coumarins and Phenindiones?

A

Medication used to treat and prevent thrombosis, thromboembolism in veins etc.

Examples are: warfarin, acenocoumarol, phenindione

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mechanism of action for COUMARINS AND PHENINDIONES?

A

Antagonises vitamin K.
It is used to prevent thrombus formation in the veins.
They take 48-72 hours to give a full anticoagulant effect.

So if you want an immediate effect, you must use unfractionated heparin (heparin) or LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different strengths of Warfarin?

A

0.5mg, 1mg, 3mg, 5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the different colours of warfarin?

A

0.5mg - white
1mg - Brown
3mg - Blue
5mg - Pink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the two MHRA advice given with warfarin?

A
  1. Calciphylaxis
    This is a painful rash.
    Common in patients with renal disease.
    REFER TO GP!
  2. Miconazole (daktarin) oral gel interaction
    - causes bleeding
    - patients must be told to stop and seek medical advice if unexplained bruising, nose bleeds and blood in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the antidote for warfarin?

A

Phytomenadione (vitamin K).

So certain foods that contain vitamin K should not be increased or decreased in the patient’s diet whilst taking warfarin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are some examples of foods containing phytomenadione (vitamin K)?

A
  • Cranberry juice
  • Pomegranate juice
  • Liver
  • Sprouts
  • Broccoli
  • Green tea
  • Salads and leafy green vegetables

AND avoid alcohol as it decreases effects of warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Can warfarin and coumarins be taken during pregnanacy?

A

No!
Because they are highly teratogenic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What anti coagulation medications can be taken during pregnancy?

A

LWMH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does target INR work?

A

INR stand for international normalised ratio (INR).

It is a blood test that tells you how long it takes for your blood to clot.
It is used to test clotting times in people taking warfarin.
Your doctor will use your INR result to work out what dose of warfarin you should take.

Less warfarin, the lower the INR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is warfarin used for?

A

Used to treat and prevent blood clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the target INR for most patients? And what is an acceptable INR?

A

The target INR for most patients is 2.5.

INR should be within 0.5 of this target value.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which conditions require an INR of 3.5?

A
  • Recurrent DVT or PE
  • Mechanical prosthetic heart valves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the indications of Warfarin?

A
  • Prevention of embolisation in rheumatic heart disease and AF
  • Prevention after insertion of prosthetic heart valve
  • Prevention and treatment of venous thrombosis and pulmonary embolism
  • T.I.A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What’s the initial and maintenance dose of Warfarin?

A

Initially 5-10mg take on day 1

Then subsequent dose dependent on INR.

A lower induction dose can be given to elderly patients and patience who don’t require quick anticoagulation.

Maintenance dose is 3-9mg daily, to be taken at the same time each day.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

For patients taking warfarin, what should be done if they are bleeding and INR is more than 8?

A

Stop warfarin and give IV vitamin k (phytomenadione) slowly. A slow IV injection.
Repeat if INR is still high after 24hrs.

Then restart warfarin when INR is <5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

For patients taking warfarin, what should be done if their INR is more than 8 but there’s no bleeding?

A

Stop warfarin and give oral vitamin K . Repeat if INR is still high after 24 hours.

Restart warfarin if INR is less than 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

For patients taking warfarin, what should be done if they are bleeding and their INR is between 5-8?

A

Stop warfarin.
And give Phytomenadione (vitamin k).

Restart when INR is less than 5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

For patients taking warfarin, what should be done if they are not bleeding and their INR is between 5-8?

A

Withhold 1-2 doses of warfarin and reduce subsequent maintenance dose.
Measure INR again after 2-3 days.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What drug increases the effect of warfarin?

A
  • Miconazole - usually avoid use. Unless INR can be closely monitored - monitor for signs of bleeding and bruising.

Fluconazole & Clarithromycin - monitor INR and adjust dose.

  • Itraconazole
  • Amiodarone
  • Bezafibrate
  • Cranberry and pomegranate juice - AVOID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What drug decreases the effect of warfarin?

A
  • St John’s Wort
  • Alcohol & leafy greens - changes in diet can effect anticoagulation control
  • Carbamazepine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What drug, taken alongside warfarin increases the risk of bleeding?

A

Antiplatelets like aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What antiplatelet is preferred, is an antiplatelet is necessary in a patient taking wafarin?

A

Aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some examples of antiplatelets drugs?

A
  • Aspirin
  • Clopidogrel - for prevention of stroke, acs etc.
  • Dipyridamole - prevention of thromboembolism associated with prosthetic heart valves.
    MR preparation used for secondary prevention of ischaemic stroke and T.I.A
  • Ticagrelor
  • Prasugrel
  • Cangrelor
32
Q

What’s the dose for dipyridamole for strokes?

A

MR preparation
200mg BD, taken with food.

33
Q

What dispensing information should be given with Dipyridamole?

A

MR capsules should be dispensed in original container (as pack contains a desiccant) and any remaining capsules should be discarded 6 weeks after opening.

34
Q

What advice is given with Warfarin?

A

Warfarin can cause Calcifilaxis, which is a painful rash. This is common with patients with renal disease. You must refer this to the GP.

Taken with Miconazole - Causes bleeding. bleeding. You must stop and seek medical advice if unexplained bruising, nose bleeds, or blood in urine occur.

35
Q

What are the two types of heparin?

A
  • Low weight molecular heparin (LWMH)
  • Unfractionated heparin
36
Q

Examples of LWMH?

A
  • Enoxaparin
  • Dalteparin
  • Tinzaparin
37
Q

Which type of heparin initiates anticoagulation more rapidly?

A

Unfractionated heparin (aka standard heparin) BUT it ha a shorter duration of action.

38
Q

Which heparin is safe to use in pregnancy?

A

Unfractionated heparin is safe to use in pregnancy as it does not cross the placenta

39
Q

Which heparin can be used in those who are at high risk of bleeding?

A

Unfractionated heparin, because it’s effects can be terminated rapidly by stopping the infusion

40
Q

Which heparin is used in the prevention of DVT and treatment of DVT, PE and MI?

A

Low weight molecular heparin

41
Q

Which heparin is usually preferred? And why?

A

LWMH due to a lower risk of heparin-induced thrombocytopenia (HIT).

And standardly, it does not require monitoring.
And can be given once daily due to duration of action being longer, making it convenient for self-admiration.

42
Q

What other indications do Dalteparin and Tinzaparin have?

A

Prophylaxis of VT in patients with solid tumours

At a dose of 20,000unit/ml syringe.

43
Q

What is used as secondary prevention of CVD?

A

Low dose aspirin, clopidogrel, or ticagrelor (for stroke prevention).

Antihypertensives for patients with a blood pressure of >140/90mmHg.

Statins can be used as a lipid lowering drug. Atorvastatin is preferred over simvastatin due to the risk of myopathy with high-dose simvastatin

44
Q

What must patients taking NOACs (aka DOACs) have?

A

Alert cards
And label 10 - take with information

45
Q

What is the mechanism of action for NOACs (aka DOCAs)?

A

They either:
1. Inhibit thrombin
2. Inhibit factor Xa

46
Q

Which NOACs inhibit thrombin?

A

Dabigatran

47
Q

Which NOACs inhibit factor Xa?

A
  • Apixaban
  • Edoxaban
  • Rivaroxaban
48
Q

What warning is given with Rivaroxaban?

A

Rivaroxaban 15mg and 20mg strengths should be taken with food or just after food/meal

49
Q

What is the indication for Apixaban?

A

Prevention of stroke and systemic embolism in non-valvular AF and at least one risk factor

50
Q

What are the risk factors a patient must have to use Apixaban?

A

Must have had:
- A stroke
- Heart failure
- Has diabetes
- Has hypertension
- Over the age of 75 or over

51
Q

Why might Novel oral anticoagulants (NOACs) (aka DOACs) be preferred than warfarin?

A

Causes less bleeding and no monitoring is required

52
Q

What dose is given for Apixaban?

A

Adult dose is 5mg twice daily.
Dose is reduced to 2.5mg twice daily in patients with at least two of these:
- Age 80 or over
- Body weight 60kg or less
- Creatinine level is 133mcmol/L or over
- Creatinine clearance is 12-29ml/min
- Taking drugs like verapamil, amiodarone, erythromycin, ciclosporin

These are the ABCs of Apixaban

53
Q

What is the reversal agent for Warfarin?

A

Phytomenadione (vitamin k)

54
Q

What is the reversal agent for Unfractionated heparin?

A

Protamine Sulphate

55
Q

What is the reversal agent for Apixaban and Rivaroxaban?

A

Andexanet Alfa (Ondexxya)

56
Q

What is the reversal agent for Dabigatran?

A

Idarucizumab

57
Q

What is used for primary prevention of CVD?

A

Antihypertensives are only offered to patients at a high risk of CVD and those with a blood pressure of >140/90mmHg.

Lipid lowering drug - NICE recommends atorvastatin as first choice for patients with a 10-year CVD
risk of >10%

Aspirin is not recommended

58
Q

Examples of Glycoprotein lib/illa inhibitors?

A
  • Abcixmab
  • Tirofiban
  • Eptifibatide
59
Q

When is DOCAs preferred vs when warfarin is preferred?

A

DOCAs is preferred in non-valvar AF

Warfarin is preferred in valvar AF

60
Q

When do you use a DOAC for the prevention of stroke?

A

When the patient has at least one of the risk factors (CHADVASC risk factors):
- diabetes
- hypertension
- previous stroke / T.I.A
- age above 75

61
Q

When do you give a reduced dose of DOACs?

A
  • Above the age of 80
  • Body weight is 60kg or less
  • Creatinine clearance
  • Drugs (taking drugs like verapamil, amiodarone, erythromycin, ciclosporin)
62
Q

Which DOACs can be used in ACS/heart attacks?

A

Only Rivaroxaban can be used in heart attacks - ACS

63
Q

Examples of DOACs and their usual doses?

A

Rivaroxaban & Edoxaban - Once daily

Apixaban and Dabigatran - twice daily

64
Q

What is the VTE prophylaxis dose for Rivaroxaban and Apixaban?

A

Rivaroxaban - 10mg OD for stroke 20mg OD

Apixaban - 2.5mg BD and for stroke 5mg BD

65
Q

What must be monitored with DOACs?

A

Monitor the kidneys

Monitor bleeding and anemia

66
Q

What are DOACs contraindicated with?

A

Antiphospholipid syndrome

67
Q

Which DOAC does not have a reversal agent?

A

Edoxaban

68
Q

What is the mechanism of action for warfarin?

A

Inhibits vitamin K

69
Q

What are the doses for Warfarin?

A

Initial - 5-10mg, for day 1
Adjust according to INR later

Maintenance - 3-9mg (same time each day)

70
Q

What are the doses for Rivaroxaban?

A

Prophylaxis of stroke/TIA with one risk factor - 20mg OD

Prophylaxis of VTE for knee replacement - 10mg OD for 2 weeks

Prophylaxis of VTE for hip replacement - 10mg OD for 5 weeks

Treatment of VTE of PE - Initial 15mg BD for 21 days, maintenance: 20mg OD

Prophylaxis of recurrent DVT or PE - 10mg OD or 20mg in high risk

Prophylaxis of ACS and other heart conditions - 2.5mg BD for 12 months

71
Q

What are the doses for Apixaban?

A

Prophylaxis of stroke/AF with at least one risk factor - 5mg BD
Reduce to 2.5mg BD if at least 2 risk factors

Prophylaxis of knee replacement - 2/5mg BD for 10-14 days

Prophylaxis of hip replacement - 2.5mg BD for 28-32 days

Treatment of DVT and PE - 10mg OD for 7 days; maintenance 5mg BD

Prophylaxis recurrent PE or DVT - 2.5mg BD

72
Q

What are the doses for Dabigatran?

A

Prophylaxis of stroke - 110mg - 150mg BD

18-74 years:
Prophylaxis of VTE for knee replacement - 110mg for 1-4 hours. Then after surgery 220mg OD for 10 days

75 years and over
75mg for 1-4 hrs, then 150 OD for 10 days

Treatment of VTE and prevention of VTE -
- For 18-74 years old, 150 BD for at least 5 days.
- For ages 75-79, 110-150 BD
- For 80 and over, 110 BD

73
Q

What are the doses for Edoxaban?

A

Everything is based on the patients weight

Adult under 61kg - 30mg BD

Adult over 61kg - 60mg OD

Duration of treatment is adjusted according to risk factors.

74
Q

What the cautionary label for Edoxaban and Apixaban?

A

Label 10
Warning - read the additional information given with this medicine

75
Q

What are the brand names for the DOACs?

A

R - Xarelto

E - Lixiana

A - Eliquis

D - Pradaxa

76
Q

What the cautionary label for Dabigatran?

A

Label 10
Warning - read the additional information given with this medicine.

Label 25
Swallow this medicine whole. Do not chew or crush

77
Q

What are the contraindications for DOACs?

A
  • You can’t use DOACs together as increases risk of bleeding.

Example - if switching from warfarin to rivaroxaban; stop warfarin first, before staring rivaroxaban to reduce risk of bleeding

  • Avoid in conditions with significant risk factors for bleeding
  • Antiphospholipid syndrome

Cardiovascular System (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions