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Cardio Therapeutics > Stroke > Flashcards

Stroke Flashcards

1
Q

TIA vs Stroke

A

TIA
-FND < 24 hr without acute infarction

Stroke
-FND > 24 hr

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2
Q

AIS: CP/SX

A

-Numbness
-Confusion, trouble speaking/seeing
-Balance loss
-Severe headache

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3
Q

NIH Stroke Scale

A
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4
Q

Supportive Care, Emergency Tx

A
  1. Oxygen
  2. BP management
  3. Temp
  4. Blood glucose
  5. IV fibirnolytics
  6. Thrombectomy

Secondary
-AP, AC, statins, BP control

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5
Q

Alteplase (TPA): CFU

A

Criteria for Use
-18+
-NIHSS > 5
-CT (-) for bleed
-Glucose 50-400
-BP < 185/110
-Onset < 4.5 hr

Door to needle time: 60 minutes

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6
Q

Alteplase: CI

A

-Intra/subcranial hemorrhage
-Previous stroke, cranial/spinal surgery, head trauma
-GI bleeding/mal
-Uncontrolled HTN
-LMWH in 24 hr
-DOAC (48+ fine)
-Endocarditis, AD
-Internal bleeding

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7
Q

Alteplase: dose, ae, monitoring

A

0.9 mg/kg (max 90 mg)
-bolus 0.09 over 1 min
-infusion 0.81 over 1 hr
-actual bw

AE
-bleeding, angioedema

Monitoring
-Neuro exam, BP, bleeding, head CT

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8
Q

Management of ICH w/in 24 hours after IV alteplase

A

-Stop alteplase infusion
-Do labs, CT

-Cryoprecipitate 10 units IV
-Tranexamic acid or Aminocaproic acid
*help reverse altepase

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9
Q

AIS: BP Meds

A

Eligible?
-Lower to <185, <110 (before alteplase)
-Maintain <180/105 (for 24 hours after alt)

No
-<= 220/110 = leave alone
-> 220/110 = lower 15%

Nicardipine, 5 mg/hr, (max 15 mg/hr) (PRIMARY USED)

Clevidipine, max 21 mg/hr

Labetalol, max 300 mg/day

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10
Q

AIS Summary

A
  1. TPA
  2. Control BP
  3. AP vs AC
  4. Statins
  5. Supportive care
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11
Q

AIS Secondary Prevention: NONCARDIOEMBOLIC

A

Antiplatelets recommended in all patients with NON-CARDIOembolic ischemic stroke

  1. Aspirin 81-325
    (no tpa = start within 48 hr, tpa = start 24-48 after tpa)
  2. Aggrenox - Dipyridamole ER (200) + Aspirin (25): 1 capsule BID
    -AE: HA, less bleeding
  3. Clopidogrel 75 mg QD
    -AE: diarrhea, rash, thrombocytopenia

DAPT
-no tpa, major: Tica 180 load, 90 BID (30 days)
-no tpa, minor: Clop 75 + asp

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12
Q

AIS Secondary Prevention: CARDIOEMBOLIC

A

Anitcoag recommended for CARDIOembolic ischemic stroke

-OACs for patients with A fib and CHADS 2/3+ (MW)
*4-14 days after onset

-Exception = VALVULAR = only use warfarin in mod-sev mitral stenosis or mechanical heart valves

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13
Q

AIS: Secondary Prevention: Lipids

A

High intensity for stroke
-Atorvastatin 40-80
-Rosuvastatin 20-40 (< 30 use 5-10)
*CI: acute liver disease, pregnancy/BF

then +ezetimibe, +PCSK9

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14
Q

Intracerebral Hemorrhage (ICH)

A

SX
-HA
-Vomiting
-High BP
-Altered consciousness

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15
Q

ICH: Reversal of Warfarin

A
  1. hold warfarin therapy
  2. give one dose of Kcentra
    a. INR 2-3.9: 25 u
    b. INR 4-6: 35 u
    c. INR > 6: 50 u
  3. give IV Vitamin K (5-10 mg / 50 mL NS)
  4. FFP 10-15 ml/kg
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16
Q

ICH: Dabigatran Induced

A

Idarucizumab, Praxbind

2.5 g / 50 mL IV bolus over 6 min x 2 doses (total 5 g)

AE: Hypokalemia, delirium, constipation

17
Q

ICH: Rivaroxaban, Apixaban Induced

A

Andexant alfa, Andexxa

AE:
-Infusion related
-Thrombosis

BBW:
-TE events, ischemic events (MI/IS), cardiac arrest, death

18
Q

Andexanet Reversal Dosing

A

Apixaban
-Over 5 mg and < 8 hours = 800 mg bolus, 8 mg/min infusion
-All others = 400 mg bolus, 4 mg/min infusion

Rivaroxaban
-Over 10 mg and < 8 hours = 800/8
-All others = 400/4

19
Q

ICH: Secondary Prevention

A

-Initially, hold all blood thinners
*VTE prophylaxis within 1-4 days
*AP for 1-2 wk, AC for 4 wk
-BP < 130/80
-Avoid alcohol/tobacco

HTN
-Give IVs to lower if 220+

20
Q

ICH: Summary

A
  1. Stop bleeding = antidotes
  2. Supportive care
21
Q

Subarachnoid Hemorrhage

A

SX
-Worst headache ever
-Stiff neck, NV

  1. Nimodipine
    *Vasospasm prophylaxis
    -AE: low bp, dizzy, flushing, HA, nausea, swollen ankles
    -60 mg Q4h x 21 days
  2. Mg (can add to nimodipine), unclear
    -AE: cns dep, mw, low bp, sweat, flush
    -0.5-1 g/hr

Cardio Therapeutics (31 decks)

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