Stroke Flashcards
WHO definition of stroke:
clinical syndrome consisting of rapidly developing clinical signs of focal/ global disturbance of cerebral function, lasting more than X hours or leading to death with no apparent cause other than that of Y
24
vascular origin
TIA is referred to as a mini stroke and presents with the same signs and symptoms however these resolve within X hrs?
24
what is the difference between a TIA and a stroke
what is the difference between a TIA and a stroke
give the name of the tool that is used to assess patients for the prescence of stroke symptoms in the community setting?
fast
Face
Arms
Speech
Time
how would you test face and check for facial weakness such as drooping?
ask px to smile
how would you check arms for muscle weakness or numbness in one or both arms?
ask px to raise their arms above their head
how would you assess a patients speech and identify that they have slurred speech or difficulty speaking?
ask a patient to repeat a sentence
the majority of strokes are haemorrhagic or ischaemic?
ischaemic
what tool is used in emergency settings for the recognition of stroke?
ROSIER
(Recognition of Stroke in the Emergency Room, or Rule Out Stroke In the Emergency Room).
a score above x on the rosier scale indicates that stroke is likely
0
name a scale that can be used to quantify stroke severity and treatment
NIHSS
what is step one treatment for a suspected TIA
aspirin 300mg single dose and clopidogrel 300mg as single dose
aspirin and clopidogrel should be commenced immediately for people that are suspected to have a tia unless antiplatelet therapy is contraindicated, list some contraindications that would apply
peptic ulcer disease, allergy
what is the appropriate first step pharmacological management for tia in a patient that is already receiving 75mg aspirin daily?
300mg clopidogrel single dose OR ticagrelor 90mg bd for 21 days UNLICENSED
what is step 2 treatment for a TIA
aspirin 75 OD and clopidogrel 75 OD 21 days
what drug and dose regimen can be used instead of clopidogrel in step 2 of the pharmacological treatment of TIA
ticagrelor 90mg bd UNLIC
what is step 3 treatment for a TIA
clopidogrel 75mg OD
(or ticagrelow 90mg bd)
lifelong
for long term prevention of tia what can be used instead of clopidogrel or ticagrelor if patients are intolerant to either of these?
aspirin 75 mg od
what other tests and considerations for someone with a TIA
MRI to check site of damage, lifestyle modifications, secondary prevention ASAP
when a patient is admitted to a stroke unit what diagnostic investigation should be performed if the patient has any of the following:
indication for thrombolysis/ thrombectomy
anticoag pre admission
known bleeding
gcs < 13
unexplained/ fluctuating symp
papilloedema
neck stiffness/ fever
severe headache
hypoxic
non-enhanced CT
for patients with acute stroke thrombolysis should be initiated with what drug?
alteplase
alteplase can only be used for thrombolysis if the patient presents within x hrs of symptoms and haemorrhage
4.5h
what is step 2 treatment for an acute stroke?
aspirin 300mg for 14 days with a PPI for gastro protection
what is strep 3 treatment for an acute stroke?
clopidogrel 75mg OD long term, if person has AF commence on DOAC instead
other non-pharmacological treatment for acute stroke
rehabilitation, lifestyle modifications
when should a statin be commenced after an acute stroke?
not straight away but can be continued in those on one preadmission
statins should be started post stroke for secondary prevention in patients presenting with
dyslipidaemia
what 4 drugs/ parameters to cover for secondary prevention of a stroke?
antiplatelet: clop 75mg OD
statin
BP
blood glucose conc
under what circumstances should antihypertensives only be commenced in the acute phase of stroke?
only in hypertensive emergency
what is the blood pressure target for someone prior to thrombolysis which may then require the need for antihypertensives prior to the procedure
below 185/110
test your knowledge…
On admission to hospital with a TIA, describe the initial immediate pharmacological management, and the ongoing antithrombotic treatment someone should receive thereafter
- Give aspirin 300 mg as a single dose AND clopidogrel 300 mg as a single dose, THEN
- Aspirin 75 mg once daily AND clopidogrel 75 mg once daily for 21 days, THEN
- Clopidogrel 75 mg once daily OR ticagrelor 90 mg twice a day (unlicensed) indefinitely (aspirin 75 mg once daily can be used if intolerant to either of these).
On admission to hospital with an ischaemic stroke (no AF), describe the initial immediate pharmacological management, and the ongoing antithrombotic treatment someone should receive thereafter.
- Give aspirin 300 mg as a single dose for 14 days, THEN
- Clopidogrel 75 mg once daily thereafter
when do people need to tell the DVLA about a stroke?
only if they are having problems one month after
