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Therapeutics > Stroke > Flashcards

Stroke Flashcards

1
Q

What are modifiable risk factors for stroke? (8)

A
  1. HTN
  2. hyperlipidemia
  3. smoking
  4. diabetes
  5. A fib
  6. CAD
  7. obesity
  8. post-menopausal hormone therapy
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2
Q

What are non-modifiable risk factors for stroke? (4)

A
  1. > 55 yo
  2. black/hispanic
  3. males
  4. family or personal Hx of stroke/TIA
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3
Q

What options are available for acute stroke therapy?

A
  • IV thrombolytics
  • endovascular intervention (thrombectomy)
  • OR BOTH
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4
Q

What thrombolytic agent are used for acute stroke therapy?

A

TPA: alteplase

TNK: tenecteplase

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5
Q

What is permissive HTN in acute stroke therapy?

A

if a pt is not a candidate for thrombolytics a SBP up to 220 is allowed to maintain perfusion

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6
Q

What is the BP requirement if thrombolytics are used?

A

SBP < 180 for 24 hours

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7
Q

What agents are used to lower BP before/during thrombolytics therapy?

A

labetalol 10-20 mg IV (repeat & double dose every 10 mins)

nicardipine 5 mg/hr IV (titrated to effect)

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8
Q

How is TPA (alteplase) dosed & administered?

A

0.9 mg/kg actual body weight (MAX 90 mg)

10% given as bolus, the rest over infusion

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9
Q

How is TPA (tenecteplase) dosed & administered?

A

0.25 mg/kg actual body weight (MAX 25 mg)

single bolus dose

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10
Q

What are the inclusion criteria for thrombolytic therapy?

A

symptom onset < 4.5 h prior
(3 h if over 80 yo)

ischemic stroke

measurable deficit on NIH stroke scale

CT w/ no evidence of intracranial hemorrhage

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11
Q

What are the absolute exclusion criteria for thrombolytics? (6)

A
  1. stroke/serious head trauma in last 3 mo
  2. Hx or signs of hemorrhage
  3. SBP > 185/DBP > 110
  4. glucose < 50 or > 400
  5. anticoagulant in last 48 hours
  6. elevated INR
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12
Q

What are the relative exclusion criteria for thrombolytics? (4)

A
  1. major surgery in last 14 days
  2. rapidly improving or minor symptoms
  3. seizure at stroke onset
  4. GI bleed in last 21 days
  5. acute MI in last 3 mo
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13
Q

What are the exclusion criteria for the 3-4.5 hr window for thrombolytics? (3)

A
  1. > 80 yo
  2. severe stroke (NIH > 25)
  3. Hx of stroke & diabetes
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14
Q

What factors are associated with increased risk of bleeding for stroke patients? (5)

A
  1. baseline NIH > 20
  2. thrombolytic protocol deviations (anticoagulant/antiplatelet in last 24 hours, admin beyond 4.5 hr, elevated BP)
  3. baseline glucose > 200
  4. advanced age
  5. edema or mass on CT scan
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15
Q

What types of strokes warrant antiplatelet prophylactic therapy?

A

small vessel lacunar strokes, large vessel embolic & thrombotic strokes

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16
Q

What types of strokes warrant anticoagulant prophylactic therapy?

A

cardioembolic strokes

17
Q

Can prasugrel be used for stroke prophylaxis?

Why/why not?

A

NO

BBW for stroke pt due to increased risk of cerebral hemorrhage

18
Q

What antiplatelet agents are TYPICALLY used for stroke prophylaxis?

A
  1. clopidogrel (Plavix)
  2. ticagrelor (Brilinta)
  3. aspirin
19
Q

If ASA stroke prophylaxis is indicated for an obese patient how should it be dosed?

A

325 mg QD

(increased dose for obese, no good reason for it)

20
Q

What stroke prophylactic agent is preferred if a patient has comorbid peripheral artery disease?

A

clopidogrel (Plavix)

21
Q

What agents should be avoided with clopidogrel (Plavix)?

include exceptions in the class if applicable

A
  1. statins (except rosuvastatin)
  2. CCBs: amlodipine, diltiazem, verapamil
  3. Ambien & Lunesta (Sonata least likely)
  4. Enables & Ditropan (use Detrol or Sanctura)
  5. PPIs
22
Q

How to manage ASA resistance?

A
  • stop other NSAIDs as they can decrease ASA effectiveness USE CELEBREX
  • increase dose
  • switch to chewable or alkaseltzer prep
  • assure compliance with urinary salicylate testing
23
Q

What stroke prophylactic agent should NOT be used in a patient with migraine history?

24
Q

What stroke prophylactic agent should NOT be used in a patient with spastic colon or irritable bowel history?

25
Q

What should be done if a patient needs a rapid antiplatelet effect for their stroke prophylaxis?

A

can do a loading dose of..
ASA (325mg) or Plavix (300 mg)

Brilinta also has faster maintenance dose effect onset at 3-5 days (others are 5-7 days)

26
Q

What stroke prophylactic agent should NOT be used in a patient a GI history?

27
Q

What stroke prophylactic agent should NOT be used in a patient who needs to be on a CCB?

28
Q

What is some basic information on TIAs?

List 3 facts :)

A
  1. TIA is a cerebral vascular ischemic event
  2. symptoms can last up to 24 hours but usually resolve in minutes
  3. risk of subsequent stroke after TIA is similar to that of a completed stroke

Therapeutics (17 decks)

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