Stroke Flashcards
Warfarin Reversal
Vitamin K
UFH Reversal
Protamine
Hemorrhagic Stroke - Anticonvulsants
Pts are at inc risk of seizure BUT DON’T initiate PTx (unless pt already on b/c Hx of seizures)
Dabigatran Reversal
Praxabind (idarucizumab)
What problem to always think about while pt is recovering from a stroke?
Depression
- start SSRI :(
- avoid Paraxotine and Tricyclic antidepressants
What antiplatelet can you not use in PTx of ischemic strokes?
Prasugrel
BP goal (tPA administered)
<180/105
- use parenteral agents to get to goal
Hemorrhagic Stroke - Antihypertensives
- Use parenteral agents
- Tx if SBP>180
BP goal (No tpA)
<220/110
- use parenteral agents to get to goal
Hemorrhagic Stroke - BP Goals
- First 24 hrs: <180/110
- inpt after 24 hrs: <160/90
- after 48 hrs: <130/80 or whatever pts goal
Inclusion Criteria for tPA admin
- ISCHEMIC stroke
- Sx onset ≤4.5hrs ago
- ≥18yo
HOLD ANTICOAGS/PLATELETS FOR NEXT 24HRS IF ADMINED
Types of Rehab needed after stroke
ST, OT, PT
HTN Tx in Black pop
CCB, Thiazide
Atherosclerotic Stroke - Dyslipidemia PTx
High Intensity Statin
- Goal LDL < 70
Rivarox/Apixaban Reversal
Andexanet (Andexxa)
HTN Tx in CKD, DM
ACE-i/ARB
Atherosclerotic Stroke Antiplatelet Tx
- 1st Line: High Dose ASA x2-14days, then 81 ASA indefinitely
- 2nd Line: 81 ASA + Clopid 75 mg QD (minor stroke)
- IF ASA Ax: Ticagrelor MonoTx (needs LD)
Hemorrhagic Stroke - Prevention of Vasospasm
- ONLY IF subarachnoid hemorrhagic stroke (inc risk for cerebral vasospasm)
- Nimodipine PO q4h x21days
HTN Tx in HFeEF
ARNI/ACE-i + BB + SGLT2-i + Aldosterone antagonist
HTN Tx in AFib
BB or Non-DHB CCB (Dilt or Verap) (rate control agents)
Exclusion Criteria for tPA admin
- BP: >185/110
- BG <50
- inc bleeding risk
HTN Tx in CAD
BB + ACE-i
Cardioembolic Stroke Antiplatelet Tx
- 1st Line: High dose ASA x2-14days, then start DOAC (if caused by AFib)
- use Warfarin or Riva if mechanical mitral valve or LV thrombosis