Stroke

Question 1

What are the blood pressure goals for tPA administration?

Answer 1

<185/110 mmHg before tPA
<180/105 mmHg after administration

Question 2

What are the blood pressure goals with no tPA?

Answer 2

<220/110 mmHg

Question 3

What medications can be given to manage blood pressure control in first 48 hours?

Answer 3

Labetalol 10-20 mg IV q10-20 min
Nicardipine 5 mg/hr
Sodium nitroprusside 0.5-10 mcg (use if DBP >140)

Question 4

What is the tPA inclusion criteria?

Answer 4

ischemic stroke diagnosis
symptom onset less than 4.5 hours

Question 5

What are the max doses for the tPA agents?

Answer 5

Alteplase - 0.9mg/kg MAX 90 mg
Tenecteplase - 0.25 mg/kg MAX 25 mg

Question 6

When is aspirin + clopidogrel, or ticagrelor indicated in stroke management?

Answer 6

only in minor strokes (NIHSS < 4)

Question 7

When is it indicated to use anticoagulants in stroke management?

Answer 7

2 + days after a cardioembolic stroke

Question 8

What is the blood pressure goals for hemorrhagic stroke?

Answer 8

first 24h - <180/110 mmHg
after 24h - <160/90 mmHg

Question 9

When is Nimodipine 60 mg initiated?

Answer 9

after a subarachnoid hemorrhagic stroke
-daily for 21 days

Question 10

What is the role of aspirin in stroke management?

Answer 10

first 2-4 weeks post stroke - 325 mg daily
after first 2-4 weeks then 81 mg daily indefinitely

Question 11

What medication should a patient be started on after an atherosclerotic ischemic stroke?

Answer 11

high intensity statin
atorvastatin 80 mg po daily
rosuvastatin 20-40 mg po daily