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PHRM 864 > Stroke > Flashcards

Stroke Flashcards

1
Q

stroke definition

A

acute focal injury due to lack of blood/oxygen

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2
Q

types of stroke

A

atherosclerotic ischemic stroke
cardioembolic ischemic stroke
hemorragic stroke

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3
Q

what is an athersclerotic ischemic stroke

A

plaque buildup

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4
Q

what is a cardioembolic ischemic stroke

A

embolus likely due to afib

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5
Q

what is a hemorrhagic stroke

A

bleeding in brain from rupture to cerberal artery

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6
Q

stroke risk factors non-modifiable

A

age
FH
female
race
low birth weight
sickle cell disease

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7
Q

disease states at risk for stroke

A

CV dx
diabetes
HLD
HTN

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8
Q

lifestyle risk factors

A

illicit drug/alcohol use
obesity
cigarette smoking

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9
Q

clinical presentation of stroke

A

difficulty speaking
facial droop
weakness
ataxia
vision changes
headache

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10
Q

what imagine do we get in a stroke?

A

heat CT or MRI

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11
Q

what vital signs do we get stroke

A

oxygen sat
BP

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12
Q

what labs do we measure in stroke

A

CBC
BMP
glucose
INR, aPTT

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13
Q

why might we check blood sugar in a patient presenting with stroke symptoms?

A

they might have hypoglycemia, if so we should give quick sugar (carbs)

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14
Q

what tests do we do when testing for stroke

A

ECG

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15
Q

if ECG shows afib what kind of stroke is it likely

A

cardioembolic

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16
Q

if ECG normal and its ischemic what stroke likely

A

athersclerotic

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17
Q

blood clot would be which stroke

A

cardioembolic

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18
Q

thrombosis or plaque would be what stroke

A

athersclerotic

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19
Q

at what BG should we give insulin?

A

> 180 mg/dL
if not treated, worse mortality

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20
Q

argument for reducing blood pressure

A

minimize neurologic effects
decrease risk cereberal edema
prevent early stroke

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21
Q

argument for not reducing blood pressure

A

dropping too quickly can limit brain perfusion which can worsen ischemia and neurological function

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22
Q

when to check BP stroke

A

q15 min x 2 hours
q30 min x 6 hours
q1 hour x 16 hours

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23
Q

BP goals within first 48 hours

A

no tPA: < 220/110 mmHg
tPA: <180/105 mmHg

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24
Q

options to lower BP in stroke

A

labetalol
nicardipine
sodium nitroprusside
all IV drips

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25
HTN management after 48 hours
start PO meds if possible resume home anti-hypertensives
26
tPA agents
alteplase tenecteplase
27
which type of stroke do we not use tPA?
hemorrhagic
28
does tPA improve mortality?
no, only helps improve neurologic function
29
inclusion criteria for tPA
ischemic stroke diagnosis confirmed by imaging (head CT) symptom onset <= 4.5 hours 18+ years
30
exclusion criteria for tPA
bleeding taking anticoag BP > 185/110 BG < 50 mg/dL
31
alteplase dosing
0.9 mg/kg IV max 90 mg
32
tenecteplase dosing
0.25 mg/kg max: 25 mg
33
what to do with antocoags after tPA
hold all anticoag and antiplatelet for 24 hours after
34
what to monitor after tPA admin
BP < 180/105 signs/sx bleeding hold all anticoag
35
antiplatelet options in ischemic stroke
ASA ASA + clopidogrel ticagrelor ASA + ticagrelor
36
first line antiplatelet for ischemic stroke
high dose ASA for 2-4 weeks
37
who gets ASA?
all ischemic pts no bleeding > 24 hour after tPA or immediately if no tPA
38
ASA + clopidogrel used whne
second line for MINOR strokes
39
ticagrelor used when
second line only in MINOR strokes if TRUE ASA allergy
40
do we use anticoags in ischemic?
no, increased risk bleeding can start 2-14 days after stroke
41
what if a pt comes in on an anticoag with ischemic stroke?
d/c anticoag and switch to ASA no tPA
42
what kind of stroke has worst prognosis
hemorrhagic
43
hemorrhagic stroke key symptom
headache
44
if warfarin caused hemorrhagic stroke what do we give
Vitamin K
45
if heparain caused hemorrhagic stroke what do we give
protamine
46
if dabigatran cause hemmorrhagic stroke what do we give
idarucizumab
47
if DOAC caused hemorrhagic stroke what do we give
andexxanant alpha
48
if antiplatelet cause hemorrhagic stroke what do we give
no reversal agent
49
when do we treat BP in hemorrhagic strok
SBP > 180
50
goal BP goal for hemorrhagic in first 24 hours
< 180/110
51
goal BP in hospital after 24 hours for hemorrhagic
<160/90 mm Hg
52
when are patients at risk for vasospasm
subarachoid hemorrhagic stroke 4-21 days after stroke
53
what drug can we give to minimize risk of vasospasm and when?
nimodipine in subarachnoid hemorrhage 60 mg every 4 hours for 21 days
54
do we prophylax for seizures?
no can continue meds if they have them or if they have hx of stroke
55
what antiplatelet used in secondary prevention with atherosclerotic first line
first 2-4 weeks: high dose ASA after 2-4 weeks: low dose ASA, ASA/dipyridamole, clopidogrel + ASA in minor
56
dipyridamole/aspirin consideration
need to titrate up headache common, need titration to prevent
57
second line secondary stroke prevention antiplatelt in atherosclerotic
clopidogrel +/- ASA (more for minor strokes) ASA intolerant pts
58
which antiplatelet contraindicated in secondary stroke prevention?
prasugrel ticagrelor not really reccommended
59
when are anticoags reccommended as secondary prevention
ischemic cardioembolic stroke caused by afib, valvular disease, or heart failure
60
when are anticoags given in secondary prevention
2-14 days after stroke discontinue ASA
61
DOACs used for who
cardioembolic pts except mitral valve or LV thrombus
62
who should use warfarin or rivaroxaban
mitral valve or LV thrombus
63
long term BP goal for all stroke pts
<130/80 mmHg
64
black preferred antihypertensive
CCB thiazide
65
CKD preferred antihypertensive
ACE/ARB
66
CAD preferred antihypertensive
ACE/ARB + BB
67
diabetes preferred HTN agent
ACE/ARB
68
HF preferred HTN agent
BB + ACE/ARB/ARNI + spironolactone
69
Afib preferred anti-hypertensive
verapamil/dilt (non-DHP CCB) or BB
70
who should get statin
atherosclerotic stroke high intensity statin
71
LDL goal for atherosclerotic stroke
<70
72
who should not get statin
cardioembolic stroke hemorrhagic stroke (unless already on )
73
risk factor reduction items
stop ilicit drugs decrease alcohol diabetes a1c < 7 physical activity diet weight loss smoking cessatio
74
reccommended antidepressants
sertraline, fluoxetine, escitalopram, citalopram
75
antidepressants to avoid
paroxetine TCAs

PHRM 864 (28 decks)

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