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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
Q

HTN management after 48 hours

A

start PO meds if possible
resume home anti-hypertensives

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26
Q

tPA agents

A

alteplase
tenecteplase

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27
Q

which type of stroke do we not use tPA?

A

hemorrhagic

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28
Q

does tPA improve mortality?

A

no, only helps improve neurologic function

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29
Q

inclusion criteria for tPA

A

ischemic stroke diagnosis confirmed by imaging (head CT)
symptom onset <= 4.5 hours
18+ years

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30
Q

exclusion criteria for tPA

A

bleeding
taking anticoag
BP > 185/110
BG < 50 mg/dL

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31
Q

alteplase dosing

A

0.9 mg/kg IV
max 90 mg

32
Q

tenecteplase dosing

A

0.25 mg/kg
max: 25 mg

33
Q

what to do with antocoags after tPA

A

hold all anticoag and antiplatelet for 24 hours after

34
Q

what to monitor after tPA admin

A

BP < 180/105
signs/sx bleeding
hold all anticoag

35
Q

antiplatelet options in ischemic stroke

A

ASA
ASA + clopidogrel
ticagrelor
ASA + ticagrelor

36
Q

first line antiplatelet for ischemic stroke

A

high dose ASA for 2-4 weeks

37
Q

who gets ASA?

A

all ischemic pts
no bleeding
> 24 hour after tPA or immediately if no tPA

38
Q

ASA + clopidogrel used whne

A

second line for MINOR strokes

39
Q

ticagrelor used when

A

second line only in MINOR strokes
if TRUE ASA allergy

40
Q

do we use anticoags in ischemic?

A

no, increased risk bleeding
can start 2-14 days after stroke

41
Q

what if a pt comes in on an anticoag with ischemic stroke?

A

d/c anticoag and switch to ASA
no tPA

42
Q

what kind of stroke has worst prognosis

A

hemorrhagic

43
Q

hemorrhagic stroke key symptom

A

headache

44
Q

if warfarin caused hemorrhagic stroke what do we give

A

Vitamin K

45
Q

if heparain caused hemorrhagic stroke what do we give

A

protamine

46
Q

if dabigatran cause hemmorrhagic stroke what do we give

A

idarucizumab

47
Q

if DOAC caused hemorrhagic stroke what do we give

A

andexxanant alpha

48
Q

if antiplatelet cause hemorrhagic stroke what do we give

A

no reversal agent

49
Q

when do we treat BP in hemorrhagic strok

A

SBP > 180

50
Q

goal BP goal for hemorrhagic in first 24 hours

A

< 180/110

51
Q

goal BP in hospital after 24 hours for hemorrhagic

A

<160/90 mm Hg

52
Q

when are patients at risk for vasospasm

A

subarachoid hemorrhagic stroke
4-21 days after stroke

53
Q

what drug can we give to minimize risk of vasospasm and when?

A

nimodipine in subarachnoid hemorrhage
60 mg every 4 hours for 21 days

54
Q

do we prophylax for seizures?

A

no
can continue meds if they have them or if they have hx of stroke

55
Q

what antiplatelet used in secondary prevention with atherosclerotic first line

A

first 2-4 weeks: high dose ASA
after 2-4 weeks: low dose ASA, ASA/dipyridamole, clopidogrel + ASA in minor

56
Q

dipyridamole/aspirin consideration

A

need to titrate up
headache common, need titration to prevent

57
Q

second line secondary stroke prevention antiplatelt in atherosclerotic

A

clopidogrel +/- ASA (more for minor strokes)
ASA intolerant pts

58
Q

which antiplatelet contraindicated in secondary stroke prevention?

A

prasugrel
ticagrelor not really reccommended

59
Q

when are anticoags reccommended as secondary prevention

A

ischemic cardioembolic stroke caused by afib, valvular disease, or heart failure

60
Q

when are anticoags given in secondary prevention

A

2-14 days after stroke
discontinue ASA

61
Q

DOACs used for who

A

cardioembolic pts except mitral valve or LV thrombus

62
Q

who should use warfarin or rivaroxaban

A

mitral valve or LV thrombus

63
Q

long term BP goal for all stroke pts

A

<130/80 mmHg

64
Q

black preferred antihypertensive

A

CCB
thiazide

65
Q

CKD preferred antihypertensive

A

ACE/ARB

66
Q

CAD preferred antihypertensive

A

ACE/ARB + BB

67
Q

diabetes preferred HTN agent

A

ACE/ARB

68
Q

HF preferred HTN agent

A

BB + ACE/ARB/ARNI + spironolactone

69
Q

Afib preferred anti-hypertensive

A

verapamil/dilt (non-DHP CCB) or BB

70
Q

who should get statin

A

atherosclerotic stroke
high intensity statin

71
Q

LDL goal for atherosclerotic stroke

A

<70

72
Q

who should not get statin

A

cardioembolic stroke
hemorrhagic stroke
(unless already on )

73
Q

risk factor reduction items

A

stop ilicit drugs
decrease alcohol
diabetes a1c < 7
physical activity
diet
weight loss
smoking cessatio

74
Q

reccommended antidepressants

A

sertraline, fluoxetine, escitalopram, citalopram

75
Q

antidepressants to avoid

A

paroxetine
TCAs

PHRM 864 (28 decks)

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