Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

module 2b > stroke > Flashcards

stroke Flashcards

1
Q

types of stroke

A
  • Ischemic: compromised blood flow, usually atherosclerotic or clot
  • Embolic: from dislodged thrombus
  • Hemorrhagic: bleeding into surrounding tissue of brain from bursting of a defective cerebral artery
  • TIA: episode of temporary (
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

stroke risk factors

A
  • modifiable: HTN, Cardiac disease (A.fib), TIAs, Diabetes, HLD, Cigarette smoking, obesity
  • non-modifiable: Age, Gender (M>F), race, family hx, low birth weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ischemic stroke presentation

A

-unilateral or bilateral numbness/weakness, inability to speak, sudden onset of vision loss, vertigo, HA, facial droop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ischemic stroke treatment

A
  • Hypoglycemic (180mg/dL) untreated= worse outcomes

- t-PA: only drug FDA approved for ischemic stroke treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

t-PA for ischemic stroke

A
  • Dosing: 0.9mg/kg IV (max of 90mg), with 10% as IV bolus (Example of 100kg patient = 9mg IV bolus + 81mg IV infusion over 60 minutes)
  • AE: bleeding
  • Monitoring: No anticoagulation/ antiplatelet for 24 hours following thrombolysis, keep BP under 180/105
  • Criteria for use: SBP under 185 or DBP under 110, Onset of symptoms can be no longer than 3-4.5 hours before beginning treatment, No oral anticoagulation, or if taking, INR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

arterial HTN

A
  • Aggressive BP decrease may worse neurological outcomes due to less profusion pressure to the ischemic areas of brain
  • T-PA treatment? If BP over 185/110 = pretreatment with Labetalol 10-20 mg IV
  • Patient not eligible for t-PA: goal is to lower BP by 15% over 24 hours: Treatment if SBP >220 or DBP >120, Labetalol, Nicardipine, Esmolol, Sodium Nitroprusside
  • BP After 1st 24 hours: Previous HTN: restart home medication, Unknown: consider starting PO BP medication depending on BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

anticoags and ischemic stroke

A
  • Heparin = no benefit
  • LMWH = did not lessen neurological risk
  • DVT prophylaxis: UFH, LMWH, compression stockings, IVC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

antiplatelets and ischemic stroke

A
  • Asprin 325mg within 24 hours of stroke

- Continue 1-2 weeks post stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

statins and ischemic stroke

A
  • Reinitiate within 72 hours of stroke

- If not already on statin = consider adding during hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

hemorrhagic stroke presentation

A

-Altered mental status, N/V, headache, Seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

hemorrhagic stroke risk factors

A

HTN, AV malformation, ruptured neoplasm, intracranial neoplasm, coagulopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

hemorrhagic stroke treatment

A
  • Surgical: craniotomy, clot evacuation, endoscopic evacuation
  • Medical: slowly lower BP, correct coagulopathy, initiate anticonvulsants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

antiplatelet and hemorrhagic stroke secondary propylaxis

A
  • daily dose of 50-325mg of aspirin
  • Aggrenox: reserved for after clopidogrel d/t cost
  • Clopidogrel: 75mg/day; greater efficacy than ASA alone for stroke prevention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cardiogenics and hemorrhagic stroke secondary propylaxis

A

Cardiogenic (caused by A.fib or valvular heart disease or CHF)

  • Warfarin to target INR range
  • Direct thrombin and factor Xa inhibitors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

HTN and hemorrhagic stroke secondary propylaxis

A
  • Monotherapy: ACE-inhibitors, CCBs, thiazide diuretics

- Combination: ACE + CCB or thiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DM and hemorrhagic stroke secondary propylaxis

A

avoid hypoglycemia (symptoms mimic stroke)

17
Q

statins and hemorrhagic stroke secondary propylaxis

A

high intensity statin

18
Q

stroke-related seizures

A
  • generally with 24-48 hours post-stroke -> 2 weeks post-stroke
  • If seizure was associated with ischemic stroke, then give treatment, Otherwise no treatment
  • Anticonvulsant: lamotrigine and gabapentin first
19
Q

depression and hemorrhagic stroke secondary prophylaxis

A
  • may affect up to 50% of stroke patients and significantly impairs recovery
  • Improvements in executive functioning found with anti-depressant therapy
  • Treatment: sertraline, fluoxetine, escitalopram, citalopram all studied: Avoid TCAs
20
Q

tPA inclusion and exclusion criteria

A

inclusion: ischemic stroke confirmed by imaging, symptoms 0-3 hours, over 18 YO
exclusion: evidence of active internal bleed, hx of previous intracranial hemorrhage, previous stroke or head trauma in past 3 months, GI or genitourinary hemorrhage in past 21 days, major surgery in past 14 days, MI in past 3 months, BP over 185/110 at time of administration, BG under 50 mg/dL, platelets under 100,000, current anticoagulant use with INR over 1.7 or aPTT over 45 seconds, CI with NOAC

21
Q

extended alteplase window

A

can be used up to 4.5 hours after symptom onset
-must meet all inclusion and exclusion criteria PLUS: under 80 YO, no hx of previous stroke or DM, no recent use of ANY anticoag, and NIHSS under 25

module 2b (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions