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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 (
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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
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3
Q

ischemic stroke presentation

A

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

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4
Q

ischemic stroke treatment

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

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

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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
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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
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7
Q

anticoags and ischemic stroke

A
  • Heparin = no benefit
  • LMWH = did not lessen neurological risk
  • DVT prophylaxis: UFH, LMWH, compression stockings, IVC
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8
Q

antiplatelets and ischemic stroke

A
  • Asprin 325mg within 24 hours of stroke

- Continue 1-2 weeks post stroke

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9
Q

statins and ischemic stroke

A
  • Reinitiate within 72 hours of stroke

- If not already on statin = consider adding during hospitalization

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10
Q

hemorrhagic stroke presentation

A

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

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11
Q

hemorrhagic stroke risk factors

A

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

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12
Q

hemorrhagic stroke treatment

A
  • Surgical: craniotomy, clot evacuation, endoscopic evacuation
  • Medical: slowly lower BP, correct coagulopathy, initiate anticonvulsants
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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
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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
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15
Q

HTN and hemorrhagic stroke secondary propylaxis

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

- Combination: ACE + CCB or thiazide

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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)

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