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Therapeutics - Cardio > Stroke > Flashcards

Stroke Flashcards

1
Q

Signs of a stroke

A

Sudden numbness or weakness of face, arm, or leg on one side of the body
Sudden severe HA
Vision trouble in 1+ eyes
Confusion, trouble speaking/understanding
Trouble walking, dizziness, loss of balance/coordination

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2
Q

How soon do you administer tPA?

A

W/in 3 hrs of sx onset (0.9 mg/kg) and door to needle time w/in 60 min

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3
Q

When can you not consider tPA w/in 3-4.5 hrs after sx onset?

A 
Age >80
Severe stroke (NIHSS > 25)

Questionably safe and beneficial:
Previous stroke and DM
Oral anticoag at any INR

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4
Q

What are the criteria for tPA use

A

Age >= 18
Ischemic stroke w/ significant deficits
Clearly defined onset w/in 3 hrs

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5
Q

Absolute Contraindications of tPA (#10)

A 
ICH or hx
Intracranial neoplasm, AVM, or aneurysm
Multilobar infarc
Active internal bleed
Ischemic stroke or serious head injury w/in 3 months
Intracranial or intraspinal surgery w/in 3 months
Bleeding diathesis
SBP>185 mmHg, DBP > 110 mmHG
Glucose < 50 mg/dL
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6
Q

What are relative CI of tPA?

A 
Seizure @ stroke onset
Majory surgery/trauma w/in 2 wks
GI/urinary tract bleed w/in 3 weeks
Acute MI w/in 3 months
Preggo
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7
Q

What weight is used for tPA dosing?

A

Actually body weight

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8
Q

tPA monitoring parameters

A

Neuro exam
BP
Risk factors/signs of bleeding

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9
Q

What are the risks associated w/ HTN in stroke?

A

Inc risk of cerebral hemorrhage

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10
Q

What are the risks associated w/ HoTN in stroke?

A

Dec cerebral blood flow

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11
Q

Pt has a stroke and BP >185/110 mmhg - what do you do?

A

Lower B 15% during first 24 hr

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12
Q

What are the three options for BP control in acute ischemic stroke?

A

Labetalol
Nicardipine
Clevidipine

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13
Q

Monitoring parameters for ischemic stroke

A

Bleeding
BP
Hyper/hypoG
Airway protection

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14
Q

How soon do you start aspirin after stroke?

A

24-48 hrs after tPA; 48 hrs w/in onset

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15
Q

Which secondary prevention option for stroke has the most evidence?

A

Aspirin

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16
Q

When are DOACs & warfarin recommended for stroke?

A

Cardioembolic stroke

17
Q

What’s a group for which DARE should be chosen over warfarin for secondary stroke prevention?

A

DOAC eligible pts w/ AF

18
Q

What is the INR goal for warfarin in cardioembolic pts w/ AFib?

A

2-3

19
Q

What are the anticoag first choices?

A

warfarin & apixiban > dabigatran

Rivaroxaban is a reasonable option

20
Q

Modifiable risk factors for ischemic stroke

A 
Metabolic syndrome
EtOH
Drug use
Hypercoagulability
Birth control
Acute infection
Inflammation

Therapeutics - Cardio (4 decks)

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