Stroke Flashcards
What to know about alteplase?
How do we dose alteplase?
What is aspirin’s dosing in stroke?
It can be administered within 3 hours of symptom onset. Watch for bleeding, must keep BP <180/105 during first 24 hours after treatment. BP <185/110 is a CI.
exclude intracrannial hemorhhage before dosing. Max of 90 mg 0.9mg/kg. Dosing is different for MI and pulmonary embolism.
162-325 mg within 24-48 hours after stroke onset.
What special things to know about aspirin?
What to know about aggrenox?
What to know about Clopidogrel(plavid)?
Bayer, Bufferin, Ecotrin. CI’d in salicylate allergy, children and teenagers. Watch for reyes syndrome and bleeding. Dyspepsia, heartburn and nausea. Yosprala is for patients who require aspirin but are at risk of developing gastric ulcers.
Watch for hypotension and headache.
Prodrug, Cyp450 2c19. Check genotype of 2c19. Serious bleeding, avoid with omeprazole(prilosec) and esomeprazole(nexium). TTP has been reported.
How do the antiplatelet drugs work?
Should prophylactic anticonvulsant meds be used in ICH?
How does mannitol work in ICH?
Aspirin binds to cox 1 and 2 resulting in decreased TXA2. Dipyridamole inhibits adenosine uptake. Clopidogrel irreversibly binds P2Y12.
NO
Osmitrol, IV, produces osmotic diuresis and pulls water from brain parenchyma. CI’d in severe renal disease.
How long can cerebral artery vasospasm occur after SAH?
What to know about nimodipine?
What are high dose statins?
3-21 days after the bleed. Oral nimodipine is used to prevent vasospasm.
Nymalize, do not administer IV due to death and serious adverse events. Watch for hypotension, Contents can be withdrawn with a parenteral syringe and transferred to an oral syringe if capsules can’t be swallowed, label and make sure it is never given IV.
Simvastatin 20-40mg, Atorvastatin 40-80mg
What is approved for secondary stroke prevention?
Apsirin, clopidogrel, aspirin + dipyradimole
