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Pharm Y3S2 > Stroke > Flashcards

Stroke Flashcards

1
Q

What percentage of people die within 1 month of having a stroke?

A

23%

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2
Q

What percentage of people die within 3 years of having a stroke?

A

60-70%

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3
Q

What is the difference between a stroke and a TIA?

A

TIA symptoms resolve within 24 hours

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4
Q

Define stroke.

A

Rapidly developing clinical signs of disturbance of cerebral function lasting for over 24 hours with no apparent cause other than that of vascular origin

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5
Q

How does an ischaemic stroke occur?

A

Cerebral thrombosis from atherosclerotic disease or distal embolism breaking off and reaching the brain, eventually causing occlusion

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6
Q

How does an intracerebral haemorrhagic stroke occur?

A

Rupture of a small vessel in the brain

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7
Q

How does a subarachnoid haemorrhagic stroke occur?

A

Rupture of intracranial aneurism

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8
Q

Which type of stroke is most common?

A

Ischaemic accounts for 70% of strokes

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9
Q

What are the symptoms of stroke?

A

Facial weakness
Arm/leg weakness
Speech slurred

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10
Q

What scale is used to recognise stroke in an emergency room?

A

ROSIER scale

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11
Q

What may be a differential diagnosis for stroke?

A

Seizure
Drug toxicity
Brain tumour
Spinal cord lesin (MS)

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12
Q

How does age affect stroke risk?

A

Risk doubles with every decade over 55

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13
Q

How does gender affect stroke risk?

A

Men at higher risk

More fatal in women

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14
Q

How does ethnicity affect stroke risk?

A

Afro-Caribbean more at risk

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15
Q

What co-morbidities can increase stroke risk?

A

Hypertension
Atrial fibrillation
Diabetes

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16
Q

What may be seen on a CT scan in stroke?

A

Ischaemic- demarcated hypotenuse zone (often difficult to spot)
Haemorrhagic- clearly visible areas of high attenuation

17
Q

When may an MRI scan be useful in stroke?

A

When investigating a TIA

18
Q

What investigations should be carried out in stroke?

A 
Blood pressure
ECG
FBC U&Es
Blood glucose
Inflammatory markers
19
Q

What acute treatment can be given in stroke?

A

Nothing administered until CT results back

20
Q

What is thrombolysis?

A

Acute treatment for ischaemic stroke

Alteplase licensed and given within 3 hours of symptom onset

21
Q

Describe the treatment after thrombolysis in ischaemic stroke.

A

Aspirin 300mg given after bleed is ruled out, continued for 14 days
High intensity statin as soon as patient can swallow

22
Q

Describe blood pressure control in ischaemic stroke.

A

Should be less than 185/110mmHg for thrombolysis

To manage, use IV infusion f short acting hypertensive i.e. GTN, labetolol

23
Q

Describe the treatment in haemorrhagic stroke.

A

Surgical intervention in ongoing bleed
Anticoagulants stopped and reversed if INR >1.4 with vitamin K and prothrombin complex concentrate
Statins started if indicated by CV risk

24
Q

Describe blood pressure control in haemorrhagic stroke.

A

Blood pressure to be managed if greater than 150mmHg up to 6 hours after symptom onset
To manage, use IV infusion f short acting hypertensive i.e. GTN, labetolol
Aim for 140mmHg for at least 7 days

25
Q

What generalised management should be considered in stroke?

A 
Assess ability to swallow
Ensure fluid balance
Monitor temperature
Tight control of blood glucose
DVT thromboprophylaxis
26
Q

What are the 4 areas of secondary prevention from 48 hours of stroke?

A

Antiplatelet (ischaemic)- clopidogrel, aspirin & MR dipyrimadole, MR diprymadole alone
Anticoagulant (embolic)- DOAC or warfarin
Statin- simvastatin 40mg, atorvastatin where cholesterol >4mmol/L
Antihypertensive- ACE or CCB

27
Q

Describe management of swallowing problems.

A

NG/PEG feed
Thickened fluids or puree diet
Review medication

28
Q

Describe management of depression in stroke.

A

Occurs in 30% of patients

SSRI first line

29
Q

Describe management of dry mouth in stroke.

A

Artificial saliva and good mouthcare

30
Q

Describe management of sialorrhoea in stroke.

A

Oral glycopyrronium
Atropine eye drops
Hyoscine patch

31
Q

Describe management of seizures in stroke.

A

Prophylactic anti epileptics if recurrent seizures diagnosed as epilepsy
Valproate and levetiracetam

32
Q

Describe management of spasticity in stroke.

A

Skeletal muscle relaxants i.e. baclofen

Botulinum toxin

Pharm Y3S2 (29 decks)

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