Stroke Flashcards
Risk factors for stroke?
HTN - most common cause (risk increases above 120/80mmHg)
A. Fib
Gender (males > females)
Ethnicity (AAs at highest risk by ethnicity)
Age (55 and older)
Atherosclerosis
DM
Transient ischemic attack (TIA)
Prior hx of stroke
Smoking
Hypercholesterolemia
Patent foramen Ovale (PFO)
SCD
Howz type of stroke determined?
Via brain imaging (either ischemic - more common or hemorrhagic)
Sx of stroke?
FAST
Face
Arms
Speech
Time
Prevention of venous thromboembolism in hemorrhagic stroke?
Use intermittent pneumatic compression
Tx of Intracerebral Hemorrhage?
Elevate bed by 30 degrees
Use Mannitol
MOA of Mannitol (used IM Intracerebral hemorrhage - ICH)?
Increases osmotic pressure to reduce intracranial pressure (ICP) ass with cerebral edema
Brand name of Mannitol?
Osmitrol
SEs of Mannitol (Osmitrol)?
Fluid and electrolyte loss
Dehydration
Hyperosmolar-induced hyperkalemia
Acidosis
Increased osmolar gap
What’s Subarachnoid hemorrhage?
SAH is bleeding in the space btw the brain and the surrounding membrane (subarachnoid space)
Role of Oral Nimodipine in SAH?
Prevents vasospasm associated with delayed ischemia
BBW of Nimodipine (Nymalize) - used in SAH?
Don’t admin IV….use oral route ONLY
To prevent severe cardiovascular adverse events including death
How should syringes with Nimodipine (Nymalize) - used in SAH - be labeled?
“For oral use only”
Pharmacologic management of Acute Ischemic Stroke?
Alteplase (recombinant tissue plasminogen activator (rt-PA) causes fibrinolysis by binding to fibrin in thrombus (clot) and converse entrapped plasminogen to plasmin
Brand name of Atleplase - used in acute ischemic stroke?
Activase
rt-PA
What must be done b4 using Atleplase (Activase; rt-PA) - used in acute ischemic stroke?
Must confirm clot on brain imaging (head CT scan) b4 use
Dosing of Atleplase (Activase; rt-PA) - used in acute ischemic stroke? Max dose?
Infuse 0.9 mg/kg IV over 60 min
10% of dose given as bolus
Max dose: 90mg
SEs of Atleplase (Activase; rt-PA) - used in acute ischemic stroke?
Major bleeding e.g ICH
Hypotension
Angioedema
When should tx of Atleplase (Activase; rt-PA) - used in acute ischemic stroke - be initiated?
Must be initiated within 3 hrs of sx onset
guidelines - up to 4.5hrs, but this isn’t FDA approved
Additional therapies in mgt of acute ischemic stroke?
Aspirin therapy
HTN mgt
Hyperglycemia mgt
DVT prevention
(Modifiable risk factors should be corrected)
Role of Aspirin in Acute Ischemic Stroke?
Prevention of early recurrent stroke (secondary prevention)
Dose of Aspirin in Acute Ischemic Stroke?
81 mg PO daily
When should Aspirin be initiated in Acute Ischemic Stroke?
W/in 24-48 hrs after stroke onset
When should Aspirin NOT be initiated in Acute Ischemic Stroke?
W/in 24 hrs of fibrinolytic therapy
Role of HTN management in Acute Ischemic Stroke?
Qualifies patients for rt-PA or reduce BP
Use ACEIs or ARBs
When should Atleplase (Activase; rt-PA) NOT be initiated as part of HTN management?
If BP is not =< 185/110 mmHg
Don’t give rt-PA
Hyperglycemia management in Acute Ischemic Stroke?
Maintain BG levels bye 140-180 mg/dL
When should DVT prevention NOT be initiated in management of Acute Ischemic Stroke?
Don’t use anticoagulant therapy within 24 hrs of receiving rt-PA therapy
List lifestyle changes used in ischemic stroke prevention
Increased physical exercise (at least 30 mins most days of the wk)
Weight reduction if necessary (maintain BMI 18.5-24.9 kg/m^2)
Women Waist circumference < 35 inches
Men waist circumference < 40 inches
Women alcohol, limit =< 1 drink/day
Men alcohol, limit =< 2 drinks/day
When’s primary prevention of ischemic stroke recommended?
Only for A. Fib pts
Secondary prevention for patients with previous cardioembolic stroke?
Anticoagulant therapy
Secondary prevention for patients with previous non-cardioembolic ischemic stroke or TIA?
Antiplatelets, (aspirin, Clopidogrel) rather than oral anticoagulant
List Antiplatelet agents used in patients with previous noncardioembolic ischemic stroke or TIA?
Aspirin
Clopidogrel (Plavix)
Dipyridamole ER/Aspirin (Aggrenox)
Brand name of Asprin (used in patients with previous non-cardioembolic ischemic stroke or TIA)?
Ascriptin
Bayer Aspirin
Bufferin
Bufferin Extra Strength
Ecotrin
St. Joseph Adult Aspirin
Others
Brand name of Clopidogrel (used in patients with previous non-cardioembolic ischemic stroke or TIA)?
Plavix
Dose of Clopidogrel (Plavix) - (used in patients with previous non-cardioembolic ischemic stroke or TIA)?
75mg daily
BBW of Clopidogrel (Plavix)?
Effectiveness depends on the activation to an active metabolite mainly by CYP 2C19.
Poor metabolizers exhibit higher cardiovascular events than patients with normal 2C19 fxn
CYP2C191 allele = fully fxnal metabolism
CYP2C192 and *3 alleles = nonfxnal
SEs of Clopidogrel (Plavix)?
Bleeding
Bruising
Rash
Thrombotic Thrombocytopenia Purpura - TTP - (rare)
SEs of Dipyridamole ER/Aspirin (Aggrenox)?
HA (> 10%)
What’s stroke?
Stroke or cerebrovascular accident (CVA) occurs when blood flow to an area of the brain is interrupted by ischemia due to a clot (thrombus or emboli) or a ruptured blood vessel (hemorrhage)
