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Cardio 1228 > Stroke (edited) > Flashcards

Stroke (edited) Flashcards

1
Q

Risk factors for stroke?

A

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

Prior Stroke or Transient ischemic attack (TIA)

Smoking

Dyslipidemia

Patent foramen Ovale (PFO)

Sickle Cell Disease

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2
Q

How is type of stroke determined?

A

Via brain imaging-CT (either ischemic - more common or hemorrhagic)

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3
Q

Sx of stroke?

A

FAST

Face
Arms
Speech
Time

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4
Q

Prevention of venous thromboembolism in hemorrhagic stroke?

A

Use intermittent pneumatic compression

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5
Q

Tx of Intracerebral Hemorrhage?

A

Elevate bed by 30 degrees

Use Mannitol

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6
Q

MOA of Mannitol (used IM Intracerebral hemorrhage - ICH)?

A

Increases osmotic pressure to reduce intracranial pressure (ICP) ass with cerebral edema

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7
Q

Brand name of Mannitol?

A

Osmitrol

CI-renal disease

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8
Q

SEs of Mannitol (Osmitrol)?

A

Fluid and electrolyte loss

Dehydration

Hyperosmolar-induced hyperkalemia

Acidosis

Increased osmolar gap

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9
Q

What’s Subarachnoid hemorrhage?

A

SAH is bleeding in the space btw the brain and the surrounding membrane (subarachnoid space)-after aneurysm rupture

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10
Q

Role of Oral Nimodipine in SAH?

A

Prevents artery vasospasm that can occur 3-21 days post aneurysm rupture associated with delayed ischemia

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11
Q

Box: Nimodipine (Nymalize) - used in SAH?

A

Don’t admin IV….use oral route ONLY-comes in an capsule or oral solution only

To prevent severe cardiovascular adverse events including death that has occurred by inadvertently injecting peripherally

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12
Q

How should syringes with Nimodipine (Nymalize) - used in SAH - be labeled?

A

“For oral use only” OR “Not for IV Use” and put in a syringe that can’t accept a needle

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13
Q

Pharmacologic management of Acute Ischemic Stroke?

A

Alteplase (recombinant tissue plasminogen activator (rt-PA) causes fibrinolysis by binding to fibrin in thrombus (clot) and converts the plasminogen to plasmin

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14
Q

Brand name of Atleplase - used in acute ischemic stroke?

A

Activase

rt-PA

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15
Q

What must be done b4 using Atleplase (Activase; rt-PA) - used in acute ischemic stroke?

A

Must confirm clot on brain imaging (head CT scan) b4 use

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16
Q

Dosing of Atleplase (Activase; rt-PA) - used in acute ischemic stroke? Max dose?

A

Infuse 0.9 mg/kg IV over 60 min
10% of dose given as bolus

Max dose: 90mg

17
Q

SEs of Atleplase (Activase; rt-PA) - used in acute ischemic stroke?

A

Major bleeding e.g ICH

Hypotension

Angioedema

18
Q

When should tx of Atleplase (Activase; rt-PA) - used in acute ischemic stroke - be initiated?

A

Must be initiated within 3 hrs of sx onset

(guidelines - up to 4.5hrs, but this isn’t FDA approved)

Must be administered within 60 minutes of hospital arrival

19
Q

Additional therapies in mgt of acute ischemic stroke?

A

Aspirin therapy

HTN mgt

Hyperglycemia mgt

DVT prevention

(Modifiable risk factors should be corrected)

20
Q

Role of Aspirin in Acute Ischemic Stroke?

A

Prevention of early recurrent stroke (secondary prevention)

21
Q

Dose of Aspirin in Acute Ischemic Stroke?

A

162-325 mg PO within 24-48 hr of stroke onset

NOT within 24 hr of fibrinolytic tx (alteplase)

22
Q

When should Aspirin be initiated in Acute Ischemic Stroke?

A

W/in 24-48 hrs after stroke onset

NOT within 24 hr of fibrinolytic tx (alteplase)

23
Q

Role of HTN management in Acute Ischemic Stroke?

A

IV labetalol, nicardipine, or clevidipine

to decrease BP<185/110 so alteplase can be administered
AND to maintain BP < 180/105 for at least 24 hr after alteplase

PTs not getting alteplase may not require BP treatment unless >= 220/120

24
Q

When should Atleplase (Activase; rt-PA) NOT be initiated as part of HTN management?

A

If BP is not =< 185/110 mmHg

Don’t give rt-PA

25
Q

Hyperglycemia management in Acute Ischemic Stroke?

A

Maintain BG levels bye 140-180 mg/dL

26
Q

When should DVT prevention NOT be initiated in management of Acute Ischemic Stroke?

A

Don’t use anticoagulant therapy within 24 hrs of receiving rt-PA therapy

27
Q

List lifestyle changes used in ischemic stroke prevention

A

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

28
Q

When’s primary prevention of ischemic stroke recommended?

A

Only for A. Fib pts

29
Q

Secondary prevention for patients with previous cardioembolic stroke?

A

Anticoagulant therapy

30
Q

Secondary prevention for patients with previous non-cardioembolic ischemic stroke or TIA?

A

Antiplatelets, (aspirin, Clopidogrel) rather than oral anticoagulant

31
Q

List Antiplatelet agents used in patients with previous noncardioembolic ischemic stroke or TIA?

A

Aspirin

Clopidogrel (Plavix)-asa allergy pts

Dipyridamole ER/Aspirin (Aggrenox)

32
Q

Brand name of Asprin to prevent stroke recurrence

A

Bayer Aspirin

Bufferin

Ecotrin

33
Q

Brand name of Clopidogrel (used in patients with previous non-cardioembolic ischemic stroke or TIA)?

A

Plavix

34
Q

Dose of Clopidogrel (Plavix) - (used in patients with previous non-cardioembolic ischemic stroke or TIA)?

A

75mg daily

35
Q

BBW of Clopidogrel (Plavix)?

A

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

36
Q

SEs of Clopidogrel (Plavix)?

A 
Bleeding-stop 5 days prior to surgery
GI hemorrhage
Bruising
Pruritis
Rash

Thrombotic Thrombocytopenia Purpura - TTP - (rare)

37
Q

SEs of Dipyridamole ER/Aspirin (Aggrenox)?

A

HA (> 10%)

38
Q

What’s stroke?

A

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)

Cardio 1228 (17 decks)

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