Stroke II

Question 1

What are the drugs that reduce the recurrence of ischemic stroke?

Answer 1

Antiplatelets

Question 2

What are the antiplatelet drugs used?

Answer 2

• ASA
• Ticlopidine
• Clopidogrel

Question 3

What is the RRR of ASA, ticlopidine, and clopidogrel for recurrence of stroke?

Answer 3

• ASA (13%)
• Ticlopidine (21%)
• Clopidogrel (8%)

Question 4

What is the MOA of clopidogrel?

Answer 4

P2Y12 inhibitor, (an ADP receptor antagonist) which is important in the activation of platelets and cross linking of fibrin.

Question 5

What is the MOA of ticlopidine?

Answer 5

ADP inhibitor

Question 6

What is the MOA of dipyridamole?

Answer 6

Phosphodiesterase inhibitor–enzyme normally breaks down cAMP to increase platelet aggregation response

Question 7

What is the drug that inhibits Gp IIb/IIIa?

Answer 7

Abciximab

Question 8

What is the RRR of coumadin of having a stroke with a-fib? ASA?

Answer 8

70% RRR w/ Warfarin

20% RRR w/ ASA

Question 9

What is the MOA of dabigatran?

Answer 9

Direct thrombin inhibitor

Question 10

What are the Xa inhibitors?

Answer 10

• Rivaroxaban

- Apixaban

Question 11

What is the prophylaxis for cardioembolic strokes? Others?

Answer 11

Warfarin

All else, antiplatelets

Question 12

What is the most important controllable risk factor for strokes?

Answer 12

HTN

Question 13

When is carotid endarterectomy indicated / better than medication control for SYMPTOMATIC patients?

Answer 13

More than 50% stenosis

Question 14

When is carotid endarterectomy indicated / better than medication control for ASYMPTOMATIC patients?

Answer 14

60%

Question 15

At what percent of carotid stenosis is surgery absolutely indicated for stroke prophylaxis?

Answer 15

70%

Question 16

The recurrence of stroke is highest later or earlier post stroke?

Answer 16

Earlier

Question 17

What percent of people have PFO?

Answer 17

30%

Question 18

What is the role of occluding PFOs to prevent stroke?

Answer 18

Still experimental

Question 19

What is the core of the stroke?

Answer 19

Area of necrosis

Question 20

What is the penumbra?

Answer 20

Ischemic, but not infarcted tissue

Question 21

What is the benign oligemia?

Answer 21

Area around the area of ischemia

Question 22

What is the primary determinant of the damage with stroke?

Answer 22

Blood flow

Question 23

What is the emergent treatment for a stroke? (5)

Answer 23

• ABCs
• Oxygen
• IV access with NS
• HOB 15 degrees
• NPO

Question 24

What is the CT that should be ordered with a suspected stroke?

Answer 24

Non-contrast CT

Question 25

What are the labs that should be drawn with a suspected stroke?

Answer 25

• PT/PTT
• CBC
• ECG
• CXR

Question 26

What is the most important question for a stroke patient?

Answer 26

When were you last normal

Question 27

Avoid HTN treatment with stroke unless over what?

Answer 27

220/120 unless giving tPA. Then 185/110.

Question 28

What is the timeframe for tPA?

Answer 28

4.5 hours of onset

Question 29

What is the chance of full recovery with tPA? Risk of death 2/2 ICH?

Answer 29

30-50% full recovery

60% chance of death

Question 30

When is an IV thrombolysis indicated?

Answer 30

within 6 hours, and after tPA is given

Question 31

What are the labs that are drawn in the post-stroke eval? (3)

Answer 31

• Hypercoagulable profiles
• Lipid panels
• BG

Question 32

What are the components of post-stroke care?

Answer 32

• Avoid aspiration
• Avoid DVT
• Mobilize
• Antiplatelet/antiplatelet and a statin

Question 33

True or false: unless contraindicated, statins are started on all post stroke patients?

Answer 33

True

Question 34

What is the number one risk factor for stroke? Which risk factor is the one we can control most?

Answer 34

Age

HTN

Question 35

What must be done following tPA administration?

Answer 35

ICU admission for 24 hours