Stroke II Flashcards
What are the drugs that reduce the recurrence of ischemic stroke?
Antiplatelets
What are the antiplatelet drugs used?
- ASA
- Ticlopidine
- Clopidogrel
What is the RRR of ASA, ticlopidine, and clopidogrel for recurrence of stroke?
- ASA (13%)
- Ticlopidine (21%)
- Clopidogrel (8%)
What is the MOA of clopidogrel?
P2Y12 inhibitor, (an ADP receptor antagonist) which is important in the activation of platelets and cross linking of fibrin.
What is the MOA of ticlopidine?
ADP inhibitor
What is the MOA of dipyridamole?
Phosphodiesterase inhibitor–enzyme normally breaks down cAMP to increase platelet aggregation response
What is the drug that inhibits Gp IIb/IIIa?
Abciximab
What is the RRR of coumadin of having a stroke with a-fib? ASA?
70% RRR w/ Warfarin
20% RRR w/ ASA
What is the MOA of dabigatran?
Direct thrombin inhibitor
What are the Xa inhibitors?
- Rivaroxaban
- Apixaban
What is the prophylaxis for cardioembolic strokes? Others?
Warfarin
All else, antiplatelets
What is the most important controllable risk factor for strokes?
HTN
When is carotid endarterectomy indicated / better than medication control for SYMPTOMATIC patients?
More than 50% stenosis
When is carotid endarterectomy indicated / better than medication control for ASYMPTOMATIC patients?
60%
At what percent of carotid stenosis is surgery absolutely indicated for stroke prophylaxis?
70%
The recurrence of stroke is highest later or earlier post stroke?
Earlier
What percent of people have PFO?
30%
What is the role of occluding PFOs to prevent stroke?
Still experimental
What is the core of the stroke?
Area of necrosis
What is the penumbra?
Ischemic, but not infarcted tissue
What is the benign oligemia?
Area around the area of ischemia
What is the primary determinant of the damage with stroke?
Blood flow
What is the emergent treatment for a stroke? (5)
- ABCs
- Oxygen
- IV access with NS
- HOB 15 degrees
- NPO
What is the CT that should be ordered with a suspected stroke?
Non-contrast CT
What are the labs that should be drawn with a suspected stroke?
- PT/PTT
- CBC
- ECG
- CXR
What is the most important question for a stroke patient?
When were you last normal
Avoid HTN treatment with stroke unless over what?
220/120 unless giving tPA. Then 185/110.
What is the timeframe for tPA?
4.5 hours of onset
What is the chance of full recovery with tPA? Risk of death 2/2 ICH?
30-50% full recovery
60% chance of death
When is an IV thrombolysis indicated?
within 6 hours, and after tPA is given
What are the labs that are drawn in the post-stroke eval? (3)
- Hypercoagulable profiles
- Lipid panels
- BG
What are the components of post-stroke care?
- Avoid aspiration
- Avoid DVT
- Mobilize
- Antiplatelet/antiplatelet and a statin
True or false: unless contraindicated, statins are started on all post stroke patients?
True
What is the number one risk factor for stroke? Which risk factor is the one we can control most?
Age
HTN
What must be done following tPA administration?
ICU admission for 24 hours
