Stroke -Issacs Flashcards
Type of Stroke
Ischemic (Atherosclerotic or Embolic-
Cardio/A.Fib)
or
Hemorrhagic
what does CHA(2)DS(2)VASc stand for
CHF HTN Age (>/= to 75 years) Diabetes Stroke/TIA Vascular disease (MI, aortic plaque, PAD) Age (64- 75 years) Sex (female = 1 pt)
Managing Risk Factors:
How ot control A.Fib
Control Rate/Rhythm
Anticoag for high risk pts with A.Fib (use CHADSVASC)
Managing Risk Factors:
Valvular Disease
use warfarin if valve replacement
Managing Risk Factors:
Alcohol use:
_____ drinks per day
= 2 drinks/day
who is recommended to get aspirin 81 mg QD for primary prevention of stroke
WOMEN with high CV risk
clinical presentation of stroke
- dysphasia (difficulty speaking)
- facial droop
- unilateral/bilateral weakness
- Ataxia (inability to coordinate muscle movement)
- Vision changes (diplopia)
- HA 9more common with hemorrhagic)
Glycemic Control and Stroke:
Why manage Hypoglycemia?
Why manage Hyperglycemia?
hypo: could be causing the altered mental status
hyper: in acute stroke situations BG over 180can result in worse outcomes (morbidity and mortality)
Thrombolytics have no impact on _____ but can improve ________
no impact on MORTALITY; improve neurologic function
What is the Inclusion Criteria for t-PA
- NOT hemorrhagic stroke (must have dx of ischemic stroke)
- Sx onset < 3 hrs ago
- > 18 years old
What is the Exclusion Criteria for t-PA
BP > 185/110
BG < 50
(basically lots of bleeding things or past surgeries)
if stroke/head trauma or MI in past 3 months
if on warfarin and INR > 1.7
Can do t-PA up to 4.5 hours after symptom onset IF the patient has NONE of the following
- Age ______
- Hx of ______
- Any recent _______
- NIHSS score > ____
Age: > 80
Hx of previous stroke or diabetes
Any recent anticoag use
NIHSS score > 25
ADEs of Alteplase
Bleeding and _________
Cerebral edema!
Dosing for t-PA
- 09 mg/kg - IV bolus over 1 minute
- 81 mg/kg - IV infusion over 60 mins
MAX of 90 mg (aka if over 100 kg there only getting 90mg total)
Ischemic Stroke: Acute Blood Pressure Goals depend on ______
if t-PA was given or not
Acute BP goal if t-PA IS NOT given:
BP < 220/120 mmHg within first 24 hours
Acute BP goal if t-PA IS given:
BP < 180/105 mmHg within first 24 hours
Drug options for decreasing BP
- Nicardipine
- Labetalol
- Sodium Nitroprusside
who gets aspirin post stroke?
ALL ISCHEMIC stroke pts (def not hemorrhagic stroke pts)
when should patients start aspirin post stroke?
if given t-PA: start 24 hours after t-PA
if NO t-PA given then immediately!
which ischemic stroke patient is NOT kept on aspirin forever/are switched to another med after a week of aspirin?
CARDIOEMBOLIC - they get switched to an anticoag
should an anticoag be given for managing acute embolic strokes?
NO anti-platelet (aspirin) for at least a week first (can increase bleeding complications)
options for managing hemorrhagic stroke: \_\_\_\_\_\_\_\_ reversing \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ anti-\_\_\_\_\_\_\_\_\_\_\_ Prevention of \_\_\_\_\_\_\_\_\_ Anti\_\_\_\_\_\_\_\_\_\_\_
supportive care reversing causative meds surgery ant-hypertensives Prevention of cerebral vasospasm Anticonvulsants
Ischemic or Hemorrhagic stroke: which one is more likely to have vasospasm complication
Hemorrhagic (try to prevent by using Nimodipine)
