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Therapeutics 2 Kappa Epsilon > Stroke -Issacs > Flashcards

Stroke -Issacs Flashcards

1
Q

Type of Stroke

A

Ischemic (Atherosclerotic or Embolic-
Cardio/A.Fib)
or
Hemorrhagic

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2
Q

what does CHA(2)DS(2)VASc stand for

A 
CHF
HTN
Age (>/= to 75 years)
Diabetes
Stroke/TIA
Vascular disease (MI, aortic plaque, PAD)
Age (64- 75 years)
Sex (female = 1 pt)
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3
Q

Managing Risk Factors:

How ot control A.Fib

A

Control Rate/Rhythm

Anticoag for high risk pts with A.Fib (use CHADSVASC)

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4
Q

Managing Risk Factors:

Valvular Disease

A

use warfarin if valve replacement

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5
Q

Managing Risk Factors:
Alcohol use:
_____ drinks per day

A

= 2 drinks/day

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6
Q

who is recommended to get aspirin 81 mg QD for primary prevention of stroke

A

WOMEN with high CV risk

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7
Q

clinical presentation of stroke

A
  • dysphasia (difficulty speaking)
  • facial droop
  • unilateral/bilateral weakness
  • Ataxia (inability to coordinate muscle movement)
  • Vision changes (diplopia)
  • HA 9more common with hemorrhagic)
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8
Q

Glycemic Control and Stroke:
Why manage Hypoglycemia?

Why manage Hyperglycemia?

A

hypo: could be causing the altered mental status
hyper: in acute stroke situations BG over 180can result in worse outcomes (morbidity and mortality)

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9
Q

Thrombolytics have no impact on _____ but can improve ________

A

no impact on MORTALITY; improve neurologic function

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10
Q

What is the Inclusion Criteria for t-PA

A
  • NOT hemorrhagic stroke (must have dx of ischemic stroke)
  • Sx onset < 3 hrs ago
  • > 18 years old
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11
Q

What is the Exclusion Criteria for t-PA

A

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

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12
Q

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 > ____
A

Age: > 80
Hx of previous stroke or diabetes
Any recent anticoag use
NIHSS score > 25

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13
Q

ADEs of Alteplase

Bleeding and _________

A

Cerebral edema!

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14
Q

Dosing for t-PA

A
  1. 09 mg/kg - IV bolus over 1 minute
  2. 81 mg/kg - IV infusion over 60 mins

MAX of 90 mg (aka if over 100 kg there only getting 90mg total)

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15
Q

Ischemic Stroke: Acute Blood Pressure Goals depend on ______

A

if t-PA was given or not

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16
Q

Acute BP goal if t-PA IS NOT given:

A

BP < 220/120 mmHg within first 24 hours

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17
Q

Acute BP goal if t-PA IS given:

A

BP < 180/105 mmHg within first 24 hours

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18
Q

Drug options for decreasing BP

A
  • Nicardipine
  • Labetalol
  • Sodium Nitroprusside
19
Q

who gets aspirin post stroke?

A

ALL ISCHEMIC stroke pts (def not hemorrhagic stroke pts)

20
Q

when should patients start aspirin post stroke?

A

if given t-PA: start 24 hours after t-PA

if NO t-PA given then immediately!

21
Q

which ischemic stroke patient is NOT kept on aspirin forever/are switched to another med after a week of aspirin?

A

CARDIOEMBOLIC - they get switched to an anticoag

22
Q

should an anticoag be given for managing acute embolic strokes?

A

NO anti-platelet (aspirin) for at least a week first (can increase bleeding complications)

23
Q 
options for managing hemorrhagic stroke:
\_\_\_\_\_\_\_\_
reversing \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
anti-\_\_\_\_\_\_\_\_\_\_\_
Prevention of \_\_\_\_\_\_\_\_\_
Anti\_\_\_\_\_\_\_\_\_\_\_
A 
supportive care
reversing causative meds
surgery
ant-hypertensives
Prevention of cerebral vasospasm
Anticonvulsants
24
Q

Ischemic or Hemorrhagic stroke: which one is more likely to have vasospasm complication

A

Hemorrhagic (try to prevent by using Nimodipine)

25
Q

Highest risk for Vasospasm is __________ days after stroke

A

4- 21

26
Q

how to prevent vasospasm complication with hemorrhagic stroke

A

use Nimodipine

27
Q

BP goals for Hemorrhagic Stroke:

A

first 24 hrs: < 180/110
After first 24 hrs in hospital: < 160/90
(normal goal after hospital aka < 140/90)

28
Q

Ischemic or Hemorrhagic stroke?

which one has risk of seizure after the stroke

A

hemorrhagic

29
Q

How to manage seizure risk with hemorrhagic strokes?

A

nothing really… it is NOT recommended to give anticonvulsants as prophylaxis

30
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Antidepressants

A

both

31
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Antiplatelet

A

Ischemic (esp. artheroscelorsis)

32
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Anticoagulant

A

Ischemic (esp. cardioembolic)

33
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Anithypertensive

A

both

34
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Rehabilitation

A

both

35
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Cholesterol Reducing Agetns

A

Ischemic (esp. atherosclerosis)

36
Q

For Post-Stroke Management:
Ischemic, Hemorrhagic, or both?
Risk factor reduction

A

both

37
Q

POST-STROKE MANAGEMENT:

which drug options are first line for secondary prevention for non-embolic ischemic stroke

A

since NON-EMBOLIC

Aspirin or Dipyradimole (or combo of the two)

38
Q

POST-STROKE MANAGEMENT:

which drug options are second line for secondary prevention for non-embolic ischemic stroke

A

Clopidogrel
or
Clopidogrel + Aspirin

39
Q

what is the combo drug of dipyridamole and aspirin called

A

Aggrenox

40
Q

POST-STROKE MANAGEMENT:

which drug options are NOT recommended for secondary prevention for non-embolic ischemic stroke

A

Ticagrelor or Prasugrel

41
Q

POST-STROKE MANAGEMENT:

which drug options are first line for secondary prevention for embolic ischemic stroke

A

any DOAC or Warfarin is cool to use (START 7+ days AFTER stroke also discontinue aspirin before starting anticoag)

42
Q

What are some prophylactic antidepressants to use in stroke pts

A

SSRIs: Sertraline; Fluoxetine; Escitalopram/Citalopraim

43
Q

What are some prophylactic antidepressants to avoid in stroke pts

A

Paroxetine (an SSRI w/more anticholinergic side effects)

TCAs (w/more anticholinergic side effects)

44
Q

what to start an antidepressant with a stoke pt

A

like almost immediately because of the delayed onset of action

Therapeutics 2 Kappa Epsilon (22 decks)

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