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Neuro > Stroke Prevention > Flashcards

Stroke Prevention Flashcards

1
Q

Non-modifiable Risk Factors

A

age, male sex, african american or hispanic, and family history

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2
Q

Modifiable Risk Factors

A

HTN, Afib, HLD, tobacco smoking, TIA, alcohol/drug use

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3
Q

Blood Pressure Goal

A

<130/80 mm Hg

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4
Q

CHADS2VASC Score
Afib Stroke Risk

A

C: CHF
H: HTN
A2: age =/>75 years
D: diabetes
S2: prior stroke/TIA
V: vascular disease
A: age 65-74 years
Sc: sex category (female)

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5
Q

At whats CHADSVASC score do we anticoagulate?

A

2

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6
Q

After Afib, when do primary prevent with Aspirin

A

patients greater than 75 years old with no other risk factors

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7
Q

After Afib, when do primary prevent with Warfarin

A

patients with chadvasc score 2 or greater

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8
Q

Secondary Prevention

A

have ALREADY had a stroke

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9
Q

If stroke is atherothrombotic, lacunar, or cryptogenic use:

A

antiplatelet therapy

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10
Q

If stroke is high-risk cardioembolic related (afib) use:

A

Anticoagulant

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11
Q

If afib is valvular anticoagulate with:

A

warfarin

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12
Q

If afib is non-valvular anticoagulate with:

A

DOAC

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13
Q

Aspirin drug interactions

A

P-450 inhibitors and inducers

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14
Q

Plavix adverse effect

A

thrombotic thrombocytopenic purpura
- will appear within one month and if it does D/C

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15
Q

Clopidogrel and preferred PPI

A

pantoprazole (least likely to interact)
lansoprazole and rabeprazole

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16
Q

Is Plavix approved for primary prevention of stroke?

A

NO

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17
Q

When is plavix first line for secondary prevention of stroke?

A

patients with peripheral arterial disease or are allergic to ASA

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18
Q

Dipryridamole (aggrenox)

A

third line antiplatelet
A/E: headache bc of vasodilation

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19
Q

When is double antiplatelet therapy indicated?

A

as secondary prevention for patients with minor stroke (NIHSS 3 or less) or TIA initiated within 24 hours
**for 21 days

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20
Q

What blood pressure meds are recommended?

A

Diuretic either alone or in combo with ACEi

21
Q

Cons of warfarin

A

close monitoring, several drug interactions, and main cause for emergencies in elderly

22
Q

Dabigatran

A

longest half life and is dialyzable

23
Q

how many doses of a DOAC does it take for full anticoagulation?

A

1-2 doses

24
Q

Which DOAC is least likely to cause major bleeding?

A

Apixaban

25
Q

Which DOAC is least likely to cause ICH?

A

all 3 DOACs are less likely to than warfarin

26
Q

Which DOACs cause the most major GI bleeds?

A

Dabigatran and Rivaroxaban
Apixaban and warfarin have lower chance

27
Q

who is high for thromboembolic events if anticoag is interrupted?

A

AFib with CHADS >4, mechanical heart valve, and thromboembolic event within 3 months

  • keep the anticoagulation more aggressive
28
Q

High risk of major bleeding surgeries

A

major cardiac, neurosurgical, orthopedic, urologic, vascular surgery
any major operation lasting > 45 minutes
kidney biopsy, polypectomy, variceal treatment, spincterectomy, pneumatic dilatation

29
Q

What to do is high risk patients undergoing high risk surgery?

A

use short half-life anticoagulant for rapid offset and onset (LMWH or target-specific oral anticoagulant)

30
Q

When to stop Dabigatran for minor surgery

A
  • > 50 GFR: 1 day
  • 31-50 GFR: 2 days
  • <31 GFR 4 days
31
Q

When to stop Dabigatran for major surgery

A
  • > 50 GFR: 2 days
  • 31-50 GFR: 4 days
  • <31 GFR 6 days
32
Q

When to stop Rivaroxaban/Apixaban for minor surgery

A
  • > 50 GFR: 1 days
  • 31-50 GFR: 1-2 days
  • <31 GFR 2 days
33
Q

When to stop Rivaroxaban/Apixaban for major surgery

A
  • > 50 GFR: 2 days
  • 31-50 GFR: 3-4 days
  • <31 GFR 4 days
34
Q

How many hours after last Rivaroxaban dose can you remove epidural catheter?

A

18 hours

35
Q

After epidural removal, when can you give next rivaroxaban dose?

A

6 hours

36
Q

Switch from Warfarin to DOAC

A

wait for INR to drop below 2.0 (apixaban/dabigatran) or 3.0 (rivaroxaban) and anticoagulate immediately

37
Q

how to switch from DOAC to warfarin

A

wait for INR to be near therapeutic range and stop DOAC (1-3 day overlap)
OR
Stop DOAC and bridge with LMWH and intiate warfarin

38
Q

how to switch from heparin to DOAC

A

initiate DOAC when heparin infusion stopped

39
Q

how to switch from DOAC to LMWH

A

wait until next dose is due

40
Q

Dabigatran interacts with

A

Rifampin, ketoconazole, and dronedarone

41
Q

Rivaroxaban interacts with

A

ketoconazole, itraconazole, lopinavir/ritonavir, conivaptan
carbamazepine, phenytoin, rifampin, st. johns wort

42
Q

Apizaban interacts with

A

rifampin, ketoconazole, clarithromycin, ritonavir

43
Q

Missed dose of Dabigatran

A

take missing dose if >6 hours

do not give via NG tube, no chew

44
Q

Missed dose of Xarelto

A

take missing dose ASAP

take with food and ok to crush and put in NG tube

45
Q

Missed dose of Apixaban

A

do not double dose is missed

46
Q

Dabigatran reversal

A

Idarucizumab

47
Q

Apixaban/Xarelto reversal

A

Andexanet alfa

48
Q
A

Neuro (4 decks)

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