Stroke & Sleep Flashcards
mini stroke due to brief blockage of blood flow to the brain with temporary symptoms that go away quickly
transient ischemic attack
modifiable risk factors for stroke
hypertension, hyperlipidemia, smokinh, diabetes, Afib, CAD, obesity, post-menopausal hormonal therapy
nonmodifiable stroke risk factors
age >55, black/hispanic race, male FH, PH of stroke
most important piece of history for med administration for stroke
when was the last time they were normal
symptoms of stroke
visual changes, facial droop, motor function of arms/legs, limb ataxia, sensory changes, language, dysarthria
therapeutic time window for stroke for reversible deficits
<2 hours
therapeutic time window for stroke for some but incomplete recovery
2-6 hours
therapeutic time window for stroke for little recovery
> 6 hours
BP goals for someone who is not a candidate for thrombolytics
permissive HTN up to 220 mmHg systolic
2 choices of thrombolytics for stroke
alteplase (TPA)
tenecteplase (TNK)
AE of thrombolytics
intracerebral hemorrhage
BP goals while on thrombolytics
systolic <180 mmHg and diastolic <110 mmHg for 24 hours
IV agents for BP management for thromboloytics
labetalol and nicardipine
main reasons TNK differs from TPA
bolus only, longer half life
symptoms of a bleed from thrombolytics
acute neurologic change, HA, NV, acute HTN, lethargy
inclusion criteria for thrombolytics
ischemic stroke diagnosis
symptoms onset <4.5 hr prior to treatment
18 or older
deficit measured on NIHSS
CT w/ no evidence of ICH
when does 3 hours become the cutoff for thrombolytics
80 or older, severe stroke
2 main B&W exclusion criteria for thrombolytics
seizure at stroke onset
anticoagulants in the last 48 hours
drug class chosen for stroke prophylaxis when a small vessel lacunar, large vessel embolic, or large vessel thrombotic stroke
antiplatelet therapy
drug class chosen for stroke prophylaxis when cardioembolic
anticoagulant
MOA of clopidogrel & ticagrelor
irreversibly blocks ADP receptors on platelets
MOA of aspirin
inhibits COX1 and thromboxane
why is prasugrel not used for stroke
BBW/CI for stroke
increased risk for cerebral hemorrhage
plavix is a prodrug activated by _ & __ which can lead to DDIs
CYP3A4 & 2C19
potential 3A4 & 2C19 DDIs with plavix
statins (not crestor)
CCBs
Ambien/Lunesta
Glyburide
PPIs
max dose of ASA when taking brilinta
100 mg
potential DDI that can affect ASA
NSAIDs (not celecoxib)
herbals
antiplatelet agent not really used anymore than inhibits plasma adenosine and platelet phosphodiesterase
dipyridamole (Aggrenox)
do not use which antiplatelet with migraines
aggrenox
avoid this antiplatelet agent with spastic colon or irritable bowel
ASA
scenarios requiring DAPT for stroke
coronary artery stents
new cerebral ischemia
Afib not candidate for anticoag
cerebral vessel dissection
fail mono
high risk post stroke 1st 3-6 mos
drugs that can cause insomnia
alcohol, caffeine, nicotine, anticholinergics, SSRI, SNRI, a-block, b-block, ACE, ARB, cholinesterase inhibitors, bronchodilators, CNS stimulant, corticosteroids, decongestants, diuretics, H2RA2, statins, opioids
drug for sleep ONSET when want to avoid BZRA and morning sedation
ramelteon
drug choices for sleep ONSET when want to avoid BZRA and do not care about morning sedation
DORA or ramelteon
drugs for sleep ONSET when not avoiding BZRA and want to avoid morning sedation
non-benzo BZRA (zalep, zolp), ramelteon
drugs for sleep ONSET when not avoiding BZRA and do not care about morning sedation
DORA, non-benzo BZRA, ramelteon
which benzo has the most favorable safety profile for insomnia
temazepam
agents with what indication for insomnia may have a higher risk for morning sedation
dual indication for maintenance and onset
drugs of choice for insomnia in elderly
ramelteon, low dose doxepin»_space; eszopiclone, zolpidem
drugs of choice for insomnia in pregnancy
diphenhydramine, doxylamine»_space; low dose doxpein
drugs of choice for sleep MAINTENANCE when want to avoid BZRA
DORA or doxepin
drugs of choice for sleep MAINTENANCE when do not want to avoid BZRA
DORA, doxepin, non-benzo BZRA