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PR3154 > STROKE, TIA > Flashcards

STROKE, TIA Flashcards

1
Q

TIA formation

A

1) Blocked artery

2) Ischemic stroke occurs when blood clot blocks blood flow in artery within the brain
i) Narrowing of carotid arteries
ii) Embolism of clot

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2
Q

penumbra

A

brain tissue still salvageable

thrombolyse in 3-4.5hr

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3
Q

TOAST criteria in Acute stroke tx

A

1) Stroke of other determined causes

2) Small-vessel disease (penetrating artery disease PAD)

3) Cardioembolic stroke –> AF

3) Large artery atherosclerosis

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4
Q

mNIHSS scale to evaluate effect of acute cerebral infarct on brain functions

A
  • lvl of consciousness
  • gaze
  • visual field
  • left arm
  • right arm
  • left leg
  • right leg
  • sensory
  • language
  • neglect
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5
Q

mNIHSS is used to ___

A

use of sx to find out location of obstruction

eligibility of rTPA

minor stroke: NIHSS 0-3

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6
Q

TIA use ABCD2

estimate risk of ischemic stroke in first 3 days after TIA

A

1) age =/> 60 yo

1) BP =/> 140/90

clinical features:
2) unilateral weakness
1) isolated speech distubrances

2) =/> 60mins
1) 10-59mins

1) DM present

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7
Q

ABCD2 score

A

high risk TIA: =/>4

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8
Q

new onset AIS
(not on antithrombotic therapy)

rTPA eligibility?

A

y: start SAPT (after 24h - 48h)

n:
1) minor stroke, high risk TIA = DAPT asap (21d)

2) not minor = start SAPT asap

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9
Q

stroke mechanism

find out cause of stroke

A
  • MRI
  • 24hr Holter, ECG: find if 1* cardioembolism (AF)
  • TTE: if got any other clots in heart, EF, valvular heart disease
  • Ultrasound carotids: atherosclerosis
  • Lipid panel, TFTs, HbA1c, blood test
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10
Q

CARDIOEMBOLIC (20%)

A

stop antiplt

if AFib: start DOAC (SPAF)

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11
Q

non cardioembolic

A

severe major ICAS
- DAPT 90d (clopi)
- lifelong SAPT

non severe, major
- lifelong SAPT

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12
Q

ICAS

A

itracranial arterial stenosis

cerebral artery
- anterior, middle, posterior

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13
Q

rTPA eligibility (inclusion & exclusioN)

A

inclusion
- acute ischemic stroke
- within 4.5hr of onset
- CT scan consistent with acute ischemic stroke

exclusion
-no haemorrhage (GI, brain)
- stroke, head trauma < 3mnths
- seizure onset of stroke
- major surgery < 14d

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14
Q

rTPA dose

can use tenecteplase also, streptokinase, urokinase

A

within 3hr/ 4.5hr

0.9mg/kg (max 90mg)

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15
Q

aspirin dose

A

Load 300mg
(no load if currently on aspirin)

Follow: 100mg OM (lifelong)

Can be mono

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16
Q

aspirin feature

A

** DAPT unless allergic (densitisation carried out, NSAID cross-allergy)

Not for 1* prevention of ASCVD unless atheroscleorsis

17
Q

clopidogrel dose

A

Load 300mg (6h onset) or 600mg (2h onset)

Follow: 75mg OM

Can be mon

18
Q

clopidogrel feature

A

CYP2C19 LOF (2* 3*)
- incr risk fo CV, CB events (MACCE)
- as less clopido effect to protec

  • CCS for 6mnths
19
Q

ticagrelor dose

A

Load: 180mg

Follow: 90mg BD ~ 12mn

Can be mono

20
Q

tica feature

A
  • Not subjected to CYP2C19 polymorphism. Preferred in most ACS indication (12mnth –> MI)
  • Higher bleeding risk
  • high adenosine (bradycardia, dyspnea)

Genotype guided selection of P2Y12i (ACS + PCI pts) for net benefit

21
Q

dipyridamole dose

A

(PO, antiplt)

25mg - 150mg TDS
Combi with aspirin
* Stroke when even on aspirin
2* prevention

22
Q

dipyridamole feature

A

Neuro: 2* post AIS
- immediated release TDS, tolerability issues need push to incr dose
- SR not avail in SG

IV: imaging agent in cardiology

23
Q

when is DAPT administered

A

within 24h - 48h (per stroke etiology)

24
Q

when is anticoag administered?

A

per indication, usually not within 24hr of rTPA

for cardioembolic

FOR vte PROPHYLAXIS

25
Q

stroke VTE prophylaxis

A

LMWH within 48h. after 24h of rTPA
- due to immobile state
- monitor bleedign risk within 72hr

40mg OD until ambulatory

26
Q

goals of therapy

A

1) thrombolytic agents: reperfusion

2) anticoag: 2* prevention of cardioembolic stroke
2* AF

3) antiplt: DAPT (21d or 90d)

tx of CV risk factors: 2nd prevention ASCVD – HTN, Hyperlipidemia, AF, DM

adherence! (lifelong SAPT, LT DAPT)

27
Q

HTN control with

A

ACEi
CCB
thiazide diuretic

28
Q

high intensity statins

A

atorvastatin 40-80mg

rosuvastatin 20-40mg

add in ezetimbe if LDL > 1.8mmol/L

PR3154 (11 decks)

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