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PM2C: Therapeutics and Patient Care: Summer > Thrombotic Diseases > Flashcards

Thrombotic Diseases Flashcards

1
Q

Define what a stroke is?

A
  1. Rapid death of brain tissue due to a disturbance in blood supply
  2. Persists for beyond 24 hours or results in death
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2
Q

Define what a TIA is?

A
  1. Transient Ischaemic Attack (TIA)

2. A mini stroke that is completely resolved within 24 hours

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3
Q

Give examples of risk factors for stroke?

A
  1. Inactivity
  2. High blood pressure
  3. Heart disease
  4. Previous stroke or TIA
  5. Obesity: unhealthy eating
  6. smoking
  7. Diabetes
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4
Q

What are main arteries that supply blood to the brain?

A
  1. Carotid arteries: Anterior: supply front and back part of brain
  2. Vertebral arteries: Posterior: Brain stem and rear regions of brain
  3. Basilar arteries: two vertebral arteries
  4. Communicating arteries: Posterior and anterior
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5
Q

Describe how a thrombosis can cause an ischaemic attack?

A
  1. Affects large arteries: Carotid (blockage in here, clog in cerebral artery), Vertebral, Basilar
  2. Larger branches: anterior, middle and posterior cerebral arteries
  3. Small branches of the larger branches
  4. Atherosclerotic plaque rupture leads to thrombosis
  5. Interrupts blood supply (oxygen and other nutrients) to neurones
  6. Rapid death of brain tissue leads to loss of brain function
  7. Changes observed within 2 to 3 hours of ischemia
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6
Q

Describe how a embolism can cause an ischaemic attack?

A
  1. This is clots from other main stream arteries such as the heart is a common source to the brain
  2. Congestive heart failure and MI (common causes of clots to left ventricle)
  3. Low ejection fraction for left side of the heart leads to emboli forming
  4. Blood stasis leads to thrombosis: clot
  5. Emboli can break up to pieces and block arteries which results in stroke
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7
Q

Describe what a haemorrhagic stroke is in relation to intercerebral?

A
  1. Intercerebral (within brain)
  2. Caused by: Hypertension, trauma, bleeding disorders and vascular effects
  3. Mechanism:
    - NIDUS group of smaller blood vessel bursts, spilling blood onto brain, less nourishment
    - Haematoma is formed which does irreversible damage to neurons
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8
Q

Describe what a haemorrhagic stroke is in relation to subarachnoid (surface of brain)?

A
  1. Weak spot in tissue wall called aneurysm bursts mainly in circle of willis (bottom mid section of brain)
  2. Risks: smoking, alcohol, hypertension, genetic, drug abuse
  3. Anterior communicating and cerebral arteries
  4. Two types: saccular (berry) and fusiform
  5. Damage: compression of tissue from expanding haematoma
  6. Direct toxic effect to the blood cells (free iron)
  7. Interrupting blood supply to neurones
  8. Surgical intervention necessary
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9
Q

Describe what occurs in a TIA stroke?

A
  1. Temporary small blockage of blood supply due to small blood clots
  2. Overcome in 30 to 60 minutes or 24 hours
  3. Can occur repeatedly or in multiple regions
  4. Major ischemic stroke can occur
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10
Q

Describe what an ABCD2 is able to identify?

A
  1. A score assessment that identifies people at high risk of a stroke
  2. Based on: Age, blood pressure, clinical features and duration of symptoms
  3. 300mg aspirin immediately: cannot assess someone like this if they’re already on anti-coagulant
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11
Q

Describe the specific symptoms of a stroke?

A
  1. Loss of consciousness or coma
  2. Worst headache
  3. Loss of vision or double vision
  4. Slurred speech
  5. Numbness in right side of face or arms and legs
  6. Weakness of face, arm or leg
  7. Loss of balance and co-ordination
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12
Q

Define how you simply recognise a stroke with the term: FAST?

A

F: Falling and drooping of face, can they smile

A: Arm weakness, can they lift them up and keep it there

S: Slurred speech, can they speak clearly?

T: Time to call 999

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13
Q

How do you manage a stroke?

A
  1. Rapid recognition of stroke symptoms
  2. Rapid action to ensure patient survival
  3. Risk of stroke in TIA patients
  4. Acute stroke: brain scans of MRI
  5. Existing treatment to prevent further strokes
  6. Neurological loss (neuroprotection)
  7. Neurorestoration (replace damaged neurons)
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14
Q

How do you pharmacological manage a patient after they’ve had TIA?

A

High score

  1. Aspirin 300mg daily
  2. Specialist assessment and management
  3. Measures for secondary prevention- assessment of individual risk factors
  4. Crescendo TIA (treated for high risk)

Low risk

  1. Assessment within one week following onset of symptoms
  2. Refer to brain imaging if necessary
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15
Q

How do you pharmacological manage a ischemic stroke?

A
  1. Thrombolytic agents:
    - Tissue plasminogen activator (tPa)
    - Alteplase (900 micrograms for 1 hour)
  2. Promotes breakdown of fibrin (lysis of blood clot)
  3. IV administration within 4.5 hours of stroke, improves clinical outcome (decrease mortality)
  4. Carotid angioplasty (stent) (cannot be used in haemorrhage stroke)
  5. Carotid endartectomy: treatment to remove the plaques
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16
Q

What is the pharmacy management of a ischemic stroke?

A
  1. Alteplase (900 micrograms within 1 hour)
  2. Aspirin 300mg for 2 weeks (if not given already) or clopidogrel 75mg
  3. Modified release Dipyridamole in combination with aspirin
  4. Other anti-coagulants, anti-hypertensives, statins and surgeries to remove blockages
17
Q

What is the pharmacy management of a haemorrhagic stroke especially subarachnoid?

A
  1. Removal or clipping of aneurysm
  2. Anti-hypertensives
  3. Craniotomy to remove blood or haemotoma

4.

18
Q

What are the long term treatment options available for a stroke and TIA?

A
  1. Clopidogrel 75mg daily, can be used in other cardiovascular diseases if aspirin is contraindicated
  2. Modified release of dipyridamole 200mg twice daily alongside aspirin (75mg daily)
    - Used in TIA
    - Ischemic stroke
    - Or if clopidogrel is not tolerated
19
Q

Describe what peripheral arterial resistance is?

A
  1. Atherosclerotic plaques in lower extremities (legs)
  2. Hardening of arteries supplying blood to legs
  3. Blocks blood supply leads to ischemia death results in myocyte death
  4. Occurs more in males, diabetes and smokers
20
Q

What are the causes, symptoms and diagnosis of peripheral arterial resistance?

A
  1. Causes: Diabetes, smoking, high blood pressure, obesity
  2. Symptoms: asymptomatic at first, poor skin, infections don’t heal, pain with walking, discolouration
  3. Diagnosis: Blood pressure at arms and legs (systolic blood pressure), angiopathy
21
Q

What is the treatment for peripheral arterial resistance?

A
  1. Change of lifestyle: stopping smoking, regular exercise, reduced alcohol consumption
  2. Medications: hyperlipidaemia, hyperglycaemia and hypertension
  3. Anti-platelet drugs: 75mg aspirin
  4. Naftidrofuryl oxalate (vasodilator): improves limping pain and impairment in walking
  5. Cilostazol: (PDE inhibitor and inhibits platelet activation): second line treatment
  6. Angioplasty and endartectomy
22
Q

Describe what deep vein thrombosis is?

A
  1. Occurs in deep vein in lower extremities such as legs
  2. Blood flows back to heart due to muscle movement
  3. Reduced movement or injury stops blood flow in veins
  4. Accumulation of platelets and plasma proteins lead to clotting
  5. Clot could be smaller: breaks up easily by fibrinolysis
  6. Large clots can prevent blood flow permanently
  7. Pulmonary embolism can occur when dislodged clots travel to heart
23
Q

Describe what the causes of deep vein thrombosis are?

A
  1. Long periods of inactivity (during or after surgery)
  2. Long stay at hospitals
  3. Blood vessel damage: varicose veins
  4. Medical conditions: Increase clotting factor
  5. Genetic conditions: thrombophillia: more likely to clot
  6. Pregnancy: make blood clot more quickly
  7. Combined contraceptive pill and hormone replacement therapy can make you clot more easily
  8. Previous DVT, smoking and diabetes
24
Q

What are the symptoms of deep vein thrombosis?

A
  1. sometimes symptomatic
  2. Pain and tenderness, swelling in the leg
  3. Heavy pain in affected area
  4. Warm skin in area of clot
  5. Redness of skin at the back of the leg
  6. Untreated can lead to pulmonary embolism
  7. Breathlessness
  8. Chest pain
25
Q

How do you diagnose DVT?

A
  1. Blood test for D dimer levels
  2. Ultrasound scan
  3. Venogram
26
Q

What are the treatment options for DVT?

A
  1. Anti-coagulants prevent clots getting bigger
  2. Heparin: anticoagulant and inhibitor of thrombin: IV infusion, injection or subcutaneous injection (Low Mw)
  3. Warfarin sodium (started at same time as heparin)
  4. Rivaroxaban
  5. Apixaban
  6. Compression stocking- to prevent formation of a new clot
  7. Walking, exercise, raising legs at rest
  8. Inferior vena carva fillers: inserted via catheter into vein, prevents large clots travelling to heart or lungs

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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