2023-09-25T02:10:08+03:00[Europe/Moscow] en true <p>stroke </p>, <p>b</p>, <p>a</p>, <p>false</p>, <p>b</p>, <p>sudden: weakness on one side, trouble walking, vision problems, speaking problems, severe headache</p>, <p>face uneven, arm drift down, strange speech, time </p>, <p>symptom onset &gt; 4.5 hours/unknown, intracranial hemorrhage, severe head trauma/spinal surgery within 3 months, GI bleed &lt;= 21 days, use of LMWH &lt;=24 hrs, DOAC use &lt;= 48 hours, infective endocarditis, aortic dissection, brain cancer</p>, <p>platelets &lt;100,000, INR &gt; 1.7, aPTT &gt;40s, PT&gt; 15s</p>, <p>cryoprecipitate, tranexamic, aminocaproic </p>, <p>&lt;180/105 for at least 24 hrs</p>, <p>140-180 mg/dL </p>, <p>O2&gt; 94%</p>, <p>oxygen, anti-fever, BG, BP, DVT prophylaxis </p>, <p>&gt;185/110; labetalol IV push, nicardipine IV, clevidipine IV</p>, <p>slowly; 15%</p>, <p>24-48 hrs after tPA; prevent conversion to hemorrhagic stroke</p>, <p>ASA 50-325 mg, ASA 25 mg + dipyridamole ER 200mg, Clopidogrel 75mg</p>, <p>Warfarin/DOACs; 2-14 days post stroke</p>, <p>anti-thrombotics, high-intensity statin, thiazide, ACEi/ARB</p>, <p>weight management, physical activity, low-salt diet, smoking cessation, reduce alcohol</p>, <p>ASA + dipyridamole </p>, <p>vasodilator; platelet inhibitor </p>, <p>headaches </p>, <p>fixed dose of 25 mg ASA + 200mg dipyridamole ER, BID dosing, avoid if CrCl &lt; 10mL/min, do not break/crush capsule </p>, <p>efficacious; ADEs </p>, <p>true</p>, <p>cryptogenic </p>, <p>cardioembolic </p>, <p>atherosclerosis, cardioembolic, local thrombus formation</p>, <p>ATP; anaerobic metabolism; lysis </p>, <p>glutamate; aspartate </p>, <p>African Americans, asian-pacific islanders, hispanics </p>, <p>men; women </p>, <p>within 20 min of ER arrival </p>, <p>glucose; coagulation tests</p>, <p>within 4.5 hours</p>, <p>within 6 hours </p>, <p>internal carotid artery; middle cerebral artery </p>, <p>carotid stenosis </p>, <p>0.9 mg/kg over 60 min with 10% given as bolus over 1 min</p>, <p>monitor patient for severe HA, HTN, nausea/vomiting; stop infusion</p>, <p>measure BP every 15 min for 2hrs; ever 30 min for 6; every hr for 16 </p> flashcards
Therapeutic Management (Ischemic Stroke)

Therapeutic Management (Ischemic Stroke)

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  • stroke

    -abrupt-onset focal neurologic deficit that lasts at least 24 hours and is of

    presumed vascular origin

  • b

    Which lasts at least 24 hours?

    a) TIA

    b) stroke

  • a

    Which lasts < 24 hours, usually less than 30 min?

    a) TIA

    b) stroke

  • false

    Strokes are more prevalent in men. T/F?

  • b

    Which is more lethal?

    a) ischemic

    b) hemorrhagic

  • sudden: weakness on one side, trouble walking, vision problems, speaking problems, severe headache

    Signs of a stroke? (5)

  • face uneven, arm drift down, strange speech, time

    What does the acronym FAST stand for?

  • symptom onset > 4.5 hours/unknown, intracranial hemorrhage, severe head trauma/spinal surgery within 3 months, GI bleed <= 21 days, use of LMWH <=24 hrs, DOAC use <= 48 hours, infective endocarditis, aortic dissection, brain cancer

    CI of Fibrinolytics in AIS treatment? (9)

  • platelets <100,000, INR > 1.7, aPTT >40s, PT> 15s

    What CBC values are contraindicated in AIS treatment with fibrinolytics? (4)

  • cryoprecipitate, tranexamic, aminocaproic

    What reversal agents can we use if we have an Intracranial bleed when

    using fibrinolytic? (3)

  • <180/105 for at least 24 hrs

    AIS-Supportive care: goal BP?

  • 140-180 mg/dL

    AIS-Supportive care: glucose goal?

  • O2> 94%

    AIS-Supportive care: oxygen goal?

  • oxygen, anti-fever, BG, BP, DVT prophylaxis

    What is included in AIS supportive care? (6)

  • >185/110; labetalol IV push, nicardipine IV, clevidipine IV

    When administering a tPA, if the BP is __________; administer _______, ________, ________

  • slowly; 15%

    If tPA NOT administered & BP >220/120 mmHg treat _______ with goal of

    lowering _____ within the first 24 hours.

  • 24-48 hrs after tPA; prevent conversion to hemorrhagic stroke

    When/Why do we use Anti-Platelets in acute management of ischemic

    strokes?

  • ASA 50-325 mg, ASA 25 mg + dipyridamole ER 200mg, Clopidogrel 75mg

    What are our anti-platelets used post-stroke?

  • Warfarin/DOACs; 2-14 days post stroke

    What medications do we use in secondary prevention if a patient has

    AFIB/Flutter?

    When does their treatment start?

  • anti-thrombotics, high-intensity statin, thiazide, ACEi/ARB

    What are the treatments for secondary prevention of Ischemic stroke? (4)

  • weight management, physical activity, low-salt diet, smoking cessation, reduce alcohol

    What is included in lifestyle counseling? (5)

  • ASA + dipyridamole

    Aggrenox =

  • vasodilator; platelet inhibitor

    Dipyridamole is a ______ and ________.

  • headaches

    What is the most common AE in Aggrenox?

  • fixed dose of 25 mg ASA + 200mg dipyridamole ER, BID dosing, avoid if CrCl < 10mL/min, do not break/crush capsule

    What are the dosing guidelines for Aggrenox? (4)

  • efficacious; ADEs

    Aggrenox is more ________ than ASA monotherapy, but has higher rates of _______.

  • true

    Aggrenox is equal to Clopidogrel in efficacy, but has worse tolerance. T/F?

  • cryptogenic

    30% of strokes are _________.

  • cardioembolic

    occurs when the heart pumps unwanted materials into the brain

    circulation, resulting in the occlusion of a brain blood vessel and

    damage to the brain tissue

  • atherosclerosis, cardioembolic, local thrombus formation

    How do Ischemic strokes occur? (3)

  • ATP; anaerobic metabolism; lysis

    Ischemia leads to ________ depletion and ________. Eventually leading to

    cell _______.

  • glutamate; aspartate

    __________ & _________ are released from ischemic tissue to perpetuate

    damage.

  • African Americans, asian-pacific islanders, hispanics

    Which races have higher risks of stroke? (3)

  • men; women

    _______ have a higher rate at younger age, but ______ have higher mortality

    & lifetime risk.

  • within 20 min of ER arrival

    When should a stroke patient receive a CT scan?

  • glucose; coagulation tests

    Once stroke is confirmed, what tests are done? (2)

  • within 4.5 hours

    When are fibrinolytics given to stroke patients?

  • within 6 hours

    When is a mechanical thrombectomy performed?

  • internal carotid artery; middle cerebral artery

    Thrombectomies are indicated for patients with occlusion in the ______ or _______.

  • carotid stenosis

    Carotid endarterectomy/stents are useful in secondary prevention if __________.

  • 0.9 mg/kg over 60 min with 10% given as bolus over 1 min

    Alteplace infusion?

  • monitor patient for severe HA, HTN, nausea/vomiting; stop infusion

    Monitoring for Fibrinolytics? (3)

    What do we do if patient has these signs?

  • measure BP every 15 min for 2hrs; ever 30 min for 6; every hr for 16

    How does BP monitoring work Post-tPA?