Stroke

Question 1

Warfarin Reversal

Answer 1

Vitamin K

Question 2

UFH Reversal

Answer 2

Protamine

Question 3

Hemorrhagic Stroke - Anticonvulsants

Answer 3

Pts are at inc risk of seizure BUT DON’T initiate PTx (unless pt already on b/c Hx of seizures)

Question 4

Dabigatran Reversal

Answer 4

Praxabind (idarucizumab)

Question 5

What problem to always think about while pt is recovering from a stroke?

Answer 5

Depression
- start SSRI :(
- avoid Paraxotine and Tricyclic antidepressants

Question 6

What antiplatelet can you not use in PTx of ischemic strokes?

Answer 6

Prasugrel

Question 7

BP goal (tPA administered)

Answer 7

<180/105
- use parenteral agents to get to goal

Question 8

Hemorrhagic Stroke - Antihypertensives

Answer 8

• Use parenteral agents
• Tx if SBP>180

Question 9

BP goal (No tpA)

Answer 9

<220/110
- use parenteral agents to get to goal

Question 10

Hemorrhagic Stroke - BP Goals

Answer 10

• First 24 hrs: <180/110
• inpt after 24 hrs: <160/90
• after 48 hrs: <130/80 or whatever pts goal

Question 11

Inclusion Criteria for tPA admin

Answer 11

• ISCHEMIC stroke
• Sx onset ≤4.5hrs ago
• ≥18yo
  HOLD ANTICOAGS/PLATELETS FOR NEXT 24HRS IF ADMINED

Question 12

Types of Rehab needed after stroke

Answer 12

ST, OT, PT

Question 13

HTN Tx in Black pop

Answer 13

CCB, Thiazide

Question 14

Atherosclerotic Stroke - Dyslipidemia PTx

Answer 14

High Intensity Statin
- Goal LDL < 70

Question 15

Rivarox/Apixaban Reversal

Answer 15

Andexanet (Andexxa)

Question 16

HTN Tx in CKD, DM

Answer 16

ACE-i/ARB

Question 17

Atherosclerotic Stroke Antiplatelet Tx

Answer 17

• 1st Line: High Dose ASA x2-14days, then 81 ASA indefinitely
• 2nd Line: 81 ASA + Clopid 75 mg QD (minor stroke)
• IF ASA Ax: Ticagrelor MonoTx (needs LD)

Question 18

Hemorrhagic Stroke - Prevention of Vasospasm

Answer 18

• ONLY IF subarachnoid hemorrhagic stroke (inc risk for cerebral vasospasm)
• Nimodipine PO q4h x21days

Question 19

HTN Tx in HFeEF

Answer 19

ARNI/ACE-i + BB + SGLT2-i + Aldosterone antagonist

Question 20

HTN Tx in AFib

Answer 20

BB or Non-DHB CCB (Dilt or Verap) (rate control agents)

Question 21

Exclusion Criteria for tPA admin

Answer 21

• BP: >185/110
• BG <50
• inc bleeding risk

Question 22

HTN Tx in CAD

Answer 22

BB + ACE-i

Question 23

Cardioembolic Stroke Antiplatelet Tx

Answer 23

• 1st Line: High dose ASA x2-14days, then start DOAC (if caused by AFib)
• use Warfarin or Riva if mechanical mitral valve or LV thrombosis