Pharmacotherapy III > Stroke > Flashcards

Stroke Flashcards

Exam 2 (59 cards)

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1
Q

What is an ischemic stroke?

A

A stroke caused by blockage of an artery to the brain, which decreases or stops blood flow and causes ischemia.

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2
Q

What is a thrombotic stroke?

A

An ischemic stroke caused by a clot that forms within a cerebral artery

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3
Q

What is an embolic stroke?

A

An ischemic stroke caused by a clot that forms somewhere else in the body and travels to the brain

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4
Q

What is a hemorrhagic stroke?

A

A stroke caused by bleeding from cerebral vessels, leading to increased intracranial pressure

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5
Q

What is an intracerebral hemorrhage (ICH)?

A

Bleeding caused by rupture of a blood vessel within the brain tissue

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6
Q

What is a subarachnoid hemorrhage (SAH)?

A

Bleeding caused by rupture of a blood vessel under the meninges

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7
Q

What is a subdural hematoma?

A

A localized collection of blood between the dura and arachnoid

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8
Q

What is the most important modifiable risk factor for stroke?

A

Hypertension

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9
Q

What are common modifiable risk factors for stroke?

A
  • Hypertension
  • Cardiac disease (atrial fibrillation, stenosis, calcification or enlargement of valves)
  • Lifestyle (smoking, poor diet, lack of exercise)
  • Diabetes
  • Obstructive sleep apnea
  • Illicit drug use
  • Prior TIA
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10
Q

What are common non-modifiable risk factors for stroke?

A
  • Age (>55 years old)
  • Sex (non-hispanic black and pacific islanders)
  • Race/ethnicity
  • Family history

Morbidity = Men > Women
Mortality = Women > Men

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11
Q

How do stroke symptoms usually begin?

A

Suddenly

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12
Q

What are common stroke symptoms?

A
  • Numbness or weakness of the face, arm, or leg
  • Confusion; trouble speaking or understanding
  • Trouble seeing in one or both eyes
  • Trouble walking, dizziness, loss of balance/coordination
  • Severe headache with no known cause
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13
Q

What does FAST stand for in stroke recognition?

A

Face, Arm, Speech, Time

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14
Q

What does BE FAST stand for in stroke recognition?

A

Balance, Eyes, Face, Arm, Speech, Time

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15
Q

What does the “F” in FAST stand for?

A

Face drooping

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16
Q

What does the “A” in FAST stand for?

A

Arm weakness or drift

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17
Q

What does the “S” in FAST stand for?

A

Speech difficulty or slurred speech

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18
Q

What does the “T” in FAST stand for?

A

Time to call emergency services immediately

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19
Q

What does the “B” in BE FAST stand for?

A

Balance problems

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20
Q

What does the “E” in BE FAST stand for?

A

Eye or vision problems

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21
Q

What is a transient ischemic attack (TIA)?

A

A temporary blockage of blood flow to the brain that resolves spontaneously

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22
Q

Why is TIA called a “mini-stroke”?

A

Because symptoms are temporary and resolve, but it still signals high stroke risk

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23
Q

How long does a TIA usually last?

A

Usually less than 30 minutes, and by definition symptoms resolve within 24 hours

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24
Q

Does a TIA require immediate evaluation?

Study These Flashcards
A

Yes, because it increases the risk of a future stroke

25
What does the ABCD2 score predict?
The risk of stroke after a TIA
26
What are common stroke mimics?
* Hypoglycemia (presents with focal neurological deficits; administer glucose in "stroke" patient with DM) * Seizures/postictal state * Brain tumor * Hypertensive encephalopathy * Migraine * Temporal arteritis
27
Which stroke mimic is especially important to rule out quickly?
Hypoglycemia
28
Why should glucose be checked in a possible stroke patient?
Because hypoglycemia can cause focal neurologic deficits and mimic stroke
29
What phrase emphasizes urgency in stroke treatment?
Time is brain
30
What is the standard time window for r-tPA in acute ischemic stroke?
Within 4.5 hours of last known well
31
What does “last known well” mean?
The last time the patient was known to be normal or symptom-free
32
Can r-tPA be given before hemorrhage is ruled out?
No, hemorrhage must be ruled out first, usually by CT
33
What type of stroke is r-tPA used for?
Acute ischemic stroke
34
What does r-tPA stand for?
Recombinant tissue plasminogen activator
35
What is the generic name for r-tPA commonly used in stroke?
Alteplase
36
What are important adverse effects of alteplase?
Bleeding, allergic reactions, and angioedema
37
What is the alteplase dose for acute ischemic stroke?
0.9 mg/kg
38
What is the maximum alteplase dose for stroke?
90 mg
39
How is alteplase given for stroke?
10% as an IV bolus over 1 minute, then the remaining 90% as an infusion over 60 minutes
40
What is the tenecteplase dose for stroke?
0.25 mg/kg
41
What is the maximum tenecteplase dose for stroke?
25 mg
42
How is tenecteplase given for stroke?
As a single IV bolus
43
After r-tPA, which medications should be avoided initially?
Antithrombotics and antiplatelets for the first 24 hours
44
What blood pressure goal is used after r-tPA in hypertension?
Less than 185/105 mmHg
45
Which agents are preferred for BP control after r-tPA?
Labetalol, nicardipine, or clevidipine
46
Why should BP not be lowered too aggressively after stroke?
Because it can reduce cerebral perfusion and worsen neurologic injury
47
What drug is used after subarachnoid hemorrhage to reduce cerebral vasospasm?
Nimodipine
48
What is the dose of nimodipine after SAH?
60 mg by mouth every 4 hours for 21 days
49
When should nimodipine be started after SAH?
Within 96 hours of onset
50
What is the purpose of nimodipine after SAH?
To reduce morbidity and mortality from cerebral vasospasm
51
What is recommended for VTE prophylaxis after ischemic stroke?
Intermittent pneumatic compression; low-dose SQ heparin or LMWH may be reasonable
52
What are major focuses of primary stroke prevention?
Lifestyle, blood pressure control, diabetes control, statins, and atrial fibrillation management
53
What antiplatelet options are used for secondary prevention after stroke or TIA?
Aspirin, clopidogrel, or aspirin plus extended-release dipyridamole
54
What dual antiplatelet regimen is used for minor stroke or high-risk TIA?
Aspirin plus clopidogrel
55
How long is aspirin plus clopidogrel used after minor stroke or high-risk TIA?
21 to 90 days, then back to a single antiplatelet agent
56
What statin is recommended after stroke without CAD or embolism when LDL is over 100 mg/dL?
Atorvastatin 80 mg daily
57
What LDL goal is recommended after stroke or TIA?
Less than 70 mg/dL
58
In very high-risk patients with stroke plus ASCVD, what may be added to reach LDL goal?
A PCSK9 inhibitor
59
What are some possible long-term complications of stroke?
Motor dysfunction, cognitive/language changes, pain, sleep disorders, bowel/bladder dysfunction, sensory changes, and psychological changes
Pharmacotherapy III
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