Stroke -Issacs

Question 1

Type of Stroke

Answer 1

Ischemic (Atherosclerotic or Embolic-
Cardio/A.Fib)
or
Hemorrhagic

Question 2

what does CHA(2)DS(2)VASc stand for

Answer 2

CHF
HTN
Age (>/= to 75 years)
Diabetes
Stroke/TIA
Vascular disease (MI, aortic plaque, PAD)
Age (64- 75 years)
Sex (female = 1 pt)

Question 3

Managing Risk Factors:

How ot control A.Fib

Answer 3

Control Rate/Rhythm

Anticoag for high risk pts with A.Fib (use CHADSVASC)

Question 4

Managing Risk Factors:

Valvular Disease

Answer 4

use warfarin if valve replacement

Question 5

Managing Risk Factors:
Alcohol use:
_____ drinks per day

Answer 5

= 2 drinks/day

Question 6

who is recommended to get aspirin 81 mg QD for primary prevention of stroke

Answer 6

WOMEN with high CV risk

Question 7

clinical presentation of stroke

Answer 7

• dysphasia (difficulty speaking)
• facial droop
• unilateral/bilateral weakness
• Ataxia (inability to coordinate muscle movement)
• Vision changes (diplopia)
• HA 9more common with hemorrhagic)

Question 8

Glycemic Control and Stroke:
Why manage Hypoglycemia?

Why manage Hyperglycemia?

Answer 8

hypo: could be causing the altered mental status
hyper: in acute stroke situations BG over 180can result in worse outcomes (morbidity and mortality)

Question 9

Thrombolytics have no impact on _____ but can improve ________

Answer 9

no impact on MORTALITY; improve neurologic function

Question 10

What is the Inclusion Criteria for t-PA

Answer 10

• NOT hemorrhagic stroke (must have dx of ischemic stroke)
• Sx onset < 3 hrs ago
• > 18 years old

Question 11

What is the Exclusion Criteria for t-PA

Answer 11

BP > 185/110
BG < 50
(basically lots of bleeding things or past surgeries)
if stroke/head trauma or MI in past 3 months
if on warfarin and INR > 1.7

Question 12

Can do t-PA up to 4.5 hours after symptom onset IF the patient has NONE of the following

• Age ______
• Hx of ______
• Any recent _______
• NIHSS score > ____

Answer 12

Age: > 80
Hx of previous stroke or diabetes
Any recent anticoag use
NIHSS score > 25

Question 13

ADEs of Alteplase

Bleeding and _________

Answer 13

Cerebral edema!

Question 14

Dosing for t-PA

Answer 14

0. 09 mg/kg - IV bolus over 1 minute
1. 81 mg/kg - IV infusion over 60 mins

MAX of 90 mg (aka if over 100 kg there only getting 90mg total)

Question 15

Ischemic Stroke: Acute Blood Pressure Goals depend on ______

Answer 15

if t-PA was given or not

Question 16

Acute BP goal if t-PA IS NOT given:

Answer 16

BP < 220/120 mmHg within first 24 hours

Question 17

Acute BP goal if t-PA IS given:

Answer 17

BP < 180/105 mmHg within first 24 hours

Question 18

Drug options for decreasing BP

Answer 18

• Nicardipine
• Labetalol
• Sodium Nitroprusside

Question 19

who gets aspirin post stroke?

Answer 19

ALL ISCHEMIC stroke pts (def not hemorrhagic stroke pts)

Question 20

when should patients start aspirin post stroke?

Answer 20

if given t-PA: start 24 hours after t-PA

if NO t-PA given then immediately!

Question 21

which ischemic stroke patient is NOT kept on aspirin forever/are switched to another med after a week of aspirin?

Answer 21

CARDIOEMBOLIC - they get switched to an anticoag

Question 22

should an anticoag be given for managing acute embolic strokes?

Answer 22

NO anti-platelet (aspirin) for at least a week first (can increase bleeding complications)

Question 23

options for managing hemorrhagic stroke:
\_\_\_\_\_\_\_\_
reversing \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
anti-\_\_\_\_\_\_\_\_\_\_\_
Prevention of \_\_\_\_\_\_\_\_\_
Anti\_\_\_\_\_\_\_\_\_\_\_

Answer 23

supportive care
reversing causative meds
surgery
ant-hypertensives
Prevention of cerebral vasospasm
Anticonvulsants

Question 24

Ischemic or Hemorrhagic stroke: which one is more likely to have vasospasm complication

Answer 24

Hemorrhagic (try to prevent by using Nimodipine)

Question 25

Highest risk for Vasospasm is __________ days after stroke

Answer 25

4- 21

Question 26

how to prevent vasospasm complication with hemorrhagic stroke

Answer 26

use Nimodipine

Question 27

BP goals for Hemorrhagic Stroke:

Answer 27

first 24 hrs: < 180/110 After first 24 hrs in hospital: < 160/90 (normal goal after hospital aka < 140/90)

Question 28

Ischemic or Hemorrhagic stroke? | which one has risk of seizure after the stroke

Answer 28

hemorrhagic

Question 29

How to manage seizure risk with hemorrhagic strokes?

Answer 29

nothing really... it is NOT recommended to give anticonvulsants as prophylaxis

Question 30

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Antidepressants

Answer 30

both

Question 31

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Antiplatelet

Answer 31

Ischemic (esp. artheroscelorsis)

Question 32

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Anticoagulant

Answer 32

Ischemic (esp. cardioembolic)

Question 33

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Anithypertensive

Answer 33

both

Question 34

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Rehabilitation

Answer 34

both

Question 35

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Cholesterol Reducing Agetns

Answer 35

Ischemic (esp. atherosclerosis)

Question 36

For Post-Stroke Management: Ischemic, Hemorrhagic, or both? Risk factor reduction

Answer 36

both

Question 37

POST-STROKE MANAGEMENT: | which drug options are first line for secondary prevention for non-embolic ischemic stroke

Answer 37

since NON-EMBOLIC | Aspirin or Dipyradimole (or combo of the two)

Question 38

POST-STROKE MANAGEMENT: | which drug options are second line for secondary prevention for non-embolic ischemic stroke

Answer 38

Clopidogrel or Clopidogrel + Aspirin

Question 39

what is the combo drug of dipyridamole and aspirin called

Answer 39

Aggrenox

Question 40

POST-STROKE MANAGEMENT: | which drug options are NOT recommended for secondary prevention for non-embolic ischemic stroke

Answer 40

Ticagrelor or Prasugrel

Question 41

POST-STROKE MANAGEMENT: | which drug options are first line for secondary prevention for embolic ischemic stroke

Answer 41

any DOAC or Warfarin is cool to use (START 7+ days AFTER stroke also discontinue aspirin before starting anticoag)

Question 42

What are some prophylactic antidepressants to use in stroke pts

Answer 42

SSRIs: Sertraline; Fluoxetine; Escitalopram/Citalopraim

Question 43

What are some prophylactic antidepressants to avoid in stroke pts

Answer 43

Paroxetine (an SSRI w/more anticholinergic side effects) | TCAs (w/more anticholinergic side effects)

Question 44

what to start an antidepressant with a stoke pt

Answer 44

like almost immediately because of the delayed onset of action