Term
Two types of strokes:
Which is most common?
Which is most severe? |
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Definition
ischemic
hemorrhagic (less common/most debilitating) |
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Term
| How is each type of stroke named? |
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Definition
Hemorrhagic is named by bleed location
Ischemic is named by etiology |
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Term
| The pathway of an ischemic stroke |
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Definition
1. Occlusion
2. Ischemia
3. Toxic cascade |
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Term
| What events lead to the occlusion? |
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Definition
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Term
| In ischemia what is occurring to the tissue? |
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Definition
Reduced nutrient/waste exchange
Anaerobic metabolism
Ion shifts |
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Term
| Explain the toxic cascade |
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Definition
1. Excess of excitatory A.A.
2. Inflammation mediators
3. Free radical production |
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Term
| What co-morbidities are associated with a hemorrhagic stroke |
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Definition
Trauma
Infection
Uncontrolled HTN
tumor
Abnormal vessels |
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Term
| Ultimately a hemorrhagic stroke manifests as... |
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Definition
| Increased cranial space volume |
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Term
| What are the 3 Cincinnati Pre-hospital Stroke Test criteria? |
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Definition
1. Facial droop
2. Arm drift
3. Abnormal speech |
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Term
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Definition
1. CT scan (quick)
2. MRI (longer) |
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Term
| Ways to prevent a stroke from ever occuring |
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Definition
1. BP control
2. No smoking
3. Anti-platelet therapy if appropriate
4. Anti-coagulation therapy if CHADS >/= 2, or PT has A. fib
5. Statin therapy if needed |
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Term
| Describe the line drawn across the body that determines if a pt will need anti-platelet or anti-coagulation therapy |
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Definition
Clot above shoulders = anti-platelet
Clot below shoulders = anti-coagulation |
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Term
| The CHADS scale is for what type of PTs? |
|
Definition
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Term
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Definition
1 - CHF
1 - HTN
1 - Age >/= 75
1 - Diabetes
2 - Stroke/TIA (previous)
@ or more anti-coagulation therapy |
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Term
| When is it okay to use rt-PA (Alteplase)? |
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Definition
ISCHEMIC stroke ONLY
Within the first 4 hours |
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Term
| What are six contraindications to using rt-PA (Alteplase)? |
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Definition
1. Symptoms have began to improve
2. Heparin within the last 48 hours
3. Active internal bleeding
4. Intra cranial surgery in the last 3 months
5. Seizure occurred at the stroke's 6. onset
BP > 185/110 |
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Term
| How is rt-PA (Alteplase) dosed? |
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Definition
0.9mg/kg IV
10% bolus 90% infusion over 1 hr
Max 90mg |
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Term
| How is rt-PA (Alteplase) monitored |
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Definition
Hours 1: every 15min
Hours 2-7: every 30min
Hours 8-24: every hour
Hours 25+: every shift |
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Term
| What is monitored after rt-PA (Alteplase) administration |
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Definition
1. Bleeding
2. Neurological recovery
3. PT/INR/aPTT
4. Hemoglobin/Hematocrit
5. Cranial CT scan |
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Term
| What trial confirmed rt-PA to be effective in ischemic stroke treatment? |
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Definition
| NINDS - Nat. Institute of Neurological Disorders |
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Term
| BY how much does rt-PA improve ischemic stroke outcomes according to the NINDS trial? |
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Definition
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Term
| What trial determined Aspirin to be an effective anti-platelet treatment? |
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Definition
| The international stroke trial |
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Term
| What trial determined that pts on aspirin had better outcomes? |
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Definition
CAST (Chinese Acute Stroke Trial)
[160-325mg used in trial] |
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Term
| What is the role of uf-heparin/LMWH in stroke pts? |
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Definition
| 3-4 days after rt-PA if the pt has some paralysis, then they need uf-hep/LMWH to prevent a VTE |
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Term
| What is the dosing of of uf-heparin/LMWH? |
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Definition
UFH = 5000u SQ q8-12h
Enoxaparin = 40mg SQ qDAY
Dalteparin 2500u SQ qDAY |
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Term
| What single factor makes the largest difference in stroke recurrence? |
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Definition
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Term
| What BP therapy is preferred in post stroke pts? |
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Definition
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Term
| How is dyslipidemia treated post stroke? |
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Definition
| 80mg atorvastatin regardless of baseline LDL |
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Term
| The brand name drug Aggrenox consist of what combination of drugs? |
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Definition
| 200mg Dipyridamole + 25mg Aspirin |
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Term
| What trial showed a dipyridamole/aspirin combination drug like Aggrenox would be an effective treatment? |
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Definition
| ESPS-2 European Stroke Prevention Study-2 |
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Term
| Describe the results of the CAPRIE (Clopidogrel vs. Aspirin in Pt Risk for Ichemic Events) trial |
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Definition
| Clopidogrel is less likely to cause MI and GI hemorrhage |
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Term
| In the CAPRIE trail clopidogrel beat out plain aspirin, but what was discovered in the ProFESS trial? |
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Definition
| Aggrenox (cdipyridamole/aspirin combo drug) was equivalent to clopidogrel alone |
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Term
| The MATCH (MGMT of atherothrombis w/ Clopidogrel in High riskj prs) trial compared Clopidogrel alone vs. a clopidogrel/aspirin combo products. What was the result in these pts? |
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Definition
| The combination of clopidogrel and aspirin greatly reduced hemorragic strokes & life threatening bleeding |
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Term
| Anti-platelet therapy should be monitored in 3 ways |
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Definition
1. Signs/symptoms of bleeding
2. Signs/symptoms of stroke
3. CBC |
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Term
| How are direct XA inhibitors (rivaroxaban/apixaban) different from WARFARIN in anti-coagulation therapy? |
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Definition
1. Cost more
2. unable to monitor
3. no antedote
4. Higher risk of MI |
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Term
| Which direct xa inhibitor has a storage issue? |
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Definition
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Term
|
Definition
Normal 150mg PO BID
Renal Reduced 75mg PO BID |
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Term
|
Definition
Normal 20mg PO qDAY
Renal reduced 15mg PO qDAY |
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Term
|
Definition
Normal 5mg PO BID
High risk 2.5mg BID
(High risk = age>/= 80, =/< 60kg, SCr>/=1.5mg/dL) |
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Term
| The RELY study determined |
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Definition
| The efficacy/safety of dabigatran to be greater than WARFARIN |
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Term
| The Rocket-AF study determined |
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Definition
| The efficacy/safety of drivaroxaban to be greater than WARFARIN |
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Term
| The ARISTOTLE study determined |
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Definition
| The efficacy/safety of apixiban to be greater than WARFARIN |
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