Term
| Tx of acute stroker depedns on category, what are the 3 |
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Definition
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Term
| look at algorythm on slide 2 to see quick overview before exam |
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Definition
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Term
| if TIA occurs in front of you how do you tx? |
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Definition
| as emergency since cant tell if full stroke at that point |
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Term
| action to take if acute TIA occurs : 4 |
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Definition
treat as emergency
basic life support
keep pt safe
transfer to ER |
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Term
| 2nd prevention of TIA stroke gold stanadrd |
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Definition
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Term
| when prescribing apsirin, 81 mg or 325? |
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Definition
| doesnt matter, want tog ive lowest dose possible but normally the dosage form drives the one used |
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Term
| the two issues with aspriin for 2nd prevention are- |
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Definition
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Term
| why isnt ticlopidine used anymore-2 |
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Definition
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Term
| if a pt fails apsirin, like intolerant or allergy what is the nex med to use |
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Definition
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Term
| * in 2nd prevention study show that if apsirin isnt usable, just switch to clop instead of combo, as combo increase risk fo bleeding and no decrease in stroke |
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Definition
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Term
| dipyridamole ER and aspriin combo shown to more effective than monotherapy, but what are the 2 rpoblems- |
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Definition
1- high % of dypyridmole pts d/c due to side effects
2. daily dose of aspirin with this is only 50 mg (if have risk of Mi would need additionla apsinrin) |
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Term
| when are anticaogs used as 2nd prevention in TIA-2 |
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Definition
| if pt has a fib or mechanical heart valves |
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Term
| INr for mechanical valves is |
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Definition
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Term
| the dose for warfarin 2nd prevention TIA is |
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Definition
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Term
| what is not a loading for warfarin |
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Definition
| 10 mg x 3 day ->7.5->5 mg |
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Term
INr monitoring for warfarin
when can you go to monthly? |
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Definition
2x weekly for first 2 weeks, then q 2 weeks
2 good INRs 2 wks apart |
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Term
| when is dabigitran superior to warfarin |
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Definition
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Term
| what are the problems with dabigitran-3 |
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Definition
no antidote
renal adjustment
elderly have hgiher GI bleeds and worse renal |
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Term
rixaroxiban and apixiban are non inferior to warfarin when?
when would you use these? |
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Definition
non valve a fib
if hard to stabilize on warfarin |
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Term
| when is surgery indicated for TIA |
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Definition
| >75% stenosis and symtpomatic |
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Term
| intitial work up for stroke pt needs to done in how long |
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Definition
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Term
| what needs to be addressed in initial work up of stroke pt at ER-3 |
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Definition
| consciousness, ataxia, vital |
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Term
| what 4 labs need to be drwan when stroke pt shows up |
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Definition
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Term
| what is the most important test to run when stroke pt comes in |
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Definition
| NON CONTRAST CT scan w/i 180 min onset of symtpoms |
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Term
pros to using MRI over CT-2
cons-2 |
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Definition
better when know thromoblytics cant be used, can better Id deep infarcts
labs dont alwyas offer MRI and contraindt in pacemakers or metal implants |
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Term
| general supoprtive measures (give to everyone)-6 |
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Definition
airway managment
Oxygen
hydration
BP control
fever control
hyperglycemia |
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Term
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Definition
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Term
| for hydraiton what is reccomedned and what is not |
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Definition
ringers/saline reccomedn
not= dextrose jic hyperglycemic |
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Term
| BP control for pt not candidate for t PA,when do you treat |
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Definition
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Term
| for pt who is candidate for t pa, what is BP control tx |
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Definition
| use labetolol before an d during t pa admin |
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Term
| what is most common time to intiate BP regimen after stroke |
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Definition
| 48 hrs (no real evidence tho) |
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Term
| indicaitons for thrombolytic therapy |
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Definition
over 18
embolic confirmed thru CT scan
pt presents w/i 3 hrs |
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Term
| some contraindications for T pa-7 |
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Definition
heparine w/i 48 hrs AND elevated aPPT
recent warfarin AND elevated INR
trauma last 3 months
recent MI
any bleeding
seizure
BP>185 or Dys>110 |
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Term
| is 75 yo a cut off for T PA? |
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Definition
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Term
| ** if have premorbid neuro deficits prior to onset of symtpoms of stroke dont do T PA |
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Definition
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Term
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Definition
| .9 mg/kg, 10% bolus over 1 min then rest over 1 hr |
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Term
| risk of hemorrhage for acute embolic stroke is what hrs |
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Definition
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Term
| when can T Pa window be extended to 4.5 hrs: |
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Definition
pt qualifies for T PA AND
<80
no anticoags
NIHSS< 25
NO prev x stroke and diabetes |
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Term
for BP control in supportive care what do you use if BP >220 or diastolic >121
what is diastolic > 140 |
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Definition
labetolol 10 mg over 1 min
nitroprusside for BP decrease 20% |
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Term
| can use low dose SQ heparin after stroke, if you wanted to how long do you have to wait? |
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Definition
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Term
| *2nd prevention for full stroke is same as TIA |
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Definition
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Term
| if intracerebral hemorrg assoc with factro def or thombocytopenia what do you do |
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Definition
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Term
| if hemorrhage stroke assoc with high INR from warfarin what do you do |
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Definition
hold warfarin
IV Vit K + PCC/FFP |
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Term
pros and cons of PCC
smae but for FFPrxn, large vol needed |
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Definition
all vit k factors, use small vol; not FDA approved
FDA approved; can cause allergic |
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Term
| when do you give seizure meds for stroke pt? |
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Definition
| hemorrhagic and had to have had one or EEG shows evidence |
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Term
| seconadry prevention of hemorrhagic stroke |
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Definition
| BP control <140/90, if diabetic 130/80 |
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Term
if subarachnoid hemorrhage tx for
how long after can this ocurr |
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Definition
vasopsam prevention/DCI
-3 wks |
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Term
| what drug is started at subarachnoid hemorg? how long do you cont it |
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Definition
nimodipine 60 mg q 4 hrs
21 days |
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Term
| seizure tx for subarrachoind hemmor |
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Definition
can do during the ACUTE STAGE
dont do it chronically!!!!! |
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Term
| other intervention for hemmrohg to reduce cerebral edema |
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Definition
mannitol .35mg/kg q 8 hrs
monitor for osmolalaltoy (want 300-310) |
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Term
| what do you give if subarachnoid pt has vasospasm |
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Definition
| dopamine 3 mg/kg/min *increases bleed risk |
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Term
| *dexmethasone used before mannitol, but since icnrease infxand glucose dont use as much |
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Definition
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Term
| surgery for hemorrhagic pt indicated if: |
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Definition
bleed need surface
not comatose
(if cerebellar cna do within 2 days) |
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Term
| intervention for hemiparesis:2 |
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Definition
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Term
| intervention for contractures and tone problems:3 |
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Definition
PT
OT
mmuscle relaxants(baclofen) |
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Term
| intervention for neuropathic/phantom pain:3 |
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Definition
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Term
| if pt has swallowing difficulties, what med intervention |
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Definition
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Term
| neurogenic incontinence (no nerves to bladder) or functional (physcial defects prevent restroom use) interventions: |
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Definition
| no medicaitons, bc they are for urge incont!!!! |
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Term
| what meds are indicated for vascular dementia |
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Definition
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Term
| lack of awareness of deficits (part right sided stroke) intervention |
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Definition
| repeat enforcement of safety pre cautions, supervise |
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Term
| post stokree depressin often seen in what side |
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Definition
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Term
| intervention for depression |
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Definition
TCAs vs SSRIs (TCAs have anticholinergic so maybe SSRI like fluoxetine
* if done within 3 mo more ADL funct |
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