cerebrovascular accidents: TIA and ischemic stroke – Flashcards
Unlock all answers in this set
Unlock answersquestion
amat
answer
love
question
types of CVA
answer
hemorrhagic and ischemic
question
types of ischemic attacks
answer
transient ischemic attack and stroke
question
ischemic stroke
answer
clot blocks blood flow to an area of the brain
question
hemorrhagic stroke
answer
bleeding occurs inside or around the brain tissue
question
thrombi
answer
artheromas in major cerebral arteries in areas of turbulent flow
question
emboli lodged in cerebral artery because of:
answer
A fib, post-MI, vegitations as in endocardidtis, prosthetic heart valves
question
subarachnoid hemorrhage (SAH)
answer
bleeding in space between brain and skull caused by aneurism
question
symptoms of SAH
answer
worst headache, N, V, loss of conciousness, coma
question
SAH physical exam findings
answer
nuchal regidity, paralysis
question
Tx goal of SAH
answer
prevent complications, delay ischemia, allow HTN to redirect bloodflow to ischemic areas
question
Tx choice for SAH
answer
nimodipine 60mg IV q4h
question
Tx of seisures due to SAH
answer
phenytoin
question
Tx of rebleeding
answer
surgical clipping
question
Tx of hydrocephalus
answer
drain and/or shunt
question
non-modifiable risk factors for stroke
answer
age (risk doubled every decade after 55) gender M>F low birth weight race black>hispanic>white genetics - paternal history
question
modifiable risk factors for stroke
answer
HTN, smoking, alcohol, diabetes, A fib, dyslipidemia, CHD, sickle cell, post menopausal therapy, obesity, diet, body fat distribution, physical inactivity
question
primary stroke prevention
answer
treat modifiable risk factors aspirin use recomended in women >65y/o with high stroke risk
question
assessment of TIA and ischemic stroke
answer
non-IV CT scan to rule out hemorrhage rule out modifiable risk factors PMH - A fib, MI neurologic exam
question
Neurologic exam (NIHSS)
answer
identifies location of ischemia guides theraputic decisions
question
NIHSS score <20
answer
mild to moderate stroke
question
NIHSS score >22
answer
very poor prognosis
question
transient ischemic attack (TIA)
answer
"mini stroke" transient focal neurologic lesion = decrease in O2 supply
question
course of TIA
answer
rapid symptom onset Sx resolves w/i 24h usually in 15mins no residual neurologic deficit warning sign of impending stroke
question
Stroke
answer
permanent focal neurologic lesion (cell death has occured)
question
course of stroke
answer
rapid symptom onset Sx last >24 hours residual neurologic deficit present
question
symptoms of TIA and stroke
answer
hemiparesis, aphasia, ataxia, parestesia, blindness, vertigo, headache
question
F.A.S.T.
answer
face, arm, speech, time (to call 911)
question
acute Tx of TIA
answer
325mg po ASA qd immediately (clopidigrel 75mg if allergy to ASA) initiate adjust secondary prevention meds non-pharmacologic management: carotid endarterectomy
question
TIA goals for therapy
answer
modify risk factors for future stroke (secondary prevention)
question
acute Tx of ischemic stroke
answer
ASA 325mg po qd (immediately) (clopidigrel 75mg po qd if allergic to ASA)
question
benefits of ASA
answer
slight reduction in early stroke recurrence no benefits in neurological deficit
question
acute Tx of ischemic stroke
answer
Alteplase (tPA) MUST ADMINISTER WITHIN 3 HOURS OF SYMPTOM ONSET (based on efficacy and safety)
question
Alteplase (tPA) (tissue plasminogen activator) dosing
answer
infuse 0.9mg/kg IV over 60 minutes within 10% of the dose given as a bolus over 1 minute (max bolus dose 90mg)
question
acute Tx of ischemic stroke goals
answer
prevent complications reduce long standing neurological deficits physical therapy/occupational therapy
question
additional Tx for ischemic stroke
answer
BP goal s<185 d<110 antithrombotic therapy secondary prevention measures
question
acute ischemic stroke BP drugs
answer
labetalol IV, nitropaste 1-2 inches, nicardipine IV follow JNC7 bp goals after discharged
question
antithrombotic therapy in acute ischemic stroke
answer
warfarin indicated if A fib and is initiated 24 hours after tPA dose
question
secondary stroke prevention general principles
answer
long term antiplatelet therapy after TIA or stroke manage risk factors
question
acceptable options for initial secondary stroke prevention therapy
answer
ASA 50-325mg monotherapy OR dipyridamole 200mg ER + ASA 25mg (aggrenox) BID OR clopidigrel 75mg po qd monotherapy
question
ASA vs. aggrenox vs. plavix
answer
aggrenox or plavix monotherapies are more recommended than ASA alone
question
clopidigrel vs. aggrenox
answer
clopidigrel more prefered by neurologists due to less adverse reactions
question
aggrenox ADEs
answer
HA, GI, dizziness, fainting, more bleeding
question
ASA + clopidigrel
answer
increase risk of hemorrhage ONLY use combination with specific indication: coronary stent or ACS
question
ASA + aggrenox
answer
may not provide adequate Tx for cardiac indications
question
statins in stroke therapy
answer
use them they are good for you decrease risk of stroke by 18% with or without CHD
