CC Nov 2015 Hypertension and acute ischemia stroke

echoecho's version from 2015-12-13 17:54


Question Answer
What is a common occurrence in acute ischemic stroke in way of blood pressure?acute elevations in BP
Whyd does mean arterial pressure increase in acute ischemic stroke?to maintain cerebral perfusion
More than 3/4 of patients with acute ischemic stroke have a SBP of > ____ mmHg; 15% have SBP > ____ mmHg135; 184
Higher values re typically seen with what type of patients?those with pre-existing HTN
BP spontaneously decreases about ___ minutes AFTER stroke onset?90
Extremes in ____ during an acute stroke are detrimental?BP
Very high BP may cause what 2 conditions?1) encephalopathy 2 renal dysfunction
Hypotension may cause what?worsening of stroke-related ischemic damage
True or false, defining the preferred range of BP has been difficult to firmly establish?true
In the Intravenous Nimodipine West European Stroke Trial (INWEST), blood pressure lowering with the calcium channel blocker Nimodipine within 24 hours of symptoms onset was associated with what outcomes at 21 days, especially if DBP decrease was > ___ mmHg?1) worse clinical 2) 10
In 2010, what did the FDA add to a black-box warning of IV Nimodipine?1) associated with cardiac arrest OR 2) deleterious drop in blood pressure OR 3) other cardiac adverse events
Why does the FDA prohibit any IV Nimodipine use?because Nimodipine (which comes in a liquid capsule) was occasionally drawn up in a syringe to allow oral administration in patients unable to take capsules. several episodes of Nimodipine that was meant for oral administration being inadvertently given IV and resulting in patient harm/death.
What medication has recently been approved as an oral solution? Indication? Why?1) Nimodipine (Nymalize) 2) subarachnoid hemorrhage because it has been established to improve outcomes and reduce ischemic deficits in these patients.
What was the finding in the Continue or Stop Post-Stroke Antihypertensives Collaborative Study (COSSACS)?patients with acute ischemic stroke were randomized to continue taking previous antihypertensive therapy after 48 hours OR to no therapy for 2 weeks. Continuation of antihypertensive therapy FAILED to show reduction in morbidity or mortality at 2 weeks or decreased mortality at 6 months
*** In 2013, the American Stroke Association recommended against lowering BP during the first 24 hours after an acute ischemic stroke unless the BP was what?> 220/120 mmHg
If elevated BP is causing other conditions to deteriorate, the American Stroke Association (ASA) recommends targeting a ____% reduction in BP and monitoring for exacerbation of the patient's neurological symptoms?15
If fibrinolytic therapy is planned, the BP goal is < _____?180/110 mmHg
When BP lowering is indicated, name 2 drugs with dosages which can be used?1) labetalol (Trandate) 10-20 mg IV over 1-2 minutes 2) nicardipine (Cardene) 5 mg/hour IV, titrated to a maximum of 15 mg/hour
What was the finding in the 2014 Efficacy of Nitric Oxide in Stroke Trial (ENOS) study?1) 4000 patients w/ acute ischemic or hemorrhagic stroke and systolic HTN were assigned to a transdermal antihypertensive group x 7 days or to NO transdermal antihypertensive therapy 2) a subset of patients taking antihypertensive medications prior to their stroke was randomized to continue or discontinue these drugs 3) at 90 days, the group receiving antihypertensive therapy (either the transdermal or the preexisting antihypertensive) had lower BP, although there was NO difference in function between the two groups
*** SUMMARY = What elevations are a common occurrence in acute ischemic stroke?in BP
*** SUMMARY = Mean arterial pressure increases in an attempt to maintain what?cerebral perfusion
*** SUMMARY = True or false. Extremes of BP during an acute stroke are detimrental?true
*** SUMMARY = Very high BP may cause what? While hypotension may worsen what?1) encephalopathy and renal dysfunction 2) stroke-related ischemic damage
*** SUMMARY = In the first 24 hours, intervention to lower BZP is recommended for what BP readings?> 220/120
*** SUMMARY = If elevated BP is causing other conditions to deteriorate, the American Stroke Association recommends targeting a ____% reduction in BP and monitoring for what?1) 15% 2) exacerbation of the patient's neurological symptoms