Strokes - Meds

jwendi4's version from 2016-11-27 01:55

Section 1

Question Answer
dabigatran (Pradaxa)direct thrombin inhibitor
dabigatranFDA approved for prevention of stroke and systemic embolism in non-valvular a fib
dabigatran150mg bid (75 mg bid if Crcl 15-30ml/m)
dabigatrangerd common, high bleeding risk, not used much anymore
rivaroxaban (Xarelto)factor Xa inhibitor
rivaroxabanFDA approved for prevention of stroke and systemic embolism in non-valvular a fib
rivaroxaban20mg qd, (15mg qd if CrCl<15)
rivaroxabannoninferior to warfarin
apixaban (Eliquis)factor Xa inhibitor
apixabanFDA approved for prevention of strok and systemic embolism in non-valvular a fib
apixaban5mg bid (low risk), 2.5 mg bid (high risk)- SCr 1.5mg or higher AND >80 yo or 60kg or less
apixabanGo to drug - drug/drug interactions
edoxaban (Savaysa)factor Xa inhibitor (not used much)

Section 2

Question Answer
FaceAsk person to smile. Does one side droop?
ArmsAsk the person to raise both arms. Does one arm drift downward?
SpeechAsk the person to repeat a simple sentence. Does the speech sound slurred or strange?
TimeTIME IS BRAIN!!!! Call 911!

Section 3

Question Answer
TIAtransient ischemic attack
tiaresolves completely w/in 24 h
tiaTTE, carotid/angio, non contrast CT/MRI
tiafix constrictions (ex carotid), lifestyle mods
tia - non-cardioembolic sourceantithrombotics (aspirin 81mg/d), or ASA+aggrenox, or clopidogrel
tia - cardioembolic sourceantithrombotics (warfarin goal inr2-3, ASA 325, Dabi, rivar, api, edo for a fib pt)

Section 4

Question Answer
ischemic strokeMOST are these
penumbra tissue that is suffering that can be salvaged if quick enough
atheroscleroticplaque blocks from a rupture or from too much
lacunarpenetrating artery disease (deep in brain)
lacunarcommon in dm and htn
cardiogenic embolismfrom a fib, valve disease, mitral valve prob, or poor coumadin
cryptogenicocclusion of intracranial artery

Section 5

Question Answer
Code Stroke1st 24 hours
therapeutic window0-3 hours from onset of symptoms- time is brain, no age cutoff
tPA0.9mg/kg - max 90 mg
tPAwant to break the clot, establish circulation and not bleed
tPAage 18 or more, stroke with signs (not tia), baseline CT no with no evidence of ICH
tPANOT >185/110, history of bleed, surgery, trauma,e tc
tPAbring bp down before giving
tPA10% bolus, then the rest over 60 minutes
tPA ok if 18-80 yo w/in 3-4.5 hours (earlier the better, don't wait)
IA - tPAintra-arterial thrombolytic - up to 6h post onset
BPmaintaining perfusion of blood more important than normotensive
BPlabetalol or nitroprusside

Section 6

Question Answer
Hemorrhagic Strokebleeding into the brain (13% of strokes)
hemorrhagic strokesudden severe headache, n/v, photophobia, neck pain
ICH30% continue to enlarge over 1st 24h
BPmaintain about 160/90