thera test 2 stroke

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coal
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268289
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thera test 2 stroke
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2014-03-28 15:50:31
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thera test 2 stroke
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  1. non modifiable risk factors of stroke
    • PF CHARS
    • prior stroke/TIA
    • family history
    • cardiac disease
    • heredity/hypercoaguable disease
    • age
    • race sex
  2. modifiable risk factors of stroke
    • DED CHODE
    • diabetes
    • EtOH/tobacco/drug use
    • dyslipidemia
    • cardiac disease
    • hypertension
    • obesity
    • diet
    • estrogen supplementation
  3. 6 stroke symptom catergories
    • movement/coordination
    • sensory
    • speech
    • vision
    • comprehension
    • severe HA with no known cause
  4. stroke symptoms of movement/coordination
    trouble walking, dizziness, loss of balance, coordination, unable to smile or lift eyebrows
  5. stroke symptoms of sensory
    numbness/weakness of face, arm or leg - especially one sided
  6. stroke symptoms of speech
    trouble speaking, garbled words, word-finding problems
  7. stroke symptoms of vision
    trouble seeing in one or both eyes
  8. stroke symptoms of comprehension
    confusion, problems understanding
  9. patient counseling check for stroke method
    • Face
    • Arms
    • Speech
    • Time
  10. main cause of cardioembolic stroke
    A-Fib
  11. most common cause for atherosclerotic cerebralvascular disease
    carotid artery stenosis
  12. causes of cryptogenic stroke
    • PFO - patent foramen ovale
    • ASD - atrial septal defect
  13. when do we use anticoagulation in primary prevention of stroke
    only if at risk of cardioembolic stoke (AFib, valve disease, ventricular thrombi)
  14. when would we use antiplatelet therapy for primary prevention in stroke
    • female and Framingham risk score >6-10% with no additional risk factors for bleeding
    • aspirin 81 mg
  15. what did the ACCOMPLISH trial favor for controlling BP with a history of stroke
    amlodipine + ACEI
  16. benefits of fibrinolytic therapy
    • decreased stroke related symptoms
    • increase chance of recovery w/o disability
    • increase chance of caring for self independently

    w/I 4.5 hours is when you see benefit, after that you could be increasing the chance of hemorrhage
  17. criteria that must be met for fibrinolytic therapy
    • acute, symptomatic stroke (not mild or improving)
    • no evidence of intracranial hemorrhage (ICH) on CT scan or history of ICH
    • no CI
    • w/I 4.5 hrs of symptom onset, ideally w/I 3 hrs
  18. CI's to fibrinolytic therapy
    • active bleed (w/I last month, relative)
    • systolic pressure over 210
    • > 4.5 hrs
    • medical history, oral anticoagulant, if on warfarin and INR < 1.7 then its OK
    • central line
    • high bleeding risk
    •   trauma
    •   surgery
    •   adnormal labs
    •   invasive catheters
    •   medications
  19. blood pressure goals for fibrinolytic therapy
    • <180/105 before and 24h following
    • use labetolol IV, or nicardipine
    • lower no more than 15% in first 24 hrs
  20. what are BP ranges if no tPA administered
    allow for permissive HTN (up to 220/120) for next 24 hours
  21. time frame of using aspirin or enoxaparin in relation to tPA
    at least 24 hours after administration
  22. some other early acute management therapies
    • aspirin w/I first 48 hours
    • VTE prophylaxis, enoxaparin over UFH
  23. lipid management in TIA or ischemic stroke
    • intensive lowering in all pts
    • initiate prior to discharge (24 hrs post tPA)
    • goals
    •   decrease LDL by > 50%
    •     atorvastatin 40-80mg
    •     rosuvastatin 20-40 mg
  24. aspirin vs Aggrenox as antiplatelet therapy
    Aggrenox more effective but maybe slightly less tolerable (HA & GI SE)
  25. Plavix vs Aggrenox as antiplatelets
    similar effectiveness but increased bleeding risk with Aggrenox and increased risk of intracranial bleeding
  26. plavix vs aspirin + Plavix as antiplatelets
    • Plavix a little better
    • if combo therapy is going to be used then duration should not exceed 3 months and possible less than that
  27. efficacy algorithm for antiplatelets
    clopidogrel = Aggrenox = ASA + Clopidogrel > ASA alone
  28. safety algorithm for antiplatelets
    clopidogrel = ASA alone > Aggrenox >> ASA + clopidogre
  29. cost algorithm for antiplatelets
    ASA < clopidogrel < clopidogrel + ASA << aggrenox
  30. when should anticoagulants be used for secondary prevention of stroke over antiplatelet therapy
    • AFib w/CHADS2 score of 1 or higher
    • prosthetic heart valve
    • rheumatic mitral valve disease
    • left ventricular thrombus present
    • possible if severe cardiomyopathy
    • recent MI w/ apical wall hypokinesis & depressed EF
  31. general rule of anticoagulants vs antiplatelet therapy
    • carotid source = antiplatelets
    • cardiogenic source = anticoagulants

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