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NVRN

NueroVascular RN

QuestionAnswer
Stroke is _______ leading cause of death 5th
What percent is Ischemic events? Hemmorrhagic events? I - 80% H - 20%
What race has highest hemm strokes Asian & Finns, AA > white
Define Stroke rapid syndrome of sudden onset, non-epileptic neurologic deficit
what is ischemic infarct dead tissue at core
What is common to happen after infarction? Hemmorrhagic transformation HT`
What is penumbra potentially viable brain tissue surrounding core infarction
What is Framingham Study 1950s, Mass, about risk factors for stroke and CAD HTN single most imp risk factor, Incr total chol, decr HDL, whole grain reduce risk, Elev C protein in women risk for carotid atherosclerosis, New L BBB,
What is GCNKSS Gr. Cinn/North KY study First ever stroke in AA > whites young/middle age, HTN/DM risks, prior stroke, 1st degree relative with hx of ICH
Northern Manhattan Stroke Study (NOMASS) Carotid atherosclerosis White>AA/non hispanics, risks: HTN, DM, smoke, hyperchol, abd obesity, afib white/hisp > AA
Strong Heart Study Native Am, >DM, smoke, obesity HTN = Arizona > Oklahoma Native Am, binge drinking
Southwest US Native Am. Stroke Study Long time to get to hospital, common HTN, DM, alcohol consumption, prev. stroke/TIA, obesity
ReGARDS born in stroke belt incr risk for stroke
What % of strokes are first time? What % need institutional care? 70% 20%
Non-modifiable risk factors for stroke Age: doubles 10y after 55y, >AA Race: AA greatest risk Gender: men > women Family hx: paternal side > risk
Modifiable risk factors CAD, HTN, smoke, DM, afib, diet, sickle cell, obesity, (post menopausal) hormone replacement, incr chol. < mod. risks = alcohol/oral contrac/migraine/sleep disorders/hypercoag/inf dis/acute inf
ABCD2 Score prediction for severity stroke with TIA: 1 - >60y 1 - BP >140/90 2 - wkn, 1 - speech w/o wkn 2 - >60min, 1 - 10-59min 1 - DM <4 = low, 4-5 = mod, >5 = high risk
What r 5 cat of TOAST - Trial of org in acute stroke tx way to categorize what caused ischemic stroke. 5 categories: 1.Lg aa atherosclerosis - occl/stenosis lg major aa 2.Cardioembolism - afib/MI/inf endocarditis/myxoma 3. Lacunar - htn,dm,smoke,hyperchol
What r 5 cat of TOAST 4. other etiology: hypercoag/venous thromb/vasculitis/art diss/cocaine/fat emboli 5. undertermined cause (cryptogenic): incomplete workup/workup with no source
What included in work up for stroke brain imaging ( ct,mri) vasc imaging cta/mra/tcd/cranial ultra cardiovasc H/P: hrt snds/holman/12 ecg/caps /pulses/jug dist/bp Duplex ultra: carotid/vertebral Echo/TEE Labs: Protein C,S/antithrombin III incr
IPH/ICH most common cause HTN #1, #2 Cocaine (ICH) trauma, amyloid angiopathy/aneurysm/vasculitis/alc abuse/cocaine/neoplasms/infections
Where are IPH's usually subcortical region, near lateral ventricles (BG/thal)
2nd most common hemm stroke aneurysmal SAH, >women, ICA
Studies to incr public detection FAST - 80% s/s face/arm/speech/time FLASH - 90% s/s face/leg/arm/speech/HA BE FAST - improve posterior stroke balance/eyes
Who uses EMS more? AA, hemm stroke, incr in stroke severity, unemployed
Stroke Severity Scales Los Angeles Motor Score - LAMS: lg vessel occl: face 0-1/grip 0,1,2/arm strength 0,1,2 Shortened NIH, sNIHSS 8 items
What should EMS not do with stroke lower bp, give glucose IV, give excessive IV volume
What is Golden Hour for tx stroke? initial MD eval - 10 min stroke team notified - 15 min CT - 25 min CT/labs interpreted - 45 min tPA - 60m
Golden 1/2 Hour MD/stroke - arrival CT - 10m CT/labs read - 25m tPA - 30m
How many triage levels? What level need to have for stroke/TIA? 5 levels Level 2 for stroke/TIA
What is med risk for cardio-embolism PFO, L atrial turbulence (smoke), post op, mitral prolapse
What is TIA sudden focal neurologic disablity, resolves in 24h, 300,000 annually
CHADS2 1 - CHF 1 - HTN 1 - >75y 1 - DM 2 - hx stroke/TIA
ED assessment/work up ABCs, disability, non-contrast CT/MRI, labs, ecg, h/p: LKN, handedness, allergies, prev stroke/TIA, risk for CAD, drug/alcohol use, anticoag meds, hx brain hem/trauma, sx hx
Stroke mimics: can you use tPA Yes. Conv. Dis, htn enceph, hypogly, complicated migraine, sz, AMS
What scale is used for Hemm? GCS 3- unresponsive, 15- normal Eyes: 1 no open, 2 pain, 3 speech, 4, spont Verbal: 1 no verbal, 2 incomp sounds, 3 inapp words, 4 confused, 5 oriented Motor: 1 none, 2 Decer, 3 decor, 4 withdraw, 5 localize pain, 6 obeys commands
Which neuroimaging is 100% sensitive for blood? Non-contrast CT
CTA is good to determine Lg vessel occl, not lacunar
Which part of MRI is best for acute stroke confirmation DWI - diffusion weighted imaging, w/in min. Ischemia = White MRP - detect presence/abscence viable tissue
which type of stroke is TCD used with SAH - blood flow in lg aa
Which lab test is needed prior to tPA? Blood glucose Coumadin - need INR
When is a lumbar puncture usually ordered, what kind of stroke? SAH
Gen mgmt of all acute stroke pts temp, NPO, card enzymes, arrhythmias, bp parameters, hyperglycemia, HOB
What are BP parameters for hemm & ischemic H: <160/90 I: untreated = permissive 220/110 treated= <185/110, then <180/105 after bolus tPA
What is correct glycemic control 80 - 140 mg/dL
What is correct HOB for hemm & ischemia H: 30 deg I: 0 deg, pt turned to side 20% incr blood flow Zodiac trial - only did lg vessels
How many bones in skull and name 8 bones: frontal/temporal(2)/parietal(2)/occipital/sphenoid/ethmoid
What is total cranial volume made up of and how much 1400-1500ml: CSF, brain tiss, blood
What are sutures of skull Sagittal - b/n 2 parietal Coronal - parietal to frontal Lambdoidal - parietal to occipital Squamosal - joins parietal, temp, occ
How many total vertebrae? How many cervical, thoracic, sacral, coccygeal? total 33: 24 vertebral & 2 fused ( atlas C1, axis C2) Cerv 7, thor 12, sacral 5, coccy 4
Name meningeal coverings of brain and spinal cord Dura mater - strong, b/n bone & dura mater Arachnoid mater - thin, loose surround brain, contains lg vessels, below subarachnoid space Pia mater - adheres to brain, choroid plexus
Where is CSF manufactured choroid plexus in Pia mater
Name and locate three ventricles in brain Lateral (2): horns Third ventricle: b/n laterals & connected by foramen of Monro Fourth ventricle: connected by aqueduct of Syvius
What is communicating vs non-communicating hydrocephalus comm: obstruction/lack of absorption non comm: obstruction in ventricle system
How much CSF is produced hour? day? total system volume? Hour: 20ml/h day: 500ml/day, total vol: 150ml
What is cellular structure/fx of neuron Dendrites: impulse reception Cell body: metabolic fx of cell Axon: carries impulse away
What makes up the Circle of Willis Anterior and Posterior circulation Connection of 3 comm aa (AcomA, PcomA (2)
Where does the ant. and post. circ originate common carotid CCA, R CCA: innominate aa/L CCA: aorta Post: subclavian aa, R innominate, L aorta
What is considered the Ant. circulation and leads off ICA Ophthalmic aa OA PcomA: post comm. aa MCA: supply to deep subcortical area ACA: linked together by AcomA
What is posterior circulation include Vertebral aa give off post inf cerebellar aa PICA Vertebral fuse to Basilar aa Basilar gives off to PCA (thalm), SCA, pontine, AICA
What % of circle of willis is ideal? Most common missing segments? Only 50% 1. ACA, 2. One of the PcomA, 3. 1st seg of PCA
What is the cerebral cortex 80% of brain wt. 2 hemispheres separated by corpus collosum 4 lobes: frontal/temp/parietal/occipital
What is major fx of Brodmanns Area 4 Voluntary motor fx: Motor strip ACA territory ( esp leg) and some MCA (lower facial wkn)
Where is Area 44: Broca's area Left MCA, frontal lobe Expressive aphasia: spoken/written lang. word finding,
Where is 9-11, cognitive fx area ACA behind forehead seen in SAH affects orientation, memory, insight, judgement, arithmetic/abstract thinking
Where is Area 1-3, primary sensory Parietal lobe sup ACA, inf MCA
Where is area 5 & 7: somesthetic assoc MCA extinction, stereognosia (tell what object it is), graphesthesia (write on skin and decipher)
What is are 39 & 40, Wernicke's area Left MCA receptive lang.
Where is area 41 & 28 Temporal lobe, MCA
What does Occipital lobe show visual integration & pathways
What does Area 17 & 18 primary visual cortex affect PCA territory
Where would you find cortical blindness stroke top of the BA or PCA occl.
Where is homonymous hemianopia found always post. to chiasm Lg parietal - MCA Medial occipital - PCA
Double vision would indicate which part of brain brain stem infarct
Internal capsule is which distrubution MCA
Thalami is PCA distribution
What does cerebellum control fine motor coordination, equilibrium/balance, ataxia, ipsilateral side affected stroke, vertigo
Brainstem stroke affects LOC, double vision, cardiac, resp, vomiting, sneezing, hiccups
What does cerebrum control association, motor, sensory, contralateral
Name cranial nerves 1 - smell, 2 - vision, 3,4,6 - EOM extraocular mvmt, 5-corneal reflex(S)/maxillary(S)/Mandibular(S)(M) teeth clench, 7-facial(S)(M), 8-acoustic/balance, 9,10-glosso/vagal, swallow, 11-spinal acc, 12-hypogloss, tongue mvmt
Where is midbrain and what are infarct findings From thalamus to pons, CN3,4 pupil dilate, EOM dysfx, decr LOC, (M)(S) disrupt
Where is Pons and infarct findings from pons to medulla oblongata, CN5,6,7,8 Pneumotaxic ctr: inhibit depth of resp/incr rate apneustic ctr: promotes inspiration gaze/diplopia, EOM dysfx, decr LOC, (M)(S), resp arrest
Where is Medulla oblongata and infarct findings from pons to spinal cord, CN8,9,10,11,12 cardiac/vasomotor ctrs decr LOC, card/vasomotor dysfx, hearing loss, dysphagia, quadriplegia
What is important about basiar art thrombosis Most misdiagnosed, hiccups, weird s/s, diplopia, vertigo, cortical blindness
Diff bn cortical and brainstem infarct Above brainstem: loss (M)(S) same side with face brainstem: CN deficit same side as infarct, but opp extremity (M)(S), sudden loss of consciousness in non-hemm
When should you do NIH? Scoring is from 0 - _______ Best NIH monitoring p tPA admission, discharge, 1 x shift, and any changes Score: 0 - 42 baseline pretx, post tPA, q4h q15-30 focused neuros, deterioration/improvemnet
What does ICH score predict death in 30 day, 0- best prognosis, 6- dead. contains: GCS, ICH vol, Intraventricular component, Supra vs Infratentorial, Age
what is Modified Rankin Score for disablility score, 0-6, intervention when score 0-1
What are absorptions/color for CT air - black/none, CSF - black/low, White matter - darker gray/low med, Gray matter - lighter gray/high med, Blood - white/high, Bone - bright white/high
How to read CT start at base of brain and moves superiorly to top of skull, looking through bottom of feet to top of head, mirror image - L side reflects right brain, vice versa
Adv/Disadv for CT Adv: fast, good for lesions dis: poor resolution, 6-8h delay b4 stroke shows
What are early/late signs for stroke on CT early: clot in vessel, hyperdense aa late: hypodensity, darkened, subacute inf
What is scoring for Modified Ranking Score 0- no s/s 1- able to carry out usual activities/duties 2- slight disable, can look after self w/o assistance 3- mod disable, some help, can walk w/o assistance
What is scoring for MRs 4- mod severe disable, not walk w/o assist, not do bodily needs w/o assist 5- Severe disable, bedridden, incontinent 6- dead
NIH scoring LOC 0- alert 1- not alert, arousable 2- needs repeated stimulation, obtunded, req strong painful stimuli to make mvmnts 3- Reflex motor response, totally unresponsive, flaccid
NIH Questions: Month/Age 0-answers mo/age 1- ans one correctly, intubated, sev dysarthria 2-both incorrect/no answer, aphasic/stuporous not responding
NIH Commands to open/close hand/eyes 0- obeys both 1- obeys one 2- Not obey/respond
NIH EOMs: horizontal eye mvmt, doll's eyes used if needed 0- Normal 1- Partial gaze palsy, can come to ctr, but goes back 2- Forced deviation/total gaze paresis
NIH Visual Fields: upper/lower, confrontation 0-no loss 1- partial hemianopia 2- complete hemianopia 3- bil hemianopia, blindness/cortical
NIH Facial Palsy: smile, raise eyebrows, grimace with noxious stimuli 0- normal symmetric mvmt 1- minor paralysis, flattened nasolabial fold 2- Partial paralysis: total paralysis lower face only 3- complete paralysis lower/upper face
NIH Motor Arm: Count of 10 Left & right 0- No drift 1- drift 2- some effort against gravity 3- No effort against gravity 4- No mvmt
NIH Motor Leg: Count of 5, Left & right 0-No drift 1- drift 2- some effort 3- no effort 4- no mvmnt
NIH Limb ataxia: Finger to nose, heel to shin 0- absent 1- present in one limb 2- present in two limbs
NIH Sensory: sensation, grimace, withdrawal 0- Normal, no loss 1- mild to mod, dull, less sharp 2- severe to total loss, not aware of being touched
NIH Language: aphasia 0- no aphasia 1- mild to mod 2- severe 3- mute, global: no speech/auditory comprehension
NIH Dysarthria: slurred speech 0- normal 1- mild to mod: slur some words 2- unintelligible
NIH Extinction/Inattention 0- No abnomality 1- visual, tactile, auditory, spatial, personal inattention, or to bil sensory 2- profound in >1 sensory, not recognize hand, etc
What is watershed infarct b/n regions
which area is worst/best outcome for ICH: cortical, BG, thalamus, Pontine, Cerebellar Worst: Pontine Best: Basal Ganglia, most common IPH,
What should you r/o with Intraventricular hemm Presence of ACA or AcomA aneurysm, usually is expansion of hemm in BG, IPH
Where is SAH Bleeding in subarachnoid space, usually from aneurysm rupture or trauma, "star" appearance or "hanging chicken"
What is 1st s/s SAH thunder clap HA
What is tx and appearance of amyloid angiapathy hemm more round and no tx can be done, more on surface
what are CTP scans for Looking to save penumbra and ischemic penumbra, measures tiss perfusion, usuall for "wake up" strokes
In MRI, which is better for disease definition, T1 or T2 T2, CSF- white, Fat- dark
What is GRE, gradiant Recall Echo in MRI Rules out blood, microbleeds may be detected
What does the FLAIR show in MRI older stroke, dating/timing of stroke onset, if neg and DWI pos, give tPA, shows 4-6h after stroke
Name MRI sequences 1- GRE id blood 2- DWI ischemia 3- FLAIR timing of onset, old isch changes 4- MRA vascular imaging`
What is gold standard imaging for vascular Catheter Angiography, IR, uses 1/2 of dye of CTA, invasive, can have IA rescue, safe to due p tPA
What is HOB for sheath mgmt <15 deg
What is doppler shift ultrasound to describe mvmt of blood away/towards probe
What is duplex imaging image lg vessels in neck, see plaque & blood, stable(hyperechoic)/unstable(hypoechoic) plaque,
What is transcranial dopper TCD flow of blood thru lg vessels in circle of willis, detect vasospasm (risk @ 5-7d), monitor tPA, brain death, sickle cell
What is risk of vasospasm? Tx of vasospasm ischemia Tx: Triple H therapy: hemodilution/hypervolemia/htn Meds: Nimodipine(neuroprotective effect, not lessen spasm, Mg, statin Intra Art tx: angioplasty, verapamil inf
What was result of NINDs tPA stroke study Got tPA FDA approved and standard of care
What is tPA dosing 0.90mg/kg, total dose 90mg Waste 10cc, give 10% as bolus, then remaining 90% inf over 1 hour.
What should BP be b4 tPA and during/after b4: 185/110 after: 180/105
what are inclusion/exclusion criteria for tPA incl: clear time of onset w/n 180 min of tx, deficits on NIH, neg CT for hemm Excl: prev stroke/trauma w/n 3 mos onset, major sz w/n 14 days, hx ICH, SBP>185/110, improve TIA
What are more excl of tPA s/s SAH, hx GI/urin hemm past 21d, art px prev 7d, Sz Todd's paralysis(mimic), incr PTT, <100,000platelet, BG <50; >400
At 3 mos, what % of pt w/ no deficits after tPA 12%, no incr death, age not a factor, severe NIH not a factor, sICH rate 6.4%, 30% more likely to have mRS 0-1 @ 3 mos
What time frame should IV tPA be adm to acute stroke w/n 4.5h
What are the drug choices to manage BP wtih tPA labatelol 10-20mg q 5-15m up to total 150mg IVP Nicardipine drip: rapid onset/offset, less titrations Cleviprex: incr med 1-2mg = decr 2-4mg of BP, rapid
what are contraindications of labatelol asthma, CHF, heart block
what is Poiseuille's Law incr in extremity size = decr BP, cuff too lg decr extremity = incr BP, cuff too small
What is BP monitoring after tPA BP q 15 x 2h, 30m x 6h, 1h x 16h, q4h
Post tPA mgmnt No invasive procedure, No antiplatelet/anticoag for 24h
What is % for recanalization wtih tPA 13-38%, better if tx is started earlier
Lg vs sm vessel occl tx wtih tPA results Lg vessel: less likely to respond, need IR Sm. vessel: very well tx
What rare complication with tPA is more common with AA and pt taking ACE/ARBs? oropharyngeal edema, may need intubation/drugs
What defines a symptomatic ICH during tx of tPA? >4 pts from original NIH + IPH on non-contrast CT
Pt can't get tPA, what r IA tx, (intra-arterial) options? thrombectomy, drip tPA directly on clot, angioplasty, stenting
List Guideline Classification for IA tx Class 1: (strong) Benefit >>> risk Class IIa: benefit>>risk (tx reasonable) Class IIb: benefit > risk (tx may be considered) Class III: risk > benefit (harm) no tx
What is the TICI score? Done for Thrombolysis cerebral infusion after tx Grade 0: no perfusion G1: penetration w min. perf G2: partial perf, G2a/2b: better G3: complete perf Goal is 2b/3 w/n 6h of stroke onset
What high risks are included with ICH HTN, >55y, anticoag therapy, amyloid angiopathy, smoke, alcohol use, asians (highest), AA 65-74y, white older age
What is 6 mos mortality rate post-ICH 30-50%, < independence in 6 mos,
Describe scoring for ICH score Score 0 = 0 death in 30 days 1 = 14% death 2= 28% death 3=70% death 4= 95% death 5&6 = 100% death
Indicators for ICH scoring GCS 3/4 - 2pts, 5-12 - 1 pt, 13-15 - 0pt ICH volume: >30ml 1 pt, <30ml - 0 pt IVH: Yes - 1pt, No - 0pt Infratentorial: Yes - 1pt, No - 0pt Age: >80 - 1pt, <80 - 0pt
What is significance of CT "spot sign" probably active bleeding expansion, 72% in 24h, most common loaction for ICH is BG d/t HTN. 2nd: amyloid angiopathy in cortical/parieto/occipital (surface)
What are clinical s/s of ICH impaired LOC, vomiting, severe HA, severe HTN
Ways to manage ICH airway mgmt, INR >1.4 needs reverse anticoag, BP reduction 160/90, CPP 60-80mm Hg (MAP-ICP=CPP)
What is first tier therapy to manage ICP ventriculostomy w CSF drainage, then manitol, hypertonic solutions, HOB 30deg, hyperventilation, sedation
What is second tier therapy to manage ICP Hemicraniectomy, hypothermia, barbituate coma
Are prophylactic sz medication necessary in ICH No, only if see sz.
When is surgery benefit in ICH? Sx not usually help Sx better in cerbellar hemm >3cm to prevent herniation
Who is most common for SAH women, 40-60y, Japanese, black>white, htn, smoke, alcohol, cocaine
Most common aa affected by SAH Base of Circle of Willis: PcomA from ICA, AcomA - ACA, MCA
What are most common forms of aneurysms? Which aneurysm type most likely to rupture? What size is an aneurysm needing sx Berry/sacular - 80-90% >7mm, worst HA
What diagnostics determine SAH? What is gold standard? Non-contrast CT If CT neg, then lumbar px CTA Gold standard: catheter angiography
What scales are used to grade SAH severity Hunt & Hess Grading Scale World Federation of Neurological Surgeons Scale
What tx is best to prevent re-bleed coiling/clipping
What monitoring is needed for SAH rupture monitor cardiac enzymes/telemetry, monitor for SIRS(HR>90, RR>20, WBC<4/>12, T >38C), hydrocephalus, hyponatremia (AcomA), 30%, cerebral salt wasting - decr free water, isotonic IV fluids
Pt 40y has sz, mass effect on CT and hemm w/ HA....what likely is cause AVM
What is formula for cardiac output CO CO = SV + HR
what is SV: stroke volume amt of blood ejected by heart with ea contraction
What is Frank-Starling Law Preload stretches heart muscle, incr degrees of stretch result in improved contractility until muscle is over stretched, dilated, & flaccid
What is afterload resistance in vasculature that heart muscle must overcome to eject volume`
What causes resistance to flow in heart atheroscloerosis, art pressure, metabolic factors(incr CO2 = dilate/decr CO2=constrict), intracranial pressure (ICP), extracranial pressure (stenosis in carotids/vertebrals), blood viscosity (incr hematocrit)
What is primary method to autoregulation Vasomotor reactivity
Where is the phlebostatic axis and what is it for? What is leveled at the tragus? 0 line for BP monitoring tragus: ICV
Normal hemodynamic values: cardiac output CO/MAP/SvO2/ICP/CPP CO - 4-8L/min MAP - 70-105 mm Hg SvO2 - 60-75% ICP - 0-15mm Hg CPP - 70-100mm Hg
What is tidal volume 5-8mf/Kg, volume of gas moved into/out of lungs in single normal insp or exp. Start with 8010ml/Kg and titrate down
What is Vital capacity and who benefits from monitoring this volume of gas exhaled after the deepest possible inhalation. Guillan Barre pts
What factors reduce diffusion pulm edema/thick membrane, fibrosis/surface area for gas exchange...
What improves ventilation/perfusion HOB 45 deg, good lung down, prone
What is diff b/n PaO2 & SaO2 PaO2: oxygen transported dissolved in blood serum SaO2: oxygen transported in combination w hemoglobin
With FiO2, what is goal PaO2 >60% produces SaO2 >90%, use FiO2<50%. Add PEEP to incr SaO2 b4 incr FiO2
pH/paCO2/PaO2/HCO norms pH: 7.35-7.45 paCO2: 35-45 paO2: 90-100 HCO3: 22-26
in resp acidosis/alkolosis how do you adjust RR with paCO2 of 55, pH 7.34 acidosis: incr RR alkolosis: decr RR
What are factors with weaning success LOC, hemodynamic stability, physiologic stability, sats, spontaneous ventilation, pulm mechanics
What are two non-invasive ventilations Bipap: have to be able to take mask off and not be restrained. PS @ insp/ PEEP@ end of exp Cpap: provided PEEP w/o pressure support
What is most preventalbe cause of death in hospitals VTE: DVT/PE/post-thrombotic syndrome
What is Virchow triad factors of DVT: change in vessel wall (injury), pattern of blood flow(venous stasis), constituency of blood(hypercoag states)
What is best method for VTE/PE prevention? What is best dx of VTE? what is best dx of PE? 1st: Medical mgmt: anticoags: lovenox 2nd: mechanical SCD Dx: LE dopplar PE dx: CT
What is Braden Scale for predicting pressure ulcer 6 -skin breakdown risk 32 - no risk for skin breakdown
Factors influencing intensity/duration in Braden: Factors in skin/support tissues in Braden: int/dur: Mobility/Activity/Sens perception skin/tiss: moisture/friction/nutrition/age/art press
A pt with an infarct with left neglect, visual field deficits &/or tactile neglect, & incontinence likely is right or left brain Right brain asoc with falls
Normal BP/prehtn/high stage 1/high stage 2 normal BP 120-80 prehtn: 120-139/80-89 high Stage 1: 140-159/90-99 Hight Stage 2; >160/100
What is first line anti-htn drug givn with 2nd drug thiazide diuretic w ACE in AA Pro: cheap, effective Con: dehydration, incr blood viscosity
what is 2nd drug of choice to combine with thiazide diuretics Ca. Ch. blockers
When are BB best used for htn CAD and afib Pro: cheap con: stopping can cause death, impotence/depression
What is best BP drug in stroke prevention/mgmnt ACE/ARB pro: stroke reduction/cardiac remodeling/renal protection Con: not good to decr BP in pt that lack renin-based htn, avoid in preg, cough
When is okay to use Minoxidil When no other agents lower BP, aggressive, monitor pericardal eff, combine with BB to prevent rebound tachy
What dose is best for statins in stroke? When does statin reduce first ever stroke? Dose: 80mg statin First ever stroke prevention: elevated C-reactive protein
when ASA best for stroke pts? Which is better ASA or Aggrenox? when not on ASA before Aggrenox bettern than ASA, risk is HA
Which is best ASA or Plavix for stroke Plavix to reduce event Plavix + ASA to lower risk of embolic events, but not long term except wtih stents
When is anticoagulation best used in relation of stroke prevention/mgmnt cardioembolic stroke/crescendo TIA/hypercoag states/art dissection assoc w embolization/cerebral venous thrombosis
Warfarin is best tx for young/old when? warfarin is superior to placebo in reducing stroke risk. Younger: no comorbidities than use ASA Older: w comorb, use warfarin
How to determine ciggarette pack year hx # of yrs smoked X # of cigg smoked / 20
medications to support smoking cessation gum: up to 24 pcs/d, pack b/n teeth and gum patch: >10cig/21mg, in 2wks/14mg, in 2wks/7mg
Created by: apalmer