Podcast
Questions and Answers
What does the PLAC test detect in the blood?
What does the PLAC test detect in the blood?
- Increase in platelet aggregation
- High levels of lipoprotein-associated phospholipase (correct)
- Elevated cholesterol levels
- Presence of anticoagulant drugs
Which of the following medications is primarily used to prevent clot formation in patients with TIAs?
Which of the following medications is primarily used to prevent clot formation in patients with TIAs?
- Dabigatran
- Beta-adrenergic blockers
- Warfarin
- Clopidogrel (correct)
In which scenario should a lumbar puncture NOT be performed?
In which scenario should a lumbar puncture NOT be performed?
- Patient with mild headache
- Patient with normal blood tests
- Patient with no history of stroke
- Patient with increased intracranial pressure (ICP) (correct)
What is the role of antihypertensive therapy in stroke prevention?
What is the role of antihypertensive therapy in stroke prevention?
Which class of antihypertensive drug is considered least effective in preventing strokes?
Which class of antihypertensive drug is considered least effective in preventing strokes?
Which of the following is NOT a medication type commonly prescribed for stroke prevention?
Which of the following is NOT a medication type commonly prescribed for stroke prevention?
What may be indicated by the presence of overt blood in the cerebrospinal fluid (CSF)?
What may be indicated by the presence of overt blood in the cerebrospinal fluid (CSF)?
Which vitamin K anticoagulant can help reduce stroke risk in patients with atrial fibrillation?
Which vitamin K anticoagulant can help reduce stroke risk in patients with atrial fibrillation?
Which medication is considered the gold standard for the treatment of acute ischemic stroke?
Which medication is considered the gold standard for the treatment of acute ischemic stroke?
What is a necessary condition for a patient to receive IV tPA within 4.5 hours after onset of stroke symptoms?
What is a necessary condition for a patient to receive IV tPA within 4.5 hours after onset of stroke symptoms?
Which of the following medications is primarily used to prevent further thrombus formation rather than to dissolve existing clots?
Which of the following medications is primarily used to prevent further thrombus formation rather than to dissolve existing clots?
In the management of a patient eligible for thrombolytic therapy, what is the maximum allowable systolic blood pressure for administering IV tPA?
In the management of a patient eligible for thrombolytic therapy, what is the maximum allowable systolic blood pressure for administering IV tPA?
Which type of stroke should never receive anticoagulant and antiplatelet medications?
Which type of stroke should never receive anticoagulant and antiplatelet medications?
What is the role of corticosteroids during the acute phase of a stroke?
What is the role of corticosteroids during the acute phase of a stroke?
What is the typical timeframe for beginning anticoagulant or antiplatelet therapy after administering tPA?
What is the typical timeframe for beginning anticoagulant or antiplatelet therapy after administering tPA?
Which of the following medications can be given orally as anticoagulant therapy?
Which of the following medications can be given orally as anticoagulant therapy?
What category of medications is primarily indicated for thrombotic stroke?
What category of medications is primarily indicated for thrombotic stroke?
What is a potential medication prescribed for increased intracranial pressure (ICP)?
What is a potential medication prescribed for increased intracranial pressure (ICP)?
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Study Notes
Stroke Screening and Diagnosis
- A blood test, known as the PLAC test, is now used to screen for recurrent stroke risk by detecting high levels of lipoprotein-associated phospholipase in the blood.
- A lumbar puncture, to collect cerebrospinal fluid (CSF), may be performed in selected patients, but should not be done if there is an increased risk of intracranial pressure (ICP) as this could lead to brainstem herniation.
- Overt blood in the CSF may indicate a hemorrhagic stroke.
Preventing Stroke
- Medications used to prevent stroke include antiplatelet drugs, anticoagulants, antihypertensives, and cholesterol-lowering drugs.
- Commonly prescribed antiplatelet drugs are aspirin and clopidogrel.
- Anticoagulants, such as warfarin, rivaroxaban, apixaban, edoxaban and dabigatran, are used to prevent blood clots in patients with atrial fibrillation.
- Thiazide diuretics, calcium channel blockers, ACE inhibitors, and angiotensin II receptor blockers (ARBs) are effective antihypertensives in reducing stroke risk.
- Statins are the primary cholesterol-lowering drugs used for stroke prevention.
Managing Acute Stroke
- Thrombolytic therapy with alteplase (tPA) is the standard treatment for acute ischemic stroke.
- tPA should ideally be administered intravenously within 3 hours of symptom onset, but can be given up to 4.5 hours in some cases.
- Aspirin is the primary pharmacologic treatment for acute ischemic stroke in patients ineligible for tPA.
- Heparin, enoxaparin, and warfarin are used to prevent further clot formation in patients with stroke.
- Anticoagulants and antiplatelet medications should never be administered to patients with hemorrhagic stroke.
- Blood pressure control is crucial in stroke patients eligible for thrombolytic therapy.
- Corticosteroids, such as prednisone or dexamethasone, may be used to treat cerebral edema.
- Osmotic diuretics (mannitol) or loop diuretics (furosemide) may be given to manage increased ICP.
- Anticonvulsants, like phenytoin or barbiturates, may be prescribed to treat seizures associated with increased ICP.
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