Stroke PDF

Definition Stroke is a type of cardiovascular disease that affects the arteries of the brain when a part of a brain can't get the needed blood and oxygen. Stroke affects men more that women. Definition A thrombus or embolus blocks blood flow to part of the brain. 87% Cause Ischemic stroke (IS)...

Definition Stroke is a type of cardiovascular disease that affects the arteries of the brain when a part of a brain can't get the needed blood and oxygen. Stroke affects men more that women. Definition A thrombus or embolus blocks blood flow to part of the brain. 87% Cause Ischemic stroke (IS) Is caused by lack of blood reaching part of the brain. The symptoms developed in a few minutes. Hemostatic process is happening to prevent this type of stroke, which is: waking up from sleep suddenly. (IS) mostly occurred at night or first morning. Loss of strength or sensation on one side of the body. Speech abnormality Signs and Symptoms Blurred vision Changed in body balance Types Definition Blood spills out from break in blood vessel in brain. 13% Cause It caused by ruptures of blood vessel in or near the brain. Suddenly very sever headache Sign and symptoms Nausea Hemorrhagic stroke (HS) Vomiting Age Gender Diet Obesity Diabetes Risk factors Alcohol More fat More ketone bodies Free radicals Hypertension is developed Hypertension is developed Stress Heart disease CPD Artery disease Stroke SCD Blood disorders Anemia Thrombocytopenia Smile Ask the individual to Arm Drift Speak and simple words When patient show his teeth or smile Facial Droop How to recognize if someone have a stroke? Raise both arms and keep them up Normal Abnormal Patient closes eyes & holds both arms out for 10 seconds One side of face doesn't move as well as the other side Normal Abnormal Normal Abnormal Speech Both sides of the face move equally Both arms move the same or both arms do not move at all One arm does not move or drifts down compared to the other Patient uses correct words with no slurring Abnormal Patient slurs words, uses the wrong words, or is unable to speak If any one of the signs is abnormal, the probability of a stroke is 72% Initiated within 4-5 hours of symptom onset reduces disability from (IS) Tissue Plasminogen Activator (t-PA) Alteplase Alteplase Streptokinase Mechanism of action In acute cases use Plasminogen activated by Urokinase Thrombolytic agents Plasmin will help in degradation of Fibrin to fibrin degradation products. And then converted to plasmin which is active form Adverse effects The thrombolytic agents do not distinguish between the fibrin of an unwanted thrombus and the fibrin of a beneficial hemostatic plug. hemorrhage is a major side effect. Will inhibit the COX -1 from converting Arachidonic acid to Prostaglandin H2. MOA Bleeding Aspirin Bronchospasm GI disturbance Side effects An extremely serious pathological condition associated with swelling of liver and brain. Reye syndrome Non-Cardioembolic Stroke Steven-Johnson-Syndrome(SJS) Antiplatelet Agents MOA Treatment Inhibit ADP-mediated platelet aggregation. Clopidogrel Pharmacological Therapy of (IS) Lethal skin disease Bleeding Side effects SJS Dipyridamole plus aspirin (ASA) MOA Vitamin K antagonist. Initially used as rodenticide warfarin is now widely used clinically as an oral anticoagulant. The INR is the standard by which the anticoagulant activity of warfarin therapy is monitored. Warfarin is rapidly absorbed after oral administration (100% bioavailability with little individual patient variation). Warfarin Itis highly bound to plasma albumin, which prevents its diffusion into the cerebrospinal fluid, urine, and breast milk. Pharmacokinetics The mean half-life of warfarin is approximately In secondary prevention use Warfarin is metabolized by 40 hours CYP450 system to inactive components. After conjugation to glucuronic acid, the inactive metabolites are excreted in urine and feces. withdrawal of the drug or administration of oral vitamin K. Whole blood Hemorrhage it is important to frequently monitor the INR and adjust the dose of warfarin. Minor bleeding may be treated by frozen plasma plasma concentrates of blood factors may also be used for rapid reversal of warfarin Adverse Effects Purple toe syndrome Warfarin is teratogenic and should never be used during pregnancy MOA Oral inhibitors If anticoagulant therapy is needed during pregnancy Both agents bind to the active site of factor Xa Heparin Or Low Molecular Weight Heparins (LMWH) thereby preventing its ability to convert prothrombin to thrombin Bleeding Rivaroxaban & Apixaban As both drugs are eliminated renally Adverse Effects declining kidney function can prolong the effect of the drugs therefore, increase the risk of bleeding. Neither drug should be used in severe renal dysfunction (creatinine clearance less than 15 mL/min). Abrupt discontinuation of these agents should be avoided. Cardioembolic Stroke MOA Anticoagulants It is the prodrug of the active moiety dabigatran which is an oral direct thrombin inhibitor. Bleeding Dabigatran etexilate Dyspepsia Adverse Effects GI adverse effects Abdominal pain Esophagitis GI Bleeding Abrupt discontinuation should be avoided. heparin is ATIII-dependent MOA It acts mainly by accelerating the rate of the neutralization of certain activated coagulation factors by antithrombin. The antithrombotic effect of heparin is well correlated to the inhibition of factor Xa. More Efficacy Heparin subcutaneously Administered intravenously Heparin is often initiated as an intravenous bolus Pharmacokinetics to achieve immediate anticoagulation 1.5- to 2.5-fold that of the normal control. Titrating the dose so that the activated partial thromboplastin time (aPTT) is (PT) means clotting factor 3 (Thromboplastin) is the clotting factor 13 Normal Time is 30 - 40 seconds Heparin and low molecular weight heparins (LMWH) Like heparin, LMWH exerts its anticoagulant activity by activating antithrombin. MOA LMWH Even though LMWH consists of shorter pentasaccharide-containing chains Many forms of LMWH catalyze factor Xa inhibition by antithrombin more than thrombin inhibition. Less Efficacy Pharmacokinetics Administered Bleeding Side Effects they retain greater capacity to accelerate factor Xa inhibition by antithrombin. Hypersensitivity Thrombocytopenia Rash Anaphylactic shock subcutaneously This is followed by lower doses continuous infusion of heparin