General
F.A.S.T.
What is face, arm, speech, and time?
Associated with A Fib
What is cardiogenic embolic strokes?
Target goal INR for Warfarin
What is 2-3?
Apixaban Antidote/reversal agent
Andexanet Alfa
It binds to fibrin in converts plasminogen to plasmin, which ultimately stimulate fibrinolysis of the clot.
What is Alteplase (T-PA)?
Main presenting symptoms for Ischemic strokes
What is numbness or weakness of face, arm, or legs (especially unilaterally)?
May be a warning sign
What is a TIA?
Adverse effect includes angioedema, swelling areas of tissue under the skin that typically affects the face and throat.
What is Dabigatran (Pradaxa)
When to D/C Apixaban before invasive or surgical procedure
What is at least 48 hours prior?
Time frame for treatment of intra-arterial delivery
What is up to 6 hours?
FDA approved treatment window
What is within 3 hours after the onset of stroke?
"Exploding headache"
What is a hemorrhagic stroke?
How long does Apixaban and Edoxaban last after the last dose?
What is at least 24 hours.
Two labs to monitor when taking Clopidrogel
What is prolonged bleeding time and CBC?
Alteplase (T-PA) most dangerous adverse effect
What is intracrainal hemorrhage?
(4) High risk groups for Ischemic Strokes
What is older than 35, men, African Americans, A fib d/t cardiogenic embolic stroke, HTN, smoking, dysplidemia, high cholesterol, (things that can lead to the narrowing of blood flow to that portion of the brain)
Atherosclerosis build up in the vein so it’s blocking the blood flow of the brain
What is large artery thrombotic strokes?
Teaching interventions for Aspirin (list 5)
What is
- Decreases platelet aggregation
- Increased risk of GI bleeding
- Administer with full glass of water after meals or with meals
- Remain upright 15-30 mins after administration
- Many drugs increase risk of bleeding
- Prolongs bleeding time 4-7 days
- Can prolong prothrombin time (PT)
- Low dose aspirin is NOT FOR PAIN
- Signs of aspirin OD (tinnitus, headache, hyperventilation, agitation, mental confusion, lethargy, diarrhea, sweating)
- Reye syndrome
How long to D/C prior to surgery?
What is 1-3 days or 3-5 days (depending on CCr, creatinine clearance)?
Do not use with strokes, only to deliver tPA directly to a clot
What is EKOS?
If there is left hemiplegia (paralysis), then there is most likely have a ________ upper motor neuron damage
What is right upper motor neuron damage?
Irreversible damage
What are ischemic strokes?
When to D/C Clopidrogel (Plavix) before planned surgery and when to start back after surgery?
What is 5-7 days before surgery and as soon as possible after surgery.
FDA has included indications for meds such as _______ to include secondary stroke prevention after the acute stroke period.
What is -statin (meds ending in) or simvastatin?
List 5 Alteplase Contraindications
What is
- Active internal bleeding
- If given for stroke and the pt has a hx of intracrainal hemorrhage
- Severe uncontrolled HTN (>185/110)
-INR > 1.7
-PT> 15
- Platelets <100,000
-If patient is on oral anticoagulants
-Heparin in the last 48 hours prior to stroke
- Elevated APTT at the presentation of ED or stroke