Stroke and TIA

T/F. Targeting multiple risk factors, such as HTN, HLD, and DM has additive benefits for secondary prevention of stroke and TIA.

• True

• False

Which of the following medications can be considered to prevent recurrent stroke in a patient with a history of ischemic stroke/TIA, insulin resistance, and no history of heart failure or bladder cancer?

• metformin

• pioglitazone

• glipizide

• sitagliptin

A 64 YOM with a history of HTN and HLD presents to your clinic after experiencing a TIA two weeks ago. His BP today is 146/88 mmHg. Meds: amlodipine 5 mg daily, atorvastatin 80 mg daily, cetirizine 10 mg daily. What is the best recommendation at this time?

• Increase amlodipine to 10 mg daily

• Switch atorvastatin 80 mg daily to rosuvastatin 40 mg daily

• Add lisinopril 10 mg daily

• Add spironolactone 25 mg daily

Which of the following is the preferred high intensity statin therapy for patients with a history of ischemic stroke, no known CHD, no major sources of embolism, and LDL > 100?

• Simvastatin 40 mg

• Pravastatin 40 mg

• Rosuvastatin 40 mg

• Atorvastatin 80 mg

A 58 YOF with a history of ischemic stroke 6 months ago presents for follow up. Current meds: atorvastatin 80 mg daily, lisinopril 20 mg daily, omeprazole 20 mg daily and sertraline 50 mg daily. LDL 75 mg/dl, TG 210 mg/dl, BP 132/78 mmHg, A1C 6.4%. What is the best recommendation at this time?

• No changes as LDL is at goal

• Switch atorvastatin to rosuvastatin 40 mg daily

• Add Vascepa 2 g twice daily

• Increase lisinopril to 40 mg daily

What is the most appropriate antiplatelet therapy for stroke prevention management for a patient with a recent TIA (ABCD2 score of 5) and no history of atrial fibrillation?

• Aspirin monotherapy

• Clopidogrel monotherapy

• Antiplatelet therapy is contraindicated

• Aspirin + clopidogrel for 21-90 days, then monotherapy

A 62 YOF with ischemic stroke 20 days ago due to 70% stenosis of a major intracranial artery presents for secondary stroke prevention. What is the best regimen for her?

• Warfarin 5 mg daily indefinitely

• Ticagrelor 90 mg BID + aspirin indefinitely

• Clopidogrel 75 mg + aspirin daily for up to 90 days

• Aspirin 81 mg daily indefinitely

Which of the following statements about antiplatelet therapy for non-cardioembolic stroke/TIA is correct?

• DAPT for > 90 days is associated with excess risk of hemorrhage

• Aspirin + clopidogrel should be continued indefinitely

• Warfarin is preferred over antiplatelet therapy

• If a patient was on aspirin at the time of stroke, increasing the dose has shown to be more effective

A 65 YOF with a history of HTN, T2DM, and afib presents for follow up after experiencing an ischemic stroke two weeks ago. She was not previously on anticoagulant therapy. She does not have a mechanical heart valve and there is no evidence of mitral stenosis. What is the best choice for her?

• Warfarin with a target INR of 2.0-3.0

• Aspirin + clopidogrel indefinitely

• Aspirin monotherapy

• Apixaban 5 mg BID

T/F. A 60 YOM with ischemic stroke, symptoms of excessive daytime sleepiness, BMI 32 who reports waking up gasping for air at night should be evaluated for OSA.

• True

• False