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WorksheetsCardio Acevedo Exam IV
Total questions: 21
Worksheet time: 13mins
What is the BP Goal for a patient with NO tPA being administered?
< 185/105
< 180/105
< 185/110
< 220/120
What is the BP goal for a patient PRIOR to administering tPA?
< 220/120
< 185/110
< 180/105
< 185/105
What is the BP goal for a patient AFTER administering tPA?
< 220/120
< 185/110
< 180/110
< 180/105
Identify all that are FDA-labeled indications for the use of Alteplase
Acute Ischemic Stroke within 3 hours of symptom onset
Current ICH
Acute Myocardial Infarction
Acute Massive Pulmonary Embolism
Current Severe Uncontrolled Hypertension
What is the Blood Glucose goal that all patients MUST have priorate tPA administration?
> 40 mg/dL
> 50 mg/dL
> 60 mg/dL
> 70mg/dL
Identify the correct definitions of Thrombotic and Embolic Ischemic Strokes
Thrombotic: clot occluding in an artery that is blocking blood flow to the brain
Embolic: clot occluding in an artery that is blocking blood flow to the brain
Thrombotic: blood clot or plaque that develops elsewhere in the body, then travels to the brain
Embolic: blood clot or plaque that develops elsewhere in the body, then travels to the brain
What is the difference between a Stroke and a Transient Ischemic Attack (TIA)?
Stroke lasts less than 24 hours, and is usually less than 30 minutes
TIA lasts at least 24 hours
TIA lasts less than 24 hours, and is usually less than 30 minutes
Stroke lasts at least 24 hours
What is the goal door to NCCT time that should be met in ≥50% of patients who may need fibrinolytic therapy or mechanical thrombectomy
20 minutes
45 minutes
60 minutes
What is the ONLY FDA Approved Agent that is used for pharmacological repercussion therapy in patients with a stroke?
Reteplase
Alteplase
Tenecteplase
How is tPA dosed for stroke?
0.9mg/kg
After bolus dose, IV administer remaining dose over 24 hours
Bolus 10% of total dose over one minute
After bolus dose, IV administer remaining dose over 1 hour
Max dose of 90mg
Identify Modifiable Risk factors for stroke
HTN
DM
Age
HF
Low Birth Weight
AM, 85yo, F, presents to your clinic for primary stroke prevention and an assessment. She has a history of HTN but is currently taking medication to control it, and has been diagnosed with T2DM. Using the CHA2DS2-VASC Score, What is AM's Score?
2
3
4
5
What are the three medications typically administered first line in Orolingual Angioedema?
Firazyr 3mL SQ
Pepcid 20mg IV
Cinryze 20IU/kg IV
Solu-medrol 125mg IV
Benadryl 50mg IV
What is the most appropriate medication to administer to a patient if they do not respond to the triple therapy? (aka: a further increase in angioedema)
Epinephrine 0.1% 0.5mL via neb
Cinryze 20IU/kg IV
Epinephrine 0.5% 0.3mL SQ
Firazyr 3mL SQ
Epinephrine 0.1% 0.3mL SQ
AM, your patient has started to experience signs and symptoms of intracranial bleeding following an administration of tPA. What is the most appropriate plan of action?
If tPA is still infusing, stop infusion
Administer Firazyr 3mL IV
Administer Cryoprecipitate (10U over 10-30min)
Administer Clevidipine 1-2mg/hr IV
Initiate an emergent non enhanced CT Scan
When is oral anticoagulation recommended for patients with acute ischemic stroke?
When the acute ischemic stroke is of noncardioembolic origin
When the acute ischemic stroke is of cardioembolic origin
When is Aspirin 160-300mg PO QD recommended in patients following an acute ischemic stroke?
When the acute ischemic stroke is of noncardioembolic origin
When the acute ischemic stroke is of cardioembolic origin
What medication is appropriate in reducing the incidence and severity of neurologic deficits regarding cerebral vasospasm?
High Intensity Statin
Nicardipine
Labetalol
Nimodipine
Sodium Nitroprusside
Identify normal intracranial pressure and increased intracranial pressure
5-10 mmHG
5-15 mmHG
< 20 mmHG for > 5 minutes
15-20 mmHG for > 5 minutes
> 20 mmHG for > 5 minutes
How can we manage cerebral edema in patients?
Mannitol 1g/kg IV bolus, followed by 0.25-0.5g/kg IV over 20 minutes for 6h
Furosemide (only if HF/PE is major concern)
Nimodipine 60mg PO Q24H x 21d
Labetalol 10-20mg IV over 1-2 min
Hypertonic Saline (3%, 23.4%)
When is it appropriate to give a patient either anti-platelet or anticoagulation therapy following a t-PA administration?
At least 12 hours later
At least 24 hours later
At least 36 hours later
At least 48 hours later
