Stroke: Stroke Prepared & Presented by Dr. Siva Reddy Challa, Professor & HOD, Dept. of Pharmacology KVSR Siddhartha College of Pharmaceutical Sciences, Siddhartha Nagar, Vijayawada-520010 Andhra Pradesh, INDIA Email: sivareddypharma@gmail.com
What is a stroke or TIA?: What is a stroke or TIA? Stroke- Sudden onset of focal neurologic deficits fitting a vascular distribution TIA Stroke-like symptoms lasting <1 hr and completely resolve Most TIAs last 15-30 minutes
Details of Facial Droop: Details of Facial Droop
PowerPoint Presentation: Details of Arm Drift
Time dependent treatment: Time dependent treatment IV t-PA must be given within 3 hours from onset of symptoms or from “time last seen normal” Intra-arterial (IA) therapy must be given within 6 hours 3 hours
Thrombolytic Therapy for Acute Ischemic Stroke: Thrombolytic Therapy for Acute Ischemic Stroke < 3 hours IV t-PA IA t-PA 3-6 hours Onset of Symptoms Therapy
Acute Management: History: Acute Management: History Symptom onset or time last seen normal Correlate times (alarms, work, drive time TV) Corroborate with witness Prodromal or previous symptoms/TIAs Exclude stroke mimics (seizure,migraine hypoglycemia, orthostasis)
Is the patient a thrombolytic candidate?: Is the patient a thrombolytic candidate? Onset < 6 hrs CT negative for hemorrhage Not anticoagulated (INR < 1.5) Keep BP < 220/120 ASA 325mg chewed DVT prophylaxis -Heparin 5000 SQ BID NO YES Keep BP <185/110 < 3 hrs -IV tPA 3-6 hrs -Intra-arterial t-PA
Blood Pressure Management in Acute Ischemic Stroke: Blood Pressure Management in Acute Ischemic Stroke No thrombolytics Thrombolytics BP >220/120 MAP>130 requires Labetalol 10-30 mg IV q 10-15min Enalapril 0.625-1.25 mg IV q 6-8hrs prn Nitroprusside 0.5-1.0 µg/kg/min cont. IV Nicardipine 2.5-15 mg/hr continuous IV DBP> 140 Nitroprusside 0.5-1.0 µg/kg/min cont. IV Nicardipine 2.5-15 mg/hr continuous IV BP > 185/110 Nitropaste 1-2 inches Labetalol 10-30 mg IV q 10-15min Enalapril 0.625-1.25 mg IV q 6-8hrs (watch for angioedema )
Fibrinolytic therapy use : Fibrinolytic therapy use
AHA Stroke Levels of Evidence: AHA Stroke Levels of Evidence Level I: Data from randomized trials with low false-positive (alpha) and low false-negative (beta) errors Level II: Data from randomized trials with high false-positive (alpha) or high false-negative (beta) errors Level III: Data from nonrandomized concurrent cohort studies Level IV:Data from nonrandomized cohort studies using historical controls Level V: Data from anecdotal case series
AHA Stroke Strength of Recomendation: AHA Stroke Strength of Recomendation Grade A:Supported by Level I evidence Grade B:Supported by Level II evidence Grade C:Supported by Levels III, IV, or V evidence
Thank You This presentation is dedicated to my students: Thank You This presentation is dedicated to my students