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% Document Info
\author{Bailey\_Rickett}
\pdfinfo{
  /Title (pharmacology-of-ischemic-stroke-management.pdf)
  /Creator (Cheatography)
  /Author (Bailey\_Rickett)
  /Subject (Pharmacology of Ischemic Stroke Management Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pharmacology of Ischemic Stroke Management Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Bailey\_Rickett} via \textcolor{DarkBackground}{\uline{cheatography.com/184326/cs/38666/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Bailey\_Rickett \\
  \uline{cheatography.com/bailey-rickett} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 12th May, 2023.\\
   Updated 12th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{2}

\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Physiology of Acute Stroke}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Most likely involves a clot that has dislodged from a peripheral site (leg veins) and landed in a cerebral vessel (Thrombic Embolism) or perhaps a clot in situ (clot in place)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{This can be very deadly.} \tn 
% Row Count 5 (+ 1)
% Row 2
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\mymulticolumn{1}{x{8.4cm}}{In hemorrhagic the blood vessel has blown out and the patient is bleeding into the brain.} \tn 
% Row Count 7 (+ 2)
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\par\addvspace{1.3em}

\begin{tabularx}{8.4cm}{X}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Secondary Prevention of Ischemic Stroke}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{Antiplatelet Therapy} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Blood Pressure Management} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{8.4cm}}{Cholesterol Management} \tn 
% Row Count 3 (+ 1)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Antiplatelet Therapy}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{{\bf{Antiplatelet therapy is recommended over anticoagulation therapy in post ischemic stroke}} (unless stroke was due to Afib/Cardioembolic, in which warfarin of other DOAC is indicated.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{Recommended to start 24-48 hours post ischemic stroke. If patient was given IV alteplase, wait 24 hours after infusion to start antiplatelet therapy.} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{For patients with noncardioembolic ischemic stroke or TIA\textless{} aspirin 50 to 325 mg daily, clopidogrel 75 mg daily, or the combination of aspirin 25 mg and extended-release dipyridamole 200 mg twice daily is indicated for secondary prevention of ischemic stroke.} \tn 
% Row Count 13 (+ 6)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{For high risk patients with recent minor ischemic stroke or high risk TIA, ASA + clopidogrel (DUAL therapy) should be initiated within 12-24 hours of symptoms onset and continued up to 90 days, followed by the continuation of single antiplatelet therapy long term.} \tn 
% Row Count 19 (+ 6)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{Oral anticoagulants for Afib patients: dabigatran, apixaban, rivaroxaban, edoxaban, warfarin.} \tn 
% Row Count 21 (+ 2)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Blood Pressure Management}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{It is recommended that a person be started on a thiazide diuretic, ACEi, or ARB} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{8.4cm}}{CCBs have not been shown to be efficacious is secondary prevention, however they could be add ons to the above mentioned to help a patient achieve BP goals or in patients who are unable to take the first line agents.} \tn 
% Row Count 7 (+ 5)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{8.4cm}}{A BP goal of \textless{} 130/80 mmHg is reasonable to help prevent secondary cardiovascular events.} \tn 
% Row Count 9 (+ 2)
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{Cholesterol Management}}  \tn
% Row 0
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\mymulticolumn{1}{x{8.4cm}}{Patients aged 75 years or younger are recommended to be placed on a high intensity statin for secondary prevention.} \tn 
% Row Count 3 (+ 3)
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\mymulticolumn{1}{x{8.4cm}}{Atorvastatin 80 mg} \tn 
% Row Count 4 (+ 1)
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\mymulticolumn{1}{x{8.4cm}}{Rosuvastatin 20 mg (now generic, less drug interactions, and less potential for myalgias/ADRs)} \tn 
% Row Count 6 (+ 2)
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{tPA-Alteplase {\bf{(Activase)}}}}  \tn
% Row 0
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MOA: & leads to reperfusion by clot breakdown. tPA catalyzes the conversion of plasminogen to plasmin which then activates "fibrinolysis" which leads to {\bf{clot degradation/dissolvement}} \tn 
% Row Count 9 (+ 9)
% Row 1
\SetRowColor{white}
Indications: who can receive this? & Patients presenting in a {\bf{3 hour time window}} with mild to severe stroke symptoms (the goal with best evidence is 3 hours or less, some hospitals will do up to 4.5 hours) \tn 
% Row Count 18 (+ 9)
% Row 2
\SetRowColor{LightBackground}
 & Patients in the 3-4.5 hour time window who are {\bf{80 yo or less}}, without history of diabetes or stroke, no anticoagulant use. \tn 
% Row Count 24 (+ 6)
% Row 3
\SetRowColor{white}
 & *It is important to try and achieve a door to needle time or no more than 60min for these patients eligible for Alteplase to increase efficacy. Brain imaging needs to be done within 20 minutes of patient arrival prior to Alteplase administration to check for hemorrhagic. (would make bleeding much worse) \tn 
% Row Count 39 (+ 15)
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\vfill
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\begin{tabularx}{8.4cm}{x{3.68 cm} x{4.32 cm} }
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\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{tPA-Alteplase {\bf{(Activase)}} (cont)}}  \tn
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Side Effects: & angioedema: stop the alteplase and ACEi if taking, start IV diphenhydramine and IV methylprednisolone, start IV ranitidine or famotidine.  Can also start EPI if it worsens. \tn 
% Row Count 9 (+ 9)
% Row 5
\SetRowColor{white}
 & Bleeding: stop alteplase, get CBC and INR, fibrinogen, and aPPT. {\bf{Get stat head CT}}. Start cryoprecipitate (frozen plasma rich in clotting factors) (with factor VIII) and tranexamic acid (TXA) \tn 
% Row Count 19 (+ 10)
% Row 6
\SetRowColor{LightBackground}
Contraindication: & not after 4.5 hours (the clot becomes well organized, could become well hemorrhagic) \tn 
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% Row 7
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 & not if CT shows acute intracranial hemorrhage \tn 
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% Row 8
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 & Not if history of AIS within3 months. \tn 
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% Row 9
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 & CI within 3 months of severe head trauma. \tn 
% Row Count 30 (+ 2)
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\begin{tabularx}{8.4cm}{x{3.68 cm} x{4.32 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{8.4cm}}{\bf\textcolor{white}{tPA-Alteplase {\bf{(Activase)}} (cont)}}  \tn
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 & CI within 3 months of major surgery. \tn 
% Row Count 2 (+ 2)
% Row 11
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 & History of intracranial hemorrhage \tn 
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% Row 12
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 & History or signs of SAH \tn 
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 & History of GI malignancy or bleed \tn 
% Row Count 8 (+ 2)
% Row 14
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 & Not in patients who are hypercoagulable \tn 
% Row Count 10 (+ 2)
% Row 15
\SetRowColor{white}
Dosing: & 0.9 mg/kg (max of 90 mg) \tn 
% Row Count 12 (+ 2)
% Row 16
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 & 10\% given as a bolus over 1 minute \tn 
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% Row 17
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 & 90\% given as an infusion over the next 59 minutes \tn 
% Row Count 17 (+ 3)
% Row 18
\SetRowColor{LightBackground}
\seqsplit{Notes/considerations} & BP should be less than 185/110 mmHg prior to administration to decrease chance of hemorrhage \tn 
% Row Count 22 (+ 5)
% Row 19
\SetRowColor{white}
 & Glucose should be \textgreater{}50mg/dL before initiation \tn 
% Row Count 25 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\mymulticolumn{1}{x{8.4cm}}{\bf\textcolor{white}{TPA}}  \tn
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\mymulticolumn{1}{p{8.4cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1683912419_IMG_2238.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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% That's all folks
\end{multicols*}

\end{document}