1 / 15

The ABCs of Secondary Stroke Prevention

The ABCs of Secondary Stroke Prevention. Chris Shaffer, FNP MMP Neurology/MMC Inpatient Neurology Consult Service Maine Nurse Practitioner Association Annual Conference May 1, 2014. Welcome to the MNPA 2014 Conference. It is a distinct honor to present to you, my esteemed peers!.

mele
Download Presentation

The ABCs of Secondary Stroke Prevention

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The ABCs of Secondary Stroke Prevention Chris Shaffer, FNP MMP Neurology/MMC Inpatient Neurology Consult Service Maine Nurse Practitioner Association Annual Conference May 1, 2014

  2. Welcome to the MNPA 2014 Conference • It is a distinct honor to present to you, my esteemed peers!

  3. Disclosures • I am employed by Maine Medical Partners Neurology and Maine Medical Center, Dept. of Medicine • I have no financial interest in any of the information presented today

  4. Objectives • Participants will understand: • 1. Indications for Antiplatelet therapy and Anticoagulation Post- Ischemic- Stroke • 2.Blood pressure goals post-stroke • 3. Diabetes management goals post-stroke • 4. Cholesterol goals post-stroke • 5. Brief overview of new anticoagulation agents in addition to warfarin (pharmacology update)

  5. Antiplatelet Therapy • Is Aspirin really enough? 81 vs 325 mg vs more? Does ASA fail?

  6. Anticoagulation • Indications: • Atrial Fibrillation- the elusive arrhythmia • PFO- what to do? ASA? Atrial septal aneurysm? Age? • Recommend reversal after ICH, SAH, SDH, Consider resuming after 1-2 weeks

  7. Atrial Fibrillation: • Atrial Fibrillation • 2.7 Million Americans have Afib! • Afib is associated with a 5-fold increase in stroke risk • 15% of all strokes are from Afib.

  8. Hypertension • Hypertension: • 72 Million Americans (2011) have HTN: >140/90 • ACEI/ARB + thiazide diuretic most protective against stroke • What SHOULD the ideal BP be in your post-stroke patient?

  9. Diabetes: • Diabetes: • 25.8 Americans have Diabetes. • What should the HbA1C be for post-stroke patients?

  10. Womens’ Issues: • It’s a girl thing: • 9 Million women die each year from heart disease worldwide • Pregnancy and cancer are pro-thrombotic states and we often overlook s/sx TIA and stroke in those populations

  11. Drugs, Fats, and Alcohol: • Hyperlipidemia: • LDL should be <100, ideally <70 (if CHD, severe stenosis, DM) • Obesity: BMI>30 increases stroke risk (duh) • Quit tobacco and secondary exposure • ETOH- the J curve

  12. Monday Morning Call • You are notified that a patient of yours is being discharged form the hospital after having an ischemic stroke. • When should you schedule this follow-up appointment? • What will you address at this visit?

  13. What Lab Tests Are Important? • Bmp vscmp • FLP • HbA1C • When? Why? How often?

  14. Clinical Resources • AHA/ASA Get With The Guidelines • http://stroke.ahajournals.org: Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack: A Guideline For Healthcare Professionals from the American Heart Association/American Stroke Association Dr. Jane Morris and Dr. John Belden, stroke experts, MMP Neurology: 207-883-1414 My expert Nurse Practitioner Colleagues at MMP Neurology: Georgeann Dickey Jason Aucoin Diana Page

  15. The End • Thank You and Enjoy the Conference! • Chris Shaffer, FNP-BC, MS-N • Maine Medical Partners Neurology • Email: shaffc1@mmc.org

More Related