Treatment Protocols & Therapeutic Interventions Flashcards

Before IV alteplase is given for acute ischemic stroke, blood pressure must be lowered to below what level?

Answer: 185/110 mmHg

AHA/ASA guidelines require BP below 185/110 mmHg before thrombolysis and below 180/105 mmHg for 24 hours afterward.

What is the standard IV alteplase dose for acute ischemic stroke?

Answer: 0.9 mg/kg, max 90 mg, with 10% as a bolus

Alteplase is dosed at 0.9 mg/kg (max 90 mg): 10% as a 1-minute bolus and the rest infused over 60 minutes.

A patient in status epilepticus is still seizing after two doses of IV lorazepam. What is the most appropriate next step?

Answer: Give an IV second-line drug such as fosphenytoin, valproate, or levetiracetam

Benzodiazepine-refractory status epilepticus calls for an IV second-line antiseizure drug; the ESETT trial found fosphenytoin, valproate, and levetiracetam about equally effective.

Which intervention is first-line for an acute multiple sclerosis relapse that impairs function?

Answer: High-dose IV methylprednisolone for 3–5 days

High-dose corticosteroids (usually methylprednisolone 1 g daily for 3–5 days) speed recovery from MS relapses.

For steroid-refractory severe MS relapses, which therapy is the usual rescue option?

Answer: Plasma exchange

Plasma exchange is recommended for severe demyelinating attacks that do not respond to high-dose corticosteroids.

Nimodipine is given after aneurysmal subarachnoid hemorrhage mainly to:

Answer: Improve outcomes related to delayed cerebral ischemia

Oral nimodipine 60 mg every 4 hours for 21 days improves neurologic outcome by reducing ischemia caused by vasospasm.

Which first-line treatment is used for myasthenic crisis with respiratory compromise?

Answer: Plasma exchange or IVIG with airway support

Myasthenic crisis is treated with ventilatory support plus rapid immunotherapy (PLEX or IVIG); high-dose steroids alone can worsen weakness at first.