Course:PHAR451/StrokePrevention

Stroke Prevention Therapeutics (Non-AFib)
PHAR 451
Section:
Instructor:	Dr. Peter Loewen
Email:	peter.loewen@ubc.ca
Office:	PHRM 3512
Office Hours:
Class Schedule:
Classroom:	PHRM 1101
Important Course Pages
	Syllabus
	Lecture Notes
	Assignments
	Course Discussion

Ischemic Stroke Prevention Therapeutics (Non-atrial fibrillation)

Pre-Session Objectives

PRIOR TO arriving at the session, participants should be able to name the stroke-applicable drugs, usual dose ranges, and common toxicities of all the following classes/drugs:

aspirin
ACE inhibitors
ARBs
clopidogrel
dipyridamole/ASA
warfarin
statins
thiazide diuretics

PRIOR TO arriving at the session, participants should be able to explain the epidemiology and pathophysiology of ischemic stroke.

Preparation for the session

Learn the pathophysiology and epidemiology of ischemic stroke
Review the session slides (link below) and come prepared to ask questions about the therapeutics as we review it together
Obtain PL's Stroke Prevention PLOP and visualize how it is constructed so you can apply it to patient cases

Objectives

After the session, and upon personal reflection & study, students will be able to: DESIGN and RATIONALIZE using EVIDENCE, a stroke prevention regimen (drugs, doses, routes, frequency) in each of the following clinical scenarios:

Primary Stroke Prevention
Secondary Stroke Prevention

The regimen should be patient-specific and comprehensive, integrating therapeutics knowledge and principles about HTN, hyperlipidemia, diabetes, and the material on the stroke prevention PLOP.

Session Materials

Therapeutic Controversies & Areas of Uncertainty

In patients who have had an ischemic stroke while taking ASA, what is the best antithrombotic strategy for secondary/tertiary prevention?
Are ACE-I effective for secondary stroke prevention?
Is clopidogrel really more effective than aspirin for secondary stroke prevention?

Supportive Literature & Further Reading

ASA primary prevention effects by gender: Berger JS et al. JAMA 2006;295:306-13
ACCP CHEST Guidelines 2012
POPADAD BMJ 2008;337:a1840
HOPE-STROKE NEJM 2000;342;145-53 / BMJ 2002;324:1-5
all ACE-I's: Lancet 2006; 368: 581-88
overall efficacy of statins and My Little Black Book
HPS
CARDS Lancet 2004;364;685-96
ASCOT-LLA Lancet 2003;361:1149-58
LIPID-STROKE NEJM 2000;343:317-26
intensive statin therapy: Cannon et al. JACC 2006;48:438-45
Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention. Lancet Neurology, Volume 8, Issue 5, Pages 453 - 463
Antithrombotic Trialists Collaboration (ATTC) Lancet 2009;373: 1849–60
CAPRIE. Lancet 1996;348:1329-39
WARSS. NEJM 2001;345:1444-51
ESPS-2, ESPRIT
CHARISMA. NEJM 2006;354 (12MAR06)
PRoFESS (antithrombotics). NEJM 2008;359 | PRoFESS (ARBs). NEJM 2008;359
SPARCL N Engl J Med 2006; 355:549-559
PROGRESS Lancet 2001;358:1033-41
MATCH Lancet 2004; 364: 331-37
CHANCE NEJM 2013