《临床药物治疗学 Clinical Pharmacotherapeutics》阅读资料：Pharmacotherapy of Neuroscience（Melody）

Eab 00 Pharmacotherapy of Neuroscience o000oc0= Melody Ryan, PharmD, MPH Associate professor Departments of Pharmacy Practice Science and Neurology KENTUCKY College of Pharmacy

Pharmacotherapy of Neuroscience Melody Ryan, PharmD, MPH Associate Professor Departments of Pharmacy Practice & Science and Neurology

Eab Objectives Recognize and select appropriate treatment oE: for stroke risk factors 00 Choose appropriate stroke preventative 3. therapy for a specific patient 8家.· To choose appropriate antiepileptic medications for an individual patient lo recognize common adverse effects o antiepileptic medications KENTUCKY College of Pharmacy

Objectives • Recognize and select appropriate treatment for stroke risk factors • Choose appropriate stroke preventative therapy for a specific patient • To choose appropriate antiepileptic medications for an individual patient • To recognize common adverse effects of antiepileptic medications

Objectives oS. Recognize common signs/symptoms of g多: Parkinson disease 00 Choose appropriate treatment for a specific patient with Parkinson disease o000oc0= Recognize common adverse effects associated with treatment of parkinson disease KENTUCKY College of Pharmacy

Objectives • Recognize common signs/symptoms of Parkinson disease • Choose appropriate treatment for a specific patient with Parkinson disease • Recognize common adverse effects associated with treatment of Parkinson disease

Eab Stroke STROKE is an Emergency Ischemic Stroke Every minute counts 00 ACT EAST FACE Does one side of the face droop? Ask the person to smile o000oc0= Is one arm weak or numb? r RMs both arms. Does one arm Blood clot stops the drift downward? flow of blood to an area of the brain Is speech slurred? C Heart and Stroke Foundation of Canada S PEECH Ask the person to repeat a simple sentence. Is the sentence repeated correctly? If the person shows any of thes IME symptoms, Call 911 or get to the hospital immediately

Stroke

E四 Risk Factors a E Non-modifiable: age, race, sex, low birth weight, o: family history o. Somewhat modifiable Modifiable: Diabetes ess well-documented Hypertension ° Hypercholesterolemia Alcohol abuse Smoking o000oc0= Hyperhomocysteinemia Oral contraceptives Drug abuse Cardiac conditions Hypercoagulability Atrial fibrillation Periodontal disease Obesity .· Inflammation and infection· Physical inactivity 8· Sleep apnea Pregnancy Metabolic syndrome Depression 0:· Migraine with aura KENTUCKY College of Pharmacy

Risk Factors Somewhat modifiable: • Diabetes Less well-documented: • Alcohol abuse • Hyperhomocysteinemia • Drug abuse • Hypercoagulability • Periodontal disease • Inflammation and infection • Sleep apnea • Metabolic syndrome • Migraine with aura Modifiable: • Hypertension • Hypercholesterolemia • Smoking • Oral contraceptives • Cardiac conditions • Atrial fibrillation • Obesity • Physical inactivity • Pregnancy • Depression Non-modifiable: age, race, sex, low birth weight, family history

Eab Goals of Therapy Prevent first infarct 00 Prevent second infarct 0o. Limit damage from infarcts KENTUCKY College of Pharmacy

Goals of Therapy • Prevent first infarct • Prevent second infarct • Limit damage from infarcts

Eab Preventing First Infarct Reduction of risk factors g:· Patient education 00 8. LoW-dose aspirin not used for men Increases risk of hemorrhagic stroke 8家:。 Low-dose aspirin may be used for high-risk women 0 KENTUCKY College of Pharmacy

Preventing First Infarct • Reduction of risk factors • Patient education • Low-dose aspirin not used for men – Increases risk of hemorrhagic stroke • Low-dose aspirin may be used for high-risk women

Eab Preventing First Infarct: Atrial Fibrillation 70% not treated appropriately Warfarin 00 Aspirin clopidogrel 当- Dabigatran KENTUCKY College of Pharmacy

Preventing First Infarct: Atrial Fibrillation – 70% not treated appropriately – Warfarin – Aspirin + clopidogrel – Dabigatran

Eab CHADS Score Congestive heart failure, hypertension, age oi :>75 years, diabetes mellitus, and prior stroke 00 or transient ischemic attack stratification scheme o i, Assign 1 point each for CHE, HTN, age275 years, or diabetes 2. Assign 2 points for previous stroke or TIA KENTUCKY ∴ Chest2012;141:e601-365 College of Pharmacy

CHADS2 Score • Congestive heart failure, hypertension, age >75 years, diabetes mellitus, and prior stroke or transient ischemic attack stratification scheme • Assign 1 point each for CHF, HTN, age ≥ 75 years, or diabetes • Assign 2 points for previous stroke or TIA Chest 2012; 141: e601S-36S

Eab CHADS Score 。· f tota=0, give no therapy or aspirin75-325 oMg/day, based on patient preference If total 1, give oral anticoagulant. For patients unsuitable for oral anticoagulation or who choose not to have oral anticoagulation 02(for reasons other than concerns about major bleeding), give aspirin clopidogrel aspirin 75-325 mg/day KENTUCKY Chest2012;141:e6015-36S College of Pharmacy

CHADS2 Score • If total=0, give no therapy or aspirin 75-325 mg/day, based on patient preference • If total ≥ 1, give oral anticoagulant. For patients unsuitable for oral anticoagulation or who choose not to have oral anticoagulation (for reasons other than concerns about major bleeding), give aspirin + clopidogrel > aspirin 75-325 mg/day Chest 2012; 141: e601S-36S