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957 Block 3 > 2. PAD > Flashcards

2. PAD Flashcards

1
Q

What is peripheral artery disease?

A

Disorder that obstructs blood supply to lower or upper extremities.

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2
Q

Why is PAD clinically important?

A
  • marker for subclinical coronary atherosclerosis
  • 45% of patients with symptomatic PAD have concurrent clinically significant CAD
  • CV events are more common in PAD than limb events
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3
Q

PAD is more prevalent in women than in men. (T/F)

A

False: more prevalent in men

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4
Q

About what percent of patients with PAD are asymptomatic?

A

50%

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5
Q

About what percent of patients with PAD have intermittent claudication?

A

15%

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6
Q

About what percent of patients with PAD have atypical pain?

A

33%

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7
Q

What is atypical pain associated with PAD?

A

extremity discomfort that is exertional but does not resolve with rest

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8
Q

What are the 5 P’s of diagnosis?

A 
pain
pallor
pulselessness
paresthesias
paralysis
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9
Q

How is ABI calculated?

A

highest ankle pressure / highest arm pressure

measurements for both right and left

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10
Q

What is a normal ABI?

A

above 0.90

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11
Q

What ABI is considered mild obstruction?

A

0.71 - 0.90

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12
Q

What ABI is considered moderate obstruction?

A

0.41 - 0.70

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13
Q

What ABI is considered severe obstruction?

A

0.00 - 0.40

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14
Q

How is PAD diagnosed?

A
  • contrast arteriography
  • duplex ultrasound
  • magnetic resonance angiography
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15
Q

What is the gold standard of PAD diagnosis?

A

contrast arteriography

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16
Q

What is the best choice for PAD diagnosis in patients with CKD?

A

Magnetic resonance angiography

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17
Q

What are the goals of treatment for PAD?

A
  • Prevention of CVD
  • Relief of symptomatic PAD
  • Prevent limb amputation
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18
Q

What are some risk factor management strategies?

A
  • Lifestyle changes
  • Blood pressure control
  • Diabetes control
  • Hyperlipidemia
  • Anti platelet therapy
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19
Q

What are the BP goals for patients with PAD?

A

< 140/90 mmHg if < 60 years old

< 150/90 mmHg if ≥ 60 years old

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20
Q

What is A1c goal for patients with PAD?

A

6.5%

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21
Q

How should hyperlipidemia be treated in patients with PAD?

A

high potency statin treatment

22
Q

All PAD patients should be on regular dose aspirin (325 mg) (T/F)

A

False: low dose aspirin (81 mg) daily

23
Q

What is the alternative antiplatelet therapy if aspirin is not tolerated?

A

Clopidogrel 75 mg

24
Q

How is symptomatic PAD treated?

A
  • exercise therapy
  • pharmacologic therapy
  • surgery
25
Q

What are the pharmacologic therapies for PAD?

A
  • Cilostazol

- Pentoxifylline

26
Q

What are the surgical methods for PAD?

A
  • endovascular

- arterial bypass

27
Q

Exercise therapy is the most beneficial in intermittent claudication. (T/F)

A

True

28
Q

How does exercise therapy benefit patients with PAD?

A
  • helps with intermittent claudication

- increase duration and distance of walking

29
Q

What exercise regimen shows the greatest benefit in PAD?

A

> 30 minutes at least 3 time per week

30
Q

What is the MOA for Cilostazol?

A
  • Selective inhibitor of phosphodiesterase III

- ↑ in cAMP leads to phosphorylation of PKA substrates

31
Q

What are the effects of Cilostazol?

A
  • positive lipid effects
  • decreased platelet aggregation
  • minor cardiac contractility
  • decrease in VSMC proliferation
  • VSMC relaxation increased
32
Q

What are the indications of Cilostazol?

A

symptomatic management of PAD: primarily intermittent claudication

33
Q

What is the typical dose of Cilostazol?

A

100 mg BID

taken 30 minutes before or 2 hours after eating

34
Q

Cilostazol should be stopped after 6 months if not effective. (T/F)

A

False: stopped after 3 months

35
Q

Cilostazol is a major substrate of what enzymes?

A

CYP3A4 and CYP2C19

36
Q

High fat meals and grapefruit juice _______(↑/↓) peak concentrations of Cilostazol.

A

↑ increase

37
Q

What are ADRs of Cilostazol?

A
  • headache/ dizziness
  • diarrhea and abnormal stool
  • infection
  • rhinitis
  • palpitation
  • peripheral edema
  • thrombocytopenia
  • bleeding
38
Q

What is the contraindication of Cilostazol?

A

hear failure of ANY severity

39
Q

What is the MOA of Pentoxifylline?

A

reduces blood viscosity via increased leukocyte and erythrocyte deformability

40
Q

Pentoxifylline is the first line agent for intermittent claudication. (T/F)

A

False: 2nd line agent

41
Q

How is Pentoxifylline dosed?

A

400 mg TID

42
Q

Pentoxifylline must be adjusted for renal dysfunction. (T/F)

A

True

43
Q

What are the ADRs with Pentoxifylline?

A

nausea and vomiting

44
Q

With a CrCl of ~60 mL/min, how must Pentoxifylline be dosed?

A

400 mg BID

45
Q

With a CrCl of ~20 mL/min, how must Pentoxifylline be dosed?

A

400 mg QD

46
Q

What are some alternate therapies for PAD?

A
  • warfarin

- herbals

47
Q

What are some herbal supplements used for PAD?

A
  • L-arginine
  • L-carnitine
  • Ginko bilboa
  • Vit E
48
Q

What are surgical endovascular reconstruction options?

A
  • percutaneous transluminal angioplasty (PTA)

- PTA with stents

49
Q

What are surgical reconstruction options?

A
  • aortoiliac/aortofemoral reconstruciton
  • femoropopliteal bypass
  • femorotibial bypass
50
Q

What are indications for surgical revascularization?

A
  • inadequate response to exercise or medical mgmt
  • severely disabled
  • lesions
  • patient would benefit
  • critical limb ischemia

957 Block 3 (6 decks)

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