5. Rorabaugh - Atherosclerosis And PVD

Question 1

Atherosclerosis

Answer 1

Arterial inflammation and the deposition of fatty plaques (atheromas) w/in the arterial wall
Blood flow it blocked

Question 2

Agents to treat Hyperlipidemia

Hint, there’s 5

Answer 2

1. HMG-CoA Reductase Inhibitors
2. Niacin
3. Bile Acid Binding Resins
4. Ezetimbe
5. Fabric Acid Derivatives

Question 3

MOA of HMG CoA Reductase Inhibitors

Answer 3

Inhibit 3-hydroxy-3methylglutaryl coenzyme A reductase. This blocks the rate limiting stop in cholesterol formation.
Ex. Statins

Question 4

MOA of Niacin

Answer 4

Vitamin B3, indirectly decreases LDL production in hepatocyte by inhibiting VLDL secretion

Question 5

MOA of Bile Acid Binding Resins

Answer 5

Prevent enterohepatic reuptake of bile acids (cholesterol metabolites) which would otherwise be reabsorbed in the jejunum and be converted back into cholesterol
Ex. Colestipol and cholestyramine

Question 6

MOA of Ezetimbe

Answer 6

Inhibits intestinal cholesterol absorption

Question 7

MOA of Fibric Acid Derivatives

Answer 7

Binds to a nuclear transcription factor that alters the expression of specific genes involved in lipid transport/metabolism

Question 8

MOA of Aspirin in Atherosclerosis

Answer 8

1. Inhibit platelet aggregation

2. Decreases inflammation of arterial wall

Question 9

Can atherosclerosis be revered?

Answer 9

Yes! Lifestyle changes can reverse coronary artery stenosis and significantly alter progression of CAD

Question 10

Characteristics of Atherosclerotic Renal Artery Stenosis

Answer 10

• atherosclerosis in the renal artery, restricting blood flow
• can affect one or both kidneys
• typically found in pts who have other comorbid diseases
• with decreased renal perfusion, kidneys think that BP is low and respond by activating the RAS system to increase BP

Question 11

Stages of ARAS

Answer 11

1. Acute occlusion and 2. occlusion for days/weeks –> increased BP, elevated renin and ANG II, elimination of obstruction can normalize BP
2. Occlusion for months –> renin/ANG levels are not elevated, elimination of obstruction does not normalize BP

Question 12

Signs and Symptoms of ARAS

Answer 12

1. Onset of HTN before 30 or severe after 55 yrs
2. Malignant or resistant HTN
3. Atrophy of kidney
4. Unexplained pulmonary edema
5. Unexplained congestive heart failure

Question 13

Treatment goals ARAS

Answer 13

• Normalize BP
• Preserve renal function
• Decrease risk of adverse CV events

Question 14

Treatment of ARAS

Answer 14

• Statins to alter lipid profile
• Anti-HTN
• Glycemic control
• Surgical option to restore blood flow

Question 15

Atherosclerotic Mesenteric Artery Disease (AMAD)

Answer 15

Stenosis of mesenteric arteries caused by atherosclerosis

Question 16

Signs and Symptoms of AMAD

Answer 16

• Abdominal pain from eating

- Significant weight loss

Question 17

Treatment of AMAD

Answer 17

Usually surgery

• Endarterectomy: remove plaque from mesenteric artery
• Bypass graphting
• Stent

Question 18

Arteriolosclerosis obliterates

Answer 18

Plaque in blood vessels that carry blood to the legs

Question 19

Classification of Claudation in Atherolosclerosis Obliterans

Answer 19

1. Asymptomatic
2. Intermittent claudication - can walk, pain sometimes
   2a. Pain free at rest, claudication (pain) while walking for long time
   2b. Pain free at rest, claudication when long for short time
3. Pain at rest and at night
4. Necrosis/gangrene

Question 20

Treatment of Atherolosclerosis Obliterans

Answer 20

Decrease serum cholesterol, stop smoking, limited exercise, antiplatelet therapy, avoid cold weather

Question 21

Thromboangitis Obliterans (Berger’s Disease)

Answer 21

Fingers and hands have segmental inflammation, only a small section of blood vessels are inflamed, causing vasoconstriction, decreasing blood flow, and leading to necrotic fingers

Question 22

Typical Pt of Thromboangitis Obliterans

Answer 22

Smoker

Question 23

Diagnosis of Thrombangitis Obliterans

Answer 23

Onset of ischemia in toes/fingers, tobacco use, exclusion of embolic sources, no other atherosclerotic risk factors

Question 24

Treatment of Theromboangitis Obliterans

Answer 24

Avoid tobacco

No cure, only treatment of symptoms; pain management, antibiotics to prevent infection, amputation of necrotic tissues

Question 25

Raynaud’s Disease

Answer 25

Vasospasms in arteries of fingers and toes

Question 26

Stages of Raynaud’s

Answer 26

1. Sudden loss of arterial blood flow –> white fingers
2. Small quantity of blood enters capillary and becomes desaturated of oxygen –> fingers turn blue
3. Vasodilation causes redness and inflammation –> red and inflamed fingers

Question 27

Treatment of Raynaud’s

Answer 27

• Alpha-1 antagonists (prazosin), blocking NorEpi stimulated vosospasms
• Nitroglycerin Ointment to dilate the vessels
• CCBs
• Avoid cold temperatures

Question 28

Varicose Veins

Answer 28

Caused by leaking valves in the veins. Gravity causes large quantities of blood to pool in distal part of the vein, leading to swelling and distention of the vein.

Question 29

Treatment of Varicose Veins

Answer 29

Conservative: avoid prolonged standing, elevate legs, compression
Laser therapy - heats vein to destroy blood flow, decreases distention and pain
Sclerotherapy - chemical injected to destroy blood flow
Endogenous obliteration - probe goes in vein and uses heat to destroy the vein

Question 30

Surgical Treatment of Varicose Veins

Answer 30

1. Ligation - tie off the vein so blood cannot flow
2. Phlebotomy - cut the vein so blood cannot flow
3. Stripping - physical take the vein out

Question 31

Arteriosclerosis

Answer 31

Hardening of the arteries - thinking and loss of elasticity of arterial walls