Block II: PAD Flashcards
ABI of [] is indicative of PAD
< 0.9
ABI of [] is normal
1.00-1.40
ABI of [] is borderline
0.91-0.99
PAD risk of death is higher if []
aymptomatic
what may mask PAD
- neuropathy or inability to feel pain
2. sedentary lifestyle, unable to exercise enough to feel pain
describe claudication
intermitted, producable ischemic pain in legs brought about from walk/exercise and alleviated by rest
pain at rest may indicate []
critical limb iscemia, imenent gangrene
what is the gold standard of Dx for PAD
ABI
less than 0.9 indicative
If ABI determined to be < 0.9, what is the next step in dx
treadmill stress test
Most CAD patients should immediately be put on what drugs
- ASA/clopidogrel
2. High intensity statin
Role ASA in CAD
decrease MACE by 23%
SE ASA
dose dependent bleeding risk
CI ASA
bleed
Role Clopidogrel in CAD
as effective as ASA in decreasing MACE
SE clopidogrel
bleed
Cyp2c19 inhib., omeprazole (PPI interaction)
CI clop.
bleed
Dual antiplatelet thereapy is/is not rec.
NOT
don’t combine ASA with clopidogrel, no shown improvement with both but greater risk bleed
What is the role varapaxar in CAD?
can be used in combo with ASA OR Clopidogrel
to decrease MACE if no Hx of MI or PAD*
SE Varapaxar
- bleeding
2. BBW: CANNOT USE WITH ACTIVE PATHOLOGICAL BLEED
DOACs should/should not be used
SHOULD NOT
No benefit shown, and bleeding risk
What is one DOAC what may help with PAD? What is its role?
Rivaroxaban, Should be used in combo with ASA
SE Rixaroxaban
BBW: MAY CAUSE SPINAL HEMATOMA, ACTIVE BLEED CI
What is lipid goal for Pt with PAD
LDL < 70
What is first line treatment for lipids in PAD
- High intensity Statin (ator 40-80, rosuv, 20-40)
+/- exetimibe if not at goal
+/- -mab if not at goal
role high intensity statin in PAD
- decrease MACE
- decrease need for revascularization procedures
- decrease amputations
- improve walking distance
- prevent claudication
Where does ezetimibe fit into the PAD equation?
If pt. not at goal with high intensity statin, or with high risk comorbids (HTN, DM, HF, CKD, etc. )
Where does PSK9 inhib, fit into PAD equation.
If pt not at goal with high intensity statin and ezetimibe
What is HTN goal with PAD
130/80
How are you treating HTN in PAD pt
- ACEI
- ARB
- CCB
- BB
* may im prove walking distance
i. e. symptomatic
what HTN drugs may do more than provide symptomatic relief, and may reduce MACE
- ramipril (ACEI)
2. telmisartan (ARB)
What medications are used to decrease glucose in PAD pt.
- GLP2 inhibitors (tides)
2. SGLT2 inhibitors (flozin)
What SGLT2 inhibitor might you what to avoid and why?
canagliflozin, study showed increased rx amputation
What is the largest risk PAD?
Smoking
What medications might symptomatically reduce claudication
- Cilostazol
2. Pentofylline
What drug is approved per AHA guideline to improve walking distance
cilostazol
What is a warning assoc. with cilostazol
HF CI BBW!
SE cilostazole
HA, dizziness, palpitations
how long might it take to see results from cilostazol
12 weeks
CI cilostazole
active bleeding, HF (BBW)
Is pentoxifylline rec. to treat claudication in PAD
no
SE pentoxifylline
N/V
CI pentoxyfilline
active bleeding, renal adj.
What are some nonpharm therapies for PAD?
walking program!
walk 30 mins a day, walk until pain, rest, walk again
Surgical intervention if lack response lifestyle mod, treatment, and sig. redux QOL/severe disability
Draw a PAD schematic for treatment
- ASA or clopidogrel
+/- varipaxor (BBW: pathological bleeed)
+/- rivaroxapan (BBW: active bleed, spinal hematoma) - High intensity statin (LDL goal < 70)
+/- exetimibe
+/- PCKS9 inhib. - IF DM2 (AIc < 7%)
GLP2 inhib -tides
SGLT2 inhib- flozin (exc. canagliflozin, may increase amputations) - If HTN (Goal 130/80)
BB, CCB, ACEI, ARB
-ramipril, telmisartan only ones to cause dec. MACE - if symptomatic
- cilostazol (AHA rec) (BBW: HF)
- Pentaxifylline
