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Pharmacology III > Block II: PAD > Flashcards

Block II: PAD Flashcards

1
Q

ABI of [] is indicative of PAD

A

< 0.9

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2
Q

ABI of [] is normal

A

1.00-1.40

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3
Q

ABI of [] is borderline

A

0.91-0.99

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4
Q

PAD risk of death is higher if []

A

aymptomatic

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5
Q

what may mask PAD

A
  1. neuropathy or inability to feel pain

2. sedentary lifestyle, unable to exercise enough to feel pain

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6
Q

describe claudication

A

intermitted, producable ischemic pain in legs brought about from walk/exercise and alleviated by rest

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7
Q

pain at rest may indicate []

A

critical limb iscemia, imenent gangrene

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8
Q

what is the gold standard of Dx for PAD

A

ABI

less than 0.9 indicative

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9
Q

If ABI determined to be < 0.9, what is the next step in dx

A

treadmill stress test

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10
Q

Most CAD patients should immediately be put on what drugs

A
  1. ASA/clopidogrel

2. High intensity statin

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11
Q

Role ASA in CAD

A

decrease MACE by 23%

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12
Q

SE ASA

A

dose dependent bleeding risk

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13
Q

CI ASA

A

bleed

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14
Q

Role Clopidogrel in CAD

A

as effective as ASA in decreasing MACE

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15
Q

SE clopidogrel

A

bleed

Cyp2c19 inhib., omeprazole (PPI interaction)

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16
Q

CI clop.

A

bleed

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17
Q

Dual antiplatelet thereapy is/is not rec.

A

NOT

don’t combine ASA with clopidogrel, no shown improvement with both but greater risk bleed

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18
Q

What is the role varapaxar in CAD?

A

can be used in combo with ASA OR Clopidogrel

to decrease MACE if no Hx of MI or PAD*

19
Q

SE Varapaxar

A
  1. bleeding

2. BBW: CANNOT USE WITH ACTIVE PATHOLOGICAL BLEED

20
Q

DOACs should/should not be used

A

SHOULD NOT

No benefit shown, and bleeding risk

21
Q

What is one DOAC what may help with PAD? What is its role?

A

Rivaroxaban, Should be used in combo with ASA

22
Q

SE Rixaroxaban

A

BBW: MAY CAUSE SPINAL HEMATOMA, ACTIVE BLEED CI

23
Q

What is lipid goal for Pt with PAD

A

LDL < 70

24
Q

What is first line treatment for lipids in PAD

A
  1. High intensity Statin (ator 40-80, rosuv, 20-40)

+/- exetimibe if not at goal
+/- -mab if not at goal

25
Q

role high intensity statin in PAD

A
  1. decrease MACE
  2. decrease need for revascularization procedures
  3. decrease amputations
  4. improve walking distance
  5. prevent claudication
26
Q

Where does ezetimibe fit into the PAD equation?

A

If pt. not at goal with high intensity statin, or with high risk comorbids (HTN, DM, HF, CKD, etc. )

27
Q

Where does PSK9 inhib, fit into PAD equation.

A

If pt not at goal with high intensity statin and ezetimibe

28
Q

What is HTN goal with PAD

A

130/80

29
Q

How are you treating HTN in PAD pt

A
  1. ACEI
  2. ARB
  3. CCB
  4. BB
    * may im prove walking distance
    i. e. symptomatic
30
Q

what HTN drugs may do more than provide symptomatic relief, and may reduce MACE

A
  1. ramipril (ACEI)

2. telmisartan (ARB)

31
Q

What medications are used to decrease glucose in PAD pt.

A
  1. GLP2 inhibitors (tides)

2. SGLT2 inhibitors (flozin)

32
Q

What SGLT2 inhibitor might you what to avoid and why?

A

canagliflozin, study showed increased rx amputation

33
Q

What is the largest risk PAD?

A

Smoking

34
Q

What medications might symptomatically reduce claudication

A
  1. Cilostazol

2. Pentofylline

35
Q

What drug is approved per AHA guideline to improve walking distance

A

cilostazol

36
Q

What is a warning assoc. with cilostazol

A

HF CI BBW!

37
Q

SE cilostazole

A

HA, dizziness, palpitations

38
Q

how long might it take to see results from cilostazol

A

12 weeks

39
Q

CI cilostazole

A

active bleeding, HF (BBW)

40
Q

Is pentoxifylline rec. to treat claudication in PAD

A

no

41
Q

SE pentoxifylline

A

N/V

42
Q

CI pentoxyfilline

A

active bleeding, renal adj.

43
Q

What are some nonpharm therapies for PAD?

A

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

44
Q

Draw a PAD schematic for treatment

A
  1. ASA or clopidogrel
    +/- varipaxor (BBW: pathological bleeed)
    +/- rivaroxapan (BBW: active bleed, spinal hematoma)
  2. High intensity statin (LDL goal < 70)
    +/- exetimibe
    +/- PCKS9 inhib.
  3. IF DM2 (AIc < 7%)
    GLP2 inhib -tides
    SGLT2 inhib- flozin (exc. canagliflozin, may increase amputations)
  4. If HTN (Goal 130/80)
    BB, CCB, ACEI, ARB
    -ramipril, telmisartan only ones to cause dec. MACE
  5. if symptomatic
    - cilostazol (AHA rec) (BBW: HF)
    - Pentaxifylline

Pharmacology III (6 decks)

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