Diabetic Foot Ulcer

Question 1

What 3 components are involved in the development of a foot ulcer?

Answer 1

• Neuropathy
• Atherosclerosis
• Immunologic defects

Question 2

What kind of antibiotics should you use to tx diabetic ulcers?

Answer 2

Broad Spectrum antibiotics like beta lactams (Zosyn)

Question 3

What should you do if your patient is allergic to penicillin?

Answer 3

Metronidazole OR Clindamycin

Plus

Fluoroquinolone OR Aztreonam OR 3rd gen. cephalosporin

Question 4

What are other antibiotics used for diabetic ulcers?

Answer 4

• Vanco
• Linezolid
• Daptomycin
• Tigecycline

Question 5

Vancomycin

Answer 5

Increasing resistance with MRSA

Question 6

Tigecycline

Answer 6

Has activity agains gram negative aerobes and anaerobic bacteria

Question 7

What adjuvant Therapy is used with diabetic ulcers?

Answer 7

Hemorrheologic Agents

Question 8

What is the purpose of using hemorrheologic agents?

Answer 8

Improves intermittent claudication

Question 9

What are the hemorrheologic agents?

Answer 9

• Pentoxifylline (trenta)

- Cilostazol

Question 10

Pentoxifylline (trenta) MOA

Answer 10

Alters the form of RBC by inhibiting platelet aggregation and increasing the erythrocyte flexibility by inhibiting PDE

Question 11

Pentoxifylline Contraindications

Answer 11

Recent retinal or cerebral hemorrhage

Question 12

Pentoxifylline Interactions

Answer 12

Warfarin

Question 13

Cilostazol MOA

Answer 13

Inhibits PDE III causing inhibition of platelet aggregation

Question 14

Cilostazol Contraindications

Answer 14

BLACK BOX warning

- Contraindicated in CHF patients

Question 15

What anti-platelet therapy should you use?

Answer 15

• PLavix (clopidogrel)

- Aspirin

Question 16

Wound Healing Agents

Answer 16

Platelet derived growth factor (PDGF) that is topically applied

Question 17

Wound Healing Example

Answer 17

Becaplermin (Regranex)