E3: PAD

Question 1

Pathophysiology of PAD

Answer 1

Atherosclerosis in the lower extremities.

Question 2

Who does PAD primarily occur in?

Answer 2

Those over 70 years of age. (15-20%)

Question 3

40% of patients with PAD also have CAD, this puts them at __________ risk of CV death.

Answer 3

2-5 Fold increased.

Question 4

The clinical presentation of PAD is often ________ delaying diagnosis and prevention of complications.

Answer 4

Asymptomatic.

Question 5

This term defines pain when walking in the buttocks, claves, and thighs. This pain is often relieved with rest, although severe cases have pain at rest. The pain occurs due to partial occlusion of the aortic and iliac arteries.

Answer 5

Intermittent Claudification

Question 6

What PAD patients are at the highest risk of ulceration, infection, or necrosis?

Answer 6

Those with diabetes and/or smoking history.

Question 7

When would PAD present as a medical emergency?

Answer 7

When full occlusion of the artery occurs. This requires revascularization to prevent limb loss.

Question 8

partial blockage of the _________ arteries leads to pain in the buttocks, thigh, and hips.

Answer 8

Aorta and Iliac

Question 9

partial blockage of the _________ artery leads to pain in the thigh and calf.

Answer 9

Femoral

Question 10

partial blockage of the _________ arteries leads to pain in the calf, ankle, or foot.

Answer 10

Popliteal
Tibial

Question 11

ABI of 1-1.4

Answer 11

Normal

Question 12

ABI of 0.8-0.9

Answer 12

Some PAD

Question 13

ABI of 0.5-0.8

Answer 13

Moderate PAD

Question 14

ABI <0.5

Answer 14

Severe PAD.

Question 15

What are our three treatment options for acute limb ischemia resulting from complete occlusion of an artery?

Answer 15

1. Thrombolytics
2. Endovascular procedures
3. Surgical Procedures

Question 16

What should all patients presenting with acute limb ischemia be administered?

Answer 16

Systemic Heparin

Question 17

For symptomatic PAD, what is the long term antiplatelet therapy?

Answer 17

Aspirin 75-325 mg once daily to reduce the risk of MI, Stroke, and vascular death.

Question 18

In asymptomatic PAD, what is the long term antiplatelet therapy?

Answer 18

Antiplatelet therapy with 75-325 mg aspirin is** reasonable** to reduce risk of MI, stroke, and vascular death.

Question 19

In symptomatic PAD after lower extremity revascularization, what is the long term anti-platelet therapy?

Answer 19

Aspirin + Clopidogrel to decrease the risk of limb related events.

Question 20

If a patient is not responding to the maximally tolerated statin dose in chronic PAD management, what drug should be added?

Answer 20

Ezetimibe

Question 21

When should anti-hypertensives be added to a chronic PAD management plan?

Answer 21

If the patient also has hypertension. However, one of the anti-hypertensives should be an ACEi or ARB.

Question 22

This drug is an effective therapy to improve symptoms and increase walking distance in patients with claudication.

Answer 22

Cilostazol.

Question 23

The mechanism of this drug is to inhibit PDE3 (phosphodiesterase 3).

This leads to an increase in cAMP. Which causes:
1. Reversible platelet inhibition.
2. Vasodilation.
3. Inhibition of vascular smooth muscle cell proliferation.

Answer 23

Cilostazol.

Question 24

Cilostazol Onset of effect.

Answer 24

2-12 weeks to increase walking distance.

Question 25

Cilostazol BBW.

Answer 25

Contraindicated in patients with HF.

Question 26

Cilostazol ADE

Answer 26

1. HA
2. GI upset

Question 27

This drug used to treat PAD symptoms is a CYP1A2, CYP2C19, CYP2D6, and CYP3A4 substrate.

It also inhibits CYP3A4 to a minor extent.

Answer 27

Cilostazol.

Question 28

What is the Xarelto dose that is approved for PAD.

Answer 28

2.5 mg BID.

Not used very often.

Question 29

The generic name of Xarelto is ___________.

Answer 29

Rivaroxaban.