1. Reproducible fatigue 2. Discomfort 3. Cramping and pain 4. Numbness in extremities during exercise resolved with rest

PAD Flashcards by Hannah Lapos

What is the most common PVD?

PAD

How well did you know this?

Not at all

Perfectly

Manifestation of progressive narrowing of arteries due to what?

atherosclerosis

How well did you know this?

Not at all

Perfectly

What are the arteries affected by PAC (biggest to smallest)?

Femoropopliteal-tibial → Aortoiliac → Carotid and vertebral → Splenic and renal → Brachiocephalic

How well did you know this?

Not at all

Perfectly

What are the high risk groups of PAC?

Elderly
AA
Current smoking
Diabetes
HTN
Hypercholesterolemia
Impaired renal function

How well did you know this?

Not at all

Perfectly

What is the primary indicator of PAD?

Intermittent claudication

How well did you know this?

Not at all

Perfectly

What is IC?

Reproducible fatigue
Discomfort
Cramping and pain
Numbness in extremities during exercise resolved with rest

How well did you know this?

Not at all

Perfectly

What are the clinical presentations of PAD?

Intermittent claudication
Pain at rest in the lower extremities
Chronic limb-threatening ischemia

How well did you know this?

Not at all

Perfectly

What can pain at rest in lower extermities be attributed to?

Blood supply is not adequate to perfuse the extremity (critical limb ischemia)

Occurs at night in the feet upon lying down

How well did you know this?

Not at all

Perfectly

What is chronic limb ischemia contribute to?

Nonhealing wounds and amputation

How well did you know this?

Not at all

Perfectly

What type of symptoms of decreased blood flow?

Cool skin temp
Shiny skin
Thickened toe nails
Lack of hair
Visible sores and ulcers that are slow to heal

How well did you know this?

Not at all

Perfectly

What is the highly sensitive and specific tool used to diagnose PAD?

Ankle brachial index

How well did you know this?

Not at all

Perfectly

What tool is reserved for PAD patents being considered for surgical revascularization?

Magnetic resonance angiography (MRA) or computed tomographic angiography (CTA)

How well did you know this?

Not at all

Perfectly

What are the differential diagnoses?

Neurological (peripheral neuropathy)
Inflammatory (arthritis)
Vascular conditions (DVT and venous congestion)

How well did you know this?

Not at all

Perfectly

Describe how to take an ABI measurement?

How well did you know this?

Not at all

Perfectly

How do you calculate ABI?

How well did you know this?

Not at all

Perfectly

How do you interpret PAD using ABI values?

How well did you know this?

Not at all

Perfectly

How to undergo diagnostic testing for suspected PAD?

What are the treatment goals for PAD?

Improvement or alleviation of symptoms
Reduction of ASCVD risk
Prevention of limb loss

What are non-charms of PAD?

Smoking cessation
Exercise
Interventional procedures

What are the types of exercises for PAD?

Walking programs
Supervised exercise training

What is the purpose for walking programs?

Increase walking duration and distance → increase pain-free walking and delayed claudication by 179%

Impaired exercise/walking distance lead to ___?

Increase in negative long-term outcomes

What is supervised exercise training?

For patients with IC
Minimum of 30-45 minutes 3 times/wk for a minimum of 12 weeks

How is supervised exercise training done?

Walking should be performed at a speed and grade of incline to produce the symptoms of IC within 3 to 5 minutes
Stop walking when the symptoms become moderate in intensity, wait for the symptoms to resolve, and then resume walking

When should you consider interventional procedures?

1. Lack of adequate response to exercise and risk factor mod 2. Severe disability from IC impairs daily activities 3. Evaluation of the risks and benefits of intervention

What are the types of interventional procedures? Compare the two?

1. Percutaneous trasluminal angioplasty (Minimally invasive) 2. Aortofemoral bypass or femoral popliteal bypass (surgically invasive, for patients with IC → critical leg ischemia

What are the pharm therapies used for?

1. Treat underlying HTN, HLD, DM 2. Antiplatelet drug therapy 3. Intermittent claudication treatment

What antiplatelet has the mose evidence? Dosing?

Aspirin: 75-325mg/day

What can be used when ASA is not tolerated?

Clopidogrel (Plavix) DAPT treatment

What can be used in combo with ASA or Plavix but not commonly used? Class?

Vorapaxar (Zontivity) Protease activated receptor 1 antagonist

What are specific recs for aspirin and clopidogrel?

1. Symptomatic PAD 2. Asymptomatic patients with PAD (ABI≤0.90) 3. Asymptomatic patients with borderline ABI (0.91-0.99) 4. DAPT

What are anticoagulation therapies?

Rivaroxaban (Xarelto)

What are the medications for IC?

Cilastazol (Pletal) Pentoxifylline (Dental)

MOA of Pletal?

Inhibitor of PDE III → increase in cyclic AMP → reversible inhibition of platelet aggregation, vasodilation, and inhibition of vascular smooth muscle cell proliferation

Dosing, BBW, CI, Counseling of Cilostazol?

Dosing: 100 mg BID (caution with severe renal and hepatic) Administer 30 min before or 2 hours after meals (breakfast and dinner) BBW: HF Metabolism: CYP3A4, 2C19 (minor) discontinue if no improvement after 3 months

What is the metabolism of Clopidogrel?

CYP2C19

How should you assess therapeutic effectiveness? and what do they measure?

1. Exercise treadmill walking test 2. ABI 3. Patient feedback

What does Exercise treadmill walking test test?

Repeated quarterly to biannually to assess improvement or decline in walking duration and distance

What does ABI assess?

Each patient visit Used to determine stabilization or progression of the disease

What does patent feedback assess?

Quality of life

What factors are we looking at for the general assessment of PAD?

**HTN:** Home monitoring **DM:** AIC Q3Months, Biannual foot exam **DLD:** General **Tobacco use:** Assess status and cessation **CVD events:** Inquire about any new ones **Meds:** Adverse events