PAD Flashcards
What is the most common PVD?
PAD
Manifestation of progressive narrowing of arteries due to what?
atherosclerosis
What are the arteries affected by PAC (biggest to smallest)?
Femoropopliteal-tibial → Aortoiliac → Carotid and vertebral → Splenic and renal → Brachiocephalic
What are the high risk groups of PAC?
- Elderly
- AA
- Current smoking
- Diabetes
- HTN
- Hypercholesterolemia
- Impaired renal function
What is the primary indicator of PAD?
Intermittent claudication
What is IC?
- Reproducible fatigue
- Discomfort
- Cramping and pain
- Numbness in extremities during exercise resolved with rest
What are the clinical presentations of PAD?
- Intermittent claudication
- Pain at rest in the lower extremities
- Chronic limb-threatening ischemia
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
What is chronic limb ischemia contribute to?
Nonhealing wounds and amputation
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
What is the highly sensitive and specific tool used to diagnose PAD?
Ankle brachial index
What tool is reserved for PAD patents being considered for surgical revascularization?
Magnetic resonance angiography (MRA) or computed tomographic angiography (CTA)
What are the differential diagnoses?
- Neurological (peripheral neuropathy)
- Inflammatory (arthritis)
- Vascular conditions (DVT and venous congestion)
Describe how to take an ABI measurement?
How do you calculate ABI?
How do you interpret PAD using ABI values?
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?
- Lack of adequate response to exercise and risk factor mod
- Severe disability from IC impairs daily activities
- Evaluation of the risks and benefits of intervention
What are the types of interventional procedures? Compare the two?
- Percutaneous trasluminal angioplasty (Minimally invasive)
- Aortofemoral bypass or femoral popliteal bypass (surgically invasive, for patients with IC → critical leg ischemia
What are the pharm therapies used for?
- Treat underlying HTN, HLD, DM
- Antiplatelet drug therapy
- 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?
- Symptomatic PAD
- Asymptomatic patients with PAD (ABI≤0.90)
- Asymptomatic patients with borderline ABI (0.91-0.99)
- 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?
- Exercise treadmill walking test
- ABI
- 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
