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Therapeutics I > PAD > Flashcards

PAD Flashcards

1
Q

What is the most common PVD?

A

PAD

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2
Q

Manifestation of progressive narrowing of arteries due to what?

A

atherosclerosis

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3
Q

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

A

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

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4
Q

What are the high risk groups of PAC?

A
  1. Elderly
  2. AA
  3. Current smoking
  4. Diabetes
  5. HTN
  6. Hypercholesterolemia
  7. Impaired renal function
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5
Q

What is the primary indicator of PAD?

A

Intermittent claudication

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6
Q

What is IC?

A
  1. Reproducible fatigue
  2. Discomfort
  3. Cramping and pain
  4. Numbness in extremities during exercise resolved with rest
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7
Q

What are the clinical presentations of PAD?

A
  1. Intermittent claudication
  2. Pain at rest in the lower extremities
  3. Chronic limb-threatening ischemia
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8
Q

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

A

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

Occurs at night in the feet upon lying down

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9
Q

What is chronic limb ischemia contribute to?

A

Nonhealing wounds and amputation

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10
Q

What type of symptoms of decreased blood flow?

A
  1. Cool skin temp
  2. Shiny skin
  3. Thickened toe nails
  4. Lack of hair
  5. Visible sores and ulcers that are slow to heal
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11
Q

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

A

Ankle brachial index

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12
Q

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

A

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

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13
Q

What are the differential diagnoses?

A
  1. Neurological (peripheral neuropathy)
  2. Inflammatory (arthritis)
  3. Vascular conditions (DVT and venous congestion)
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14
Q

Describe how to take an ABI measurement?

A
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15
Q

How do you calculate ABI?

A
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16
Q

How do you interpret PAD using ABI values?

A
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17
Q

How to undergo diagnostic testing for suspected PAD?

A
18
Q

What are the treatment goals for PAD?

A
  1. Improvement or alleviation of symptoms
  2. Reduction of ASCVD risk
  3. Prevention of limb loss
19
Q

What are non-charms of PAD?

A
  1. Smoking cessation
  2. Exercise
  3. Interventional procedures
20
Q

What are the types of exercises for PAD?

A
  1. Walking programs
  2. Supervised exercise training
21
Q

What is the purpose for walking programs?

A

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

22
Q

Impaired exercise/walking distance lead to ___?

A

Increase in negative long-term outcomes

23
Q

What is supervised exercise training?

A
  1. For patients with IC
  2. Minimum of 30-45 minutes 3 times/wk for a minimum of 12 weeks
24
Q

How is supervised exercise training done?

A
  1. Walking should be performed at a speed and grade of incline to produce the symptoms of IC within 3 to 5 minutes
  2. Stop walking when the symptoms become moderate in intensity, wait for the symptoms to resolve, and then resume walking
25
Q

When should you consider interventional procedures?

A
  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
26
Q

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

A
  1. Percutaneous trasluminal angioplasty (Minimally invasive)
  2. Aortofemoral bypass or femoral popliteal bypass (surgically invasive, for patients with IC → critical leg ischemia
27
Q

What are the pharm therapies used for?

A
  1. Treat underlying HTN, HLD, DM
  2. Antiplatelet drug therapy
  3. Intermittent claudication treatment
28
Q

What antiplatelet has the mose evidence? Dosing?

A

Aspirin: 75-325mg/day

29
Q

What can be used when ASA is not tolerated?

A

Clopidogrel (Plavix) DAPT treatment

30
Q

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

A

Vorapaxar (Zontivity) Protease activated receptor 1 antagonist

31
Q

What are specific recs for aspirin and clopidogrel?

A
  1. Symptomatic PAD
  2. Asymptomatic patients with PAD (ABI≤0.90)
  3. Asymptomatic patients with borderline ABI (0.91-0.99)
  4. DAPT
32
Q

What are anticoagulation therapies?

A

Rivaroxaban (Xarelto)

33
Q

What are the medications for IC?

A

Cilastazol (Pletal)

Pentoxifylline (Dental)

34
Q

MOA of Pletal?

A

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

35
Q

Dosing, BBW, CI, Counseling of Cilostazol?

A

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

36
Q

What is the metabolism of Clopidogrel?

A

CYP2C19

37
Q

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

A
  1. Exercise treadmill walking test
  2. ABI
  3. Patient feedback
38
Q

What does Exercise treadmill walking test test?

A

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

39
Q

What does ABI assess?

A

Each patient visit

Used to determine stabilization or progression of the disease

40
Q

What does patent feedback assess?

A

Quality of life

41
Q

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

A

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

Therapeutics I (32 decks)

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