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Pharmacology > PAD > Flashcards

PAD Flashcards

1
Q

What is the most common symptoms of PAD (2)?

A
  • intermittent claudication

- pain in lower extremities at rest

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2
Q

What is first line treatment for PAD?

A

-exercise (supervised )

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3
Q

What are the Fontaine classification of PAD (6)?

A

I:asymptomatic
II: mild-no limitation with walking
IIa: moderate IC with more than 2 blocks
IIb: severe, IC with walking less than 2 blocks
III: ischemic pain at rest, limited blood flow
IV: ulceration/gangrene-no blood flow

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4
Q

What are the recommended treatments for the the levels of PAD/Fontaine classification?

A

All patients with PAD-give statins
I- aspirin 75-325 mg/day or clopidogrel 75mg/day, use anti-hypertensive, can use Cilostazol
IIa-if ABI<0.9 give aspirin, use ACE/ARB for HTN
IIb: if ABI 0.91-0.99 aspirin benefit uncertain
IIb: dual anti-platelet therapy uncertain
III: don’t use pentoxifylline or chelation therapy or oral anti-coagulation

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5
Q

Which factors promote platelet aggregation (3)?

A
  • ADP
  • serotonin
  • TAX2
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6
Q

Where does GPIA bind? GPIB?GPIIA/IIIB?

A

GPAI- binds collagen
GPIB: binds vWF
GPA IIA/IIIB binds fibrin

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7
Q

Which factors stop platelet aggregation?

A

prostacyclin/PGI2-binds receptors on platelets

  • works against TAX2
  • NO( nitric oxide induces vasodilation)
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8
Q

what happens when there is defect in the endothelium?

A
  1. PGI2 and NO no longer produced and vessel constricts
  2. platelets become activated and bind collagen and vWF
  3. platelets release ADP, TAX2, serotonin/5-HT, and PAF
  4. released chemicals induce more platelet aggregation
  5. Extrinsic and Intrinsic pathway are activated and form factor XA which is converted into thrombin and thrombin forms fibrin
  6. Receptor GPIIA/IIIB binds fibrin and cross links platelets together
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9
Q

What is MOA of aspirin?

A

-blocks enzyme COX 1 which irreversibly inhibits prostaglandin H2 and stops TXA2 which stops platelet activation and aggregation

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10
Q

What are side effects to aspirin?

A
  • GI bleeds

- Gastric Ulcers

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11
Q

Why give a low dose aspirin? What is the low dose range?

A
  • low dose preferentially blocks TXA2 and leaves behind prostaglandins
  • low dose range: 75mg-325mg
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12
Q

What are contraindications of aspirin (3)?

A
  • active bleeding
  • hemophilia
  • thrombocytopenia
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13
Q

T/F Ibuprofen is reversible while aspirin is irreversible

A

True

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14
Q

What is the lifetime of a platelet?

A

7-10 days

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15
Q

How many days should a patient stop taking aspirin before a surgery?

A

10 days

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16
Q

Name 2 functions of TXA2?

A
  • potent vasoconstriction

- promotes platelet aggregation

17
Q

What is MOA of clopidogrel?

A
  • irreversibly blocks ADP receptors on platelets to inhibit activation of GP IIa/IIIb stopping fibrin cross linking between platelets
  • blocks platelet aggregation
18
Q

What are side effects of clopidogrel (3)?

A
  • chest pain
  • purpura
  • generalized rash
19
Q

what are the contraindications of clopidogrel (2)?

A
  • intracranial hemorrhage

- active bleeding

20
Q

What is MOA of Cilostazole (2)?

A
  • blocks PDE-III which stops degradation of cAMP(increased) which decreases intracellular calcium and stops platelet activation and aggregation
  • direct artery vasodilator
21
Q

what are side effects of cilostazole (5)?

A
  • headache
  • dizziness
  • diarrhea
  • tachycardia
  • fever-infection
22
Q

What are contraindications for cilostazole?

A

-CHF patients

23
Q

If a patient cant take aspirin, what do you give?

A

-clopidogrel

24
Q

what do give for IC?

A

-Cilostazole

25
Q

What is MOA of pentoxifylline

A
  • alters RBC flexibility so platelets can’t attach
  • reduces blood viscosity
  • decreases fibrinogen concentration
26
Q

What are side effects of pentoxifylline (4)?

A
  • headache
  • dyspnea
  • nausea
  • vomiting
27
Q

What are contraindications of pentoxifylline (2)?

A
  • recent retinal and cranial bleeds

- active bleeding

28
Q

T/F Pentoxifylline is recommended in IC

A

False

29
Q

What is MOA for dypiramidole?

A

same as

  • blocks PDE-III, increases cAMP and decreases intracellualr calcium
  • stops platelet activation and aggregation
  • direct artery vasodilator -adenosine?
30
Q

What are side effects of dypiramidole?

A
  • angina

- hypotension

31
Q

What is contraindication for dypiramidole (2)?

A
  • CAD

- active bleeding

32
Q

What is MOA for vorapaxar?

A

-irreversibly binds PAR-1 receptor and blocks thrombin mediated platelet aggregation
-lasts up to 4 weeks after stopping
-

33
Q

what are side effects of vorapaxar (4)?

A
  • iron deficiency
  • rash
  • depression
  • > 10% bleed,
34
Q

Contraindications for Vorapaxar?Black box warning? (5)

A
  • hx of stroke
  • surgical patients
  • active bleed
  • intracranial hemorrhage
  • hepatic/renal impairment
35
Q

What should you monitor for patients taking Vorapaxar?

A

H&H

36
Q

T/F Vorapaxar is best used as mono therapy and never combined with aspirin or clopidogrel

A

False: never used as mono therapy

37
Q

If patient has no improvement with initial tx, what should you consider?

A

3 month trial of cilostazole

Pharmacology (47 decks)

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