PAD (Exam 1)

Question 1

Peripheral Artery Disease (PAD)

Answer 1

atherosclerosis in arteries going to limbs reduces blood flow and leads to ischemia
demand > supply

Question 2

PAD risk factors

Answer 2

cigarettes
diabetes
dyslipidemia
hypertension
CKD

Question 3

Symptoms of PAD

Answer 3

asymptomatic in most
intermittent claudication
poor growth of toenails
cold/pale feet
soreness and pain

Question 4

Intermittent Claudication

Answer 4

pain in muscles of lower extremities induced by exercise and relieved by rest

Question 5

Ankle-Brachial Index (ABI)

Answer 5

Test used in diagnosis of PAD
systolic BP in ankle/ systolic BP in arm
measured laying down

Question 6

API measurement indicative of PAD

Answer 6

less than 0.9

Question 7

Goals of Treatment

Answer 7

Reduce claudication and improve mobility
Prevent progression and reduce CV risk

Question 8

Control risk factors of PAD

Answer 8

Stop smoking
antiHTN meds (ACE/ARB)
control LDL (statins)
antiplatelet therapy (aspirin/plavix)

Question 9

Which medication is approved for PAD as an add on to aspirin therapy?

Answer 9

rivaroxaban (Xarelto)

Question 10

Reducing claudication

Answer 10

supervised exercise
meds to improve blood flow: cilostazol, pentoxifylline
surgery

Question 11

Cilostazol (Pletal) drug class

Answer 11

PDE3 inhibitor

Question 12

Cilostazol (Pletal) MOA

Answer 12

inhibits PDE3 to increase cAMP/cGMP
this leads to vasodilation and reduces platelet activation

Question 13

Absorption of Cilostazol (Pletal)

Answer 13

taken PO BID on EMPTY stomach
high fat meals increase absorption = toxicity

Question 14

Metabolism of Cilostazol (Pletal)

Answer 14

hepatic metabolism
substrate for CYP3A4 + CYP2C19

Question 15

Drugs that ____ CYP34A or CYP2C19 will _____ serum concentrations of cilostazol.

Answer 15

inhibit

increase

Question 16

CYP3A4 inhibitors

Answer 16

diltiazem
verapamil
grapefruit juice

Question 17

Dose of cilostazol should be decreased by ___ for concurrent use with inhibitors

Answer 17

50%

Question 18

Cilostazol (Pletal) ADRs

Answer 18

headache
diarrhea
dizzy/nausea
bleeding
hypotension

Question 19

Cilostazol (Pletal) id contraindicated in _____ because ____

Answer 19

heart failure

youll probs die (PDE3Is)

Question 20

Which is the only med that shows reduction in claudication for PAD

Answer 20

Cilostazol (Pletal)
does not alter ABI

Question 21

Pentoxifylline (Trental, Pentoxil) Drug Class

Answer 21

non-selective PDE inhibitor
Xanthine derivative

Question 22

Pentoxifylline (Trental, Pentoxil) MOA

Answer 22

increases cAMP/cGMP for vasodilation and antiplatelet
Inhibits TNF-alpha
increases RBC flexibility
decreases blood viscosity

Question 23

Which drug is known as “hemorrheologic”

Answer 23

Pentoxifylline (Trental, Pentoxil)

Question 24

Pentoxifylline (Trental, Pentoxil) metabolism

Answer 24

CYP1A2

Question 25

Pentoxifylline (Trental, Pentoxil) absorption

Answer 25

take PO TID with meals

Question 26

Pentoxifylline (Trental, Pentoxil) ADRs

Answer 26

N/V

Question 27

Which medication is not recommended for PAD due to lack of efficacy?

Answer 27

Pentoxifylline (Trental, Pentoxil)

Question 28

Off label use of Pentoxifylline (Trental, Pentoxil)

Answer 28

alcoholic hepatits