PAD (Peripheral Artery Disease) Flashcards
What are some major risk factors for PAD? (7)
-O,C,D,H,H,D,H
Older age >40 yro
Cig smoking
Diabetes
Hypercholesterolemia
HTN
Decr renal function
Hyperhomocysteinemia
What’s a simple diagnostic test for PAD?
Cardinal sx of PAD?
Ankle brachial index or ABI
Claudication Pain, but its only in about 10% of your pt’s
What are some intermittent claudication sx’s? (5)
When would sx’s resolve?
What would the physical exam show u ?
Fatigue, discomfort, cramping , pain , numbness in buttock, thigh or calves.
Sxs may resolve within a few mins with rest
Nonspecific signs of decr blood flow to the extremities such as cool skin temp, cyanosis, bruits, thickened toenails, muscle atrophy, lack of hair on the calf, feet and or toes
Diagnosis of PAD should include ?
What value of ABI gives u a diagnosis of PAD?
Detailed pt hx of sx’s and associated atheroschlerosis risk factors
-Phys Exam of pt
-Ankle Brachial Index (ABI)
-0.9 and below
What are some Non Pharm Therapies for PAD? (2)
Smoking cessation (advise to quit!, avoid 2nd hand smoke too)
Exercise (walking is proven to incr pain free walking and delayed onset of claudication)
Tx of Major Risk Factors :
- BP
-Goals?
-Which drugs are ideal for sx and asx pt’s?
-Use __ when compelling indication exists - Lipids
-Use ___ statin with goal of LDL reduction by ?
-Examples of drugs? - Diabetes
-Which A1C value in pt’s has a 5x more likely rate to develop IC and hospitalization from PAD?
-What is reccomended ?
- Similar to those pt’s with CVD
-ACEi’s and Arbs
-Beta blockers - High intensity statin , >= 50%
-Ator 80 mg, rosuv 20 mg, PCSK9 inhibs, ezetimibe - > 7.5%
GLP1 receptor agonist and or SGLT2 I’s
Which drug has the most compelling evidence for tx of PAD?
Guidelines for ASA 75-325 mg/day ? (which pt groups)
What can u use if ASA not tolerated?
Aspirin
Sx PAD yes, Asx PAD reasonable
clopidogrel
ASA AE’s ?
G,D,N,V,G,F,H
Whats a relative CI?
GI side effects, dyspepsia, nausea, vomiting, GI bleeding, frank melena, hematemesis
History of gi bleeding, PUD, or other sources of GI or GU bleeding
Which P2Y12 inhibs can u use in PAD?
-Note, they lead to LESS __
Maintenance dose of each ?
When should u withdraw the drugs prior to a major surgery?
Clopidogrel and Ticagrelor
Platelet aggregation
Plavix = 75 mg daily
Brilinta = 90 mg BID
5 days
Clopidogrel is usually used as a single agent in symptomatic PAD…. when would it be used in addition to aspirin as DAPT?
For sx PAD, IC (intermittent claudication), prior limb revasc, or prior amputation in pt’s who are NOT at incr risk for bleeding
Clopidogrel vs Ticagrelor… Explain the difference between their FDA approval in usage in PAD
-Clopidogrel is indicated for PAD.
-Ticagrelor looks promising to prevent limb events in PAD but it is NOT YET INDICATED
Rivaroxaban :
What kind of drug?
FDA approval for pt’s with PAD with which conditions?
Dose?
Target selective factor Xa inhibitor
-Previous limb arterial surgery, bypass or PTCA, previous limb or foot amputation or IC with ABI<0.9 or Periph artery stenosis >= 50%
2.5 mg PO twice daily + aspirin
What’s used for symptom management in IC?
What effects does it have?
It has improvement in IC sx’s however has no improvement in ?
Dose?
BOXED WARNING??
Improvement timeline?
DC tx if no improvement after?
PAD guidelines?
Cilostazol
Vasodilation + some antiplatelet effects
CV death or QOL
100 mg PO BID
dont use with coexisting HF of any severity!
likely in 2-4 weeks but could take up to 12 wks
3 months
Recc’s cilostazol as effective therapy to improve sx’s and incr walking distance in pt’s with IC
Pentoxifylline
-Improves __ and ___
-DAta was ___
-It’s still FDA approved for ?
-PAD Guidelines recc?
periph blood flow + tissue oxygenation
not so promising! Didnt fare any better than placebo! Cilostazol did better in trials
IC
DOES NOT RECC pentox for tx of claudication
Vorapaxar
-MOA?
-FDA approved for?
-Dose?
-PAD guidelines?
PAR1 antag
reduction of thrombotic cv events in pt’s w/history of MI or with PAD
2.08 mg PO daily in combo with either aspirin or clopidogrel
Overall clinical benefit is UNCERTAIN
