Peripheral Arterial Disease

Question 1

What is the most common for of PAD?

Answer 1

progressive narrowing of arteries due to atherosclerosis

Plaque formation in the arteries, resulting in decreased blood flow to the legs

Question 2

PAD is associated with elevated risk of ________ morbidity and mortality even in the absence of prior hx of AMI (acute myocardial infarction), or stroke.

Answer 2

cardiovascular disease

Question 3

What are the treatment goals for PAD?

Answer 3

• improving quality of life
• controlling comorbid conditions contributing to PAD

Question 4

What are some comorbid conditions contributing to PAD?

Answer 4

• HTN
• Hyperlipidemia
• Diabetes

Question 5

Will patients in the early stages of PAD show signs of symptoms?

Answer 5

NO

Question 6

What are the 2 most common characteristics of PAD?

Answer 6

• intermittent claudication
• pain @ rest in the lower extremities

Question 7

What is the primary indicator in PAD?

Answer 7

Intermittent Claudication

Question 8

What are some descriptors patient use to explain PAD?

Answer 8

Fatigue, discomfort, cramping, pain or numbness in buttock, thigh ot calf during exercise and resolves within a few minutes with rest.

Question 9

What would a physical examination of PAD reveal?

Answer 9

• cool skin temperature
• thickened toenails
• lack of hair on calf, feet, toes

Question 10

T/F: There are no laboratory tests you woud run for PAD

Answer 10

TRUE

Question 11

What is the main diagnostic test you would perform?

Answer 11

Ankle Brachial Index: highly sensitive and specific

Question 12

Fontaine Stage I: Pt is…

Answer 12

asymptomatic

Question 13

Fontaine Stage II: Pt presents w/

Answer 13

mild claudication & limb symptoms but NO limitation walking

Question 14

Fontaine Stage IIa: pt presents w/

Answer 14

moderate claudication/limb symptoms

can walk >2 blocks without stopping

Question 15

Fontaine Stage IIb: pt presents w/

Answer 15

severe claudication

can only walk <2 blocks w/o stopping

Question 16

Fontaine Stage III: pt presents w/

Answer 16

Ischemic rest pain

Question 17

Fontaine Stage IV: pt presents w/

Answer 17

ischemic ulceration or ischemic gangrene

Question 18

Treatments for PAD

Answer 18

• smoking cessation
• exercise
• Percutaneous transluminal angioplasty (PTA) or stent placement
• Drug therapy

Question 19

What will drug therapy control?

Answer 19

• cholesterol
• blood pressure
• blood sugar
• prevent blood clots
• provide symptom relief

Question 20

Which drug is this the Mechanism of Action for:

Irreversibly inhibits prostaglanding cyclooxygenase in plateles

Prevents formation of thromboxane A2

Answer 20

Aspirin

Question 21

Which drug has the following side effects?

GI upset/bleeding

Answer 21

Aspirin

Question 22

Which drug has the following contraindications:

active bleeding, hemophilia, thrombocytopenia, deficiency of platelets

Answer 22

Aspirin

Question 23

What is synthesized from Arachidonic Acid via the COX pathway and plays a role in Aspirin MOA?

• powerful vasconstrictor
• platelet agonist

Answer 23

Thromboxane Az (TXA2)

Question 24

MOA: inhibits binding of ADP analogues to its platelet receptor (P2YI2) causing ireversible inhibition of plateles

Answer 24

Clopidogrel and Ticlodipine

Question 25

**Side effects:** chest pain, **purpura,** generalized pain, rash **Contraindications:** active pathologic bleeding **(peptic ulcer, intracranial hemorrhage)** **\*\*Recommend this over no antiplatelet therapy**

Answer 25

Clopidogrel

Question 26

**Side Effects:** leuko**penia**, rash, thrombocyto**penia**, neutro**penia**, agranulocytosis, aplastic anemia. **Contraindications:** active bleeding, hemophilia, thrombocytopenia

Answer 26

Ticlodipine

Question 27

**T/F:** Ticlodipine is recommended over clopidogrel

Answer 27

**False:** clopidogrel is recommended over ticlodipine

Question 28

**MOA:** inhibits activity of **adenosine and phosphodiesterase**, increasing **cyclic AMP**, leading to inhibition of platelet aggregation. Stimulates **PGD2**, resulting in **vasodilation**

Answer 28

**Dipyridamole** and **cliostazol**

Question 29

**Side effects:** angina, dyspnea, hypotension, headache, dizziness **Contraindications:** active bleeding, CAD (coronary steal syndrome)

Answer 29

Dipyridamole

Question 30

**Side Effects:** fever, infections, tachycardia **Contraindications:** **All CHF patients (decreased survival)**

Answer 30

Cliostazol

Question 31

**MOA:** Alters **RBC flexibility**, decreases **platelet adhesion**, reduces **blood viscosity**, decreases **fibrinogen concentration**

Answer 31

Pentoxifylline

Question 32

**Side effects:** dyspnea, nausea, vomiting, headache, dizziness **Contraindications:** recent **retinal/cerebral hemorrhage**; active bleeding

Answer 32

Pentoxifylline

Question 33

**MOA: PAR-1** (Protease-activated receptor-1) **antagonist.** Long half life — effectively irreversible: **lasts 4 weeks after stopping**

Answer 33

Vorapaxar

Question 34

**Side Effects:** **\>10% bleeding** 1-10%: depression, rash, **iron deficiency**, retinopathy Monitor signs of bleeding, H&H **Contraindications:** **\*\*US Box warning: Hx of stroke, TIA, intracranial hemorrhage, active bleeding** **- concern for use in patients with hepatic or renal impairment due to increased risk of bleeding**

Answer 34

**Vorapaxar**

Question 35

**T/F:** No RCTs that state that ASA, or other antiplatelet therapies can actually prevent or delay the progression of PAD

Answer 35

True