Peripheral Arterial Disease Flashcards
What is the most common for of PAD?
progressive narrowing of arteries due to atherosclerosis
Plaque formation in the arteries, resulting in decreased blood flow to the legs
PAD is associated with elevated risk of ________ morbidity and mortality even in the absence of prior hx of AMI (acute myocardial infarction), or stroke.
cardiovascular disease
What are the treatment goals for PAD?
- improving quality of life
- controlling comorbid conditions contributing to PAD
What are some comorbid conditions contributing to PAD?
- HTN
- Hyperlipidemia
- Diabetes
Will patients in the early stages of PAD show signs of symptoms?
NO
What are the 2 most common characteristics of PAD?
- intermittent claudication
- pain @ rest in the lower extremities
What is the primary indicator in PAD?
Intermittent Claudication
What are some descriptors patient use to explain PAD?
Fatigue, discomfort, cramping, pain or numbness in buttock, thigh ot calf during exercise and resolves within a few minutes with rest.
What would a physical examination of PAD reveal?
- cool skin temperature
- thickened toenails
- lack of hair on calf, feet, toes
T/F: There are no laboratory tests you woud run for PAD
TRUE
What is the main diagnostic test you would perform?
Ankle Brachial Index: highly sensitive and specific
Fontaine Stage I: Pt is…
asymptomatic
Fontaine Stage II: Pt presents w/
mild claudication & limb symptoms but NO limitation walking
Fontaine Stage IIa: pt presents w/
moderate claudication/limb symptoms
can walk >2 blocks without stopping
Fontaine Stage IIb: pt presents w/
severe claudication
can only walk <2 blocks w/o stopping
Fontaine Stage III: pt presents w/
Ischemic rest pain
Fontaine Stage IV: pt presents w/
ischemic ulceration or ischemic gangrene
Treatments for PAD
- smoking cessation
- exercise
- Percutaneous transluminal angioplasty (PTA) or stent placement
- Drug therapy
What will drug therapy control?
- cholesterol
- blood pressure
- blood sugar
- prevent blood clots
- provide symptom relief
Which drug is this the Mechanism of Action for:
Irreversibly inhibits prostaglanding cyclooxygenase in plateles
Prevents formation of thromboxane A2
Aspirin
Which drug has the following side effects?
GI upset/bleeding
Aspirin
Which drug has the following contraindications:
active bleeding, hemophilia, thrombocytopenia, deficiency of platelets
Aspirin
What is synthesized from Arachidonic Acid via the COX pathway and plays a role in Aspirin MOA?
- powerful vasconstrictor
- platelet agonist
Thromboxane Az (TXA2)
MOA: inhibits binding of ADP analogues to its platelet receptor (P2YI2) causing ireversible inhibition of plateles
Clopidogrel and Ticlodipine
Side effects: chest pain, purpura, generalized pain, rash
Contraindications: active pathologic bleeding (peptic ulcer, intracranial hemorrhage)
**Recommend this over no antiplatelet therapy
Clopidogrel
Side Effects: leukopenia, rash, thrombocytopenia, neutropenia, agranulocytosis, aplastic anemia.
Contraindications: active bleeding, hemophilia, thrombocytopenia
Ticlodipine
T/F: Ticlodipine is recommended over clopidogrel
False: clopidogrel is recommended over ticlodipine
MOA: inhibits activity of adenosine and phosphodiesterase, increasing cyclic AMP, leading to inhibition of platelet aggregation. Stimulates PGD2, resulting in vasodilation
Dipyridamole and cliostazol
Side effects:
angina, dyspnea, hypotension, headache, dizziness
Contraindications:
active bleeding, CAD (coronary steal syndrome)
Dipyridamole
Side Effects:
fever, infections, tachycardia
Contraindications:
All CHF patients (decreased survival)
Cliostazol
MOA: Alters RBC flexibility, decreases platelet adhesion, reduces blood viscosity, decreases fibrinogen concentration
Pentoxifylline
Side effects:
dyspnea, nausea, vomiting, headache, dizziness
Contraindications:
recent retinal/cerebral hemorrhage; active bleeding
Pentoxifylline
MOA: PAR-1 (Protease-activated receptor-1) antagonist. Long half life — effectively irreversible: lasts 4 weeks after stopping
Vorapaxar
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
Vorapaxar
T/F: No RCTs that state that ASA, or other antiplatelet therapies can actually prevent or delay the progression of PAD
True
