Peripheral Artery Disease Therapy

Question 1

goal of acute limb ischemia therapy

Answer 1

revascularize immediately, immediate administration of systemic heparin in any scenario!

Question 2

thrombolytics

Answer 2

local administration to the site of occlusion in extremity

Question 3

endovascular

Answer 3

balloon stenting

thrombectomy

Question 4

thrombectomy (surgical)

Answer 4

insert catheter into the lower extremity and vacuum out a clot

Question 5

bypass surgery (surgical)

Answer 5

using a vessel to bring blood to a location beyond the occlusion (bypassing the occlusion)

Question 6

amputation (surgical)

Answer 6

if unable to revascularize, must amputate to avoid necrosis and gangrene that will lead to infection

Question 7

treatment for symptomatic patients (pain/cramping)

Answer 7

aspirin 75mg-325mg/ day (the effectiveness of using ASA + P2Y12 inhibitor in symptomatic hasn’t been established. Combo may be helpful post-revascularization treatment)

Question 8

treatment for asymptomatic patients

Answer 8

antiplatelet therapy, P2Y12 inhibitors

Question 9

long term treatment for PAD

Answer 9

1. statin
2. antiplatelet
3. BP control (ACEi/ARB)
4. symptomatic? Add cilostazol
5. revascularize? aspirin + clopidogrel

Question 10

cilostazol MOA

Answer 10

inhibits phosphodiesterase III, increasing cAMP, having reversible inhibition of platelet aggregation, vasodilation, and inhibition of vascular smooth muscle proliferation

Question 11

cilostazol onset of action

Answer 11

effect on walking distance is 2-4 weeks, but could require up to 12 weeks (must be transparent with the patient that this therapy does not have an immediate effect!)

Question 12

black box warning for cilostazol

Answer 12

contraindicated in patients with HF

Question 13

adverse events of cilostazol

Answer 13

headache (due to vasodilitary effects), GI upset and diarrhea

Question 14

drug interactions with cilostazol

Answer 14

substrate of: CYP1A2, CYP2C19, CYP2D6, CYP3A4

weak inhibitor of: CYP3A4