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PHA 416 - Therapeutics IV > Exam 1 - Peripheral Arterial Disease > Flashcards

Exam 1 - Peripheral Arterial Disease Flashcards

1
Q

What does PAD stand for?

A

Peripheral Artery Disease

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2
Q

T/F: PAD also = PVD.

A

TRUE

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3
Q

PAD is a _______ disease.

A

PAD is a VASCULAR disease.

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4
Q

Name the risk factors for PAD.

A

1) Age >40
2) Cigarette smoking
3) DM
4) HTN
5) Dyslipidemia

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5
Q

Age >40, cigarette smoker, DM, HTN, and dyslipidemia are all risk factors for what?

A

PAD

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6
Q

What is the focus of treatment for PAD?

A
  • Improve functional capacity

- Reduce morbidity and mortality

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7
Q

What are the symptoms of PAD?

A
  • Intermittent claudication

- Pain at rest in lower extremities – critical limb ischemia (medical emergency)

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8
Q

What is the term that describes angina of muscles in legs, thighs, calves - when moving and not getting adequate blood flow because obstruction?

A

INTERMITTENT CLAUDICATION

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9
Q

Name the signs of PAD.

A
  • Cool skin temp
  • Thickened toenails
  • Lack of hair on calf, feet, toes
  • Decreased/absent peripheral pulses
  • Cyanosis of calf, feet, toes
  • Ulcers or gangrene of calf, feet, toes
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10
Q

Intermittent claudication and Critical limb ischemia are symptoms of what disease state?

A

PAD

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11
Q

A 45 year old diabetic patient presents with cool skin temperature, thickened toenails, a lack of hair on their toes and feet, and an absence of peripheral pulses, may have what disease state?

A

PERIPHERAL ARTERIAL DISEASE

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12
Q

What is another name for critical limb ischemia?

A

Acute Extremity Ischemia

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13
Q

What are the three stages of the clinical presentation of critical limb ischemia?

A

1) Viable
2) Threatened
3) Nonviable

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14
Q

When a patient is classified as having Viable Acute Extremity Ischemia, what is treatment?

A

Urgent work-up

-Have time to work on risk factors

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15
Q

When a patient is classified as having Threatened Acute Extremity Ischemia, what is treatment?

A

Emergency surgery

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16
Q

When a patient is classified as having Nonviable Acute Extremity Ischemia, what is treatment?

A

Amputation

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17
Q

What are the patient assessment tools used in screening for PAD?

A
  • Comprehensive H&P
  • Ankle-brachial index (ABI)
  • Duplex US
  • MRA or CTA
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18
Q

What is the term for the patient assessment tool that determines BP in the ankle?

A

ABI (Ankle-brachial index)

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19
Q

What do you do with the ABI?

A

Compare to BP in the arm

-If <40% of arm, then it’s severe PAD

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20
Q

What are the goals of treatment?

A
  • Manage risk factors (smoking, DM, HTN, dyslipidemia)
  • Increase maximal walking distance
  • Increase duration of pain-free walking
  • Prevent critical limb ischemia
  • Improving overall QOL and reduce CV complications and death
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21
Q

What is the A1c goal for Diabetes patients with PAD?

A

<7%

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22
Q

Which specific antidiabetic agents may lower CV risk?

A

Metformin, SGLT2 inhibitors, GLP-1 agonists

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23
Q

Which diabetic meds have MACE benefit?

A

Metformin
SGLT2 inhibitors
GLP-1 agonists

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24
Q

What is the BP goal for patients with HTN diagnosed with PAD?

A

Goal <130/80

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25
Q

T/F: There are no antihypertensive agents specified for PAD.

A

TRUE

26
Q

T/F: Beta blockers are first line therapy in treatment for HTN patients diagnosed with PAD.

A

FALSE - Beta blocker are 2nd line therapy

27
Q

Which drugs can be used for treating patients with dyslipidemia diagnosed with PAD?

A
  • Statins
  • PCSK9 inhibitors
  • Ezetemibe
  • EPA-only Om-3 FA if triglycerides >150 mg/dL
28
Q

What is the PAD treatment for all patients?

A
  • CV event reduction
  • Next, antiplatelet therapy
  • -ASA
  • -Clopidogrel alone (P2Y12 inhibitor)
  • -Dual antiplatelet (Clopidogrel + ASA)

-Statin (high-intensity)

29
Q

What is the treatment for symptomatic PAD patients?

A
  • Exercise training program (12 weeks or longer)

- Can consider Cilostazal (Pletal)

30
Q

What is the treatment for refractory PAD?

A

Vascular surgery

31
Q

What are the recommended agents for Cardiovascular Risk Reduction treatment of PAD in asymptomatic (ABI <0.9) patients?

A

1) ASA 75-325 mg/day

2) Statin

32
Q

What are the recommended agents for symptomatic patients in the treatment of PAD for cardiovascular risk reduction?

A

Preferred: ASA 75-325 mg/day
Alternative: Clopidogrel 75 mg/day
Select patients: ASA + Clopidogrel
Statin

33
Q

T/F: All patients should be given a statin.

A

TRUE

34
Q

For symptom relief, if exercise program is not effective for symptom control, what can be added to the treatment regimen?

A

Cilostazol 100 mg BID

35
Q

What is the MOA for Cilostazol (Pletal)?

A

It is a PDE-3 inhibitor - increases cAMP

  • Decreases platelet aggregation
  • Direct arterial vasodilator
36
Q

What is Cilostazol (Pletal) metabolized by?

A

CYP3A4, 2C19

-Potential interactions

37
Q

Name the adverse effects for Cilostazol (Pletal).

A

HA, diarrhea, edema, palpitations, dizziness, other GI issues

38
Q

What is a contraindication to using Cilostazol (Pletal)?

A

HF

39
Q

Name two other antithrombotic options for treatment of PAD.

A

1) Vorapaxar (Zontivity)

2) Rivaroxaban

40
Q

What is the MOA for Vorapaxar (Zontivity)?

A

PAR-1 antagonist

-decreases platelet aggregation

41
Q

What does Vorapaxar (Zontivity) do?

A

Causes a reduction in vascular events in PAD

42
Q

Why is Vorapaxar (Zontivity) not used a lot?

A

Because of increased bleeding events (ICH)

43
Q

What is the name of the factor X inhibitor that could also be used as an antithrombtic option in the treatment of PAD?

A

Rivaroxaban

44
Q

How is Rivaroxaban given as an anti-thrombotic option in the treatment of PAD?

A

2.5 mg BID with low-dose aspirin

45
Q

What does Rivaroxaban do as an anti-thrombotic option for the treatment of PAD?

A

Reduction in vascular events

46
Q

Why is Rivaroxaban not used a lot as an anti-thrombotic option in the treatment of PAD?

A

Increase in bleeding events

-A trade-off between decreased CV events and increased bleeding

47
Q

T/F: Surgical intervention is the treatment in refractory PAD or Critical Limb Ischemia.

A

TRUE

48
Q

What are the surgical interventions available in refractory PAD or Critical limb ischemia?

A
  • PTA (Percutaneous Transluminal Angioplasty)
  • Stent placement
  • PABG (Peripheral Artery Bypass Graft)
49
Q

What does it mean when PAD is refractory?

A

The patient didn’t respond to exercise or anti-platelet therapy

50
Q

What is Carotid Atherosclerotic Disease?

A

A form of PAD

51
Q

What are the symptoms of Carotid Atherosclerotic Disease?

A
  • Unilateral weakness/numbness
  • Vision disturbances
  • Inability to speak
52
Q

What is one sign (the only one listed) that a patient might have Carotid Atherosclerotic Disease?

A

Carotid bruit

53
Q

What are the tools used in the diagnostic evaluation of Carotid Atherosclerotic Disease?

A
  • Angiography
  • Duplex ultrasound
  • MRA
  • CTA
54
Q

Name the risk factors for Carotid Atherosclerotic Disease.

A
  • Age
  • Smoking
  • DM
  • HTN
  • Dyslipidemia
55
Q

What are the goals of treatment in Carotid Atherosclerotic Disease?

A
  • Improve control of co-morbid conditions

- Reducing cerebrovascular complications and death

56
Q

What is the treatment for Carotid Atherosclerotic Disease?

A
  • Risk factor modifications
  • Medical management
  • Endarterectomy
  • Carotid artery stenting
57
Q

What is the treatment for antiplatelet medical management in Carotid Atherosclerotic Disease in asymptomatic patients?

A

ASA 81 mg/day

58
Q

What is the treatment for antiplatelet medical management in the treatment of Carotid Atherosclerotic Disease in patients that are symptomatic?

A

ASA 81 mg/day + Clopidogrel 75 mg/day

59
Q

What is the recommended agent for antiplatelet therapy for mechanical interventions in pre- and post-carotid endarterectomy?

A

ASA 81 mg/day

60
Q

What are the recommended agents for antiplatelet therapy for mechanical interventions in post-carotid artery stenting?

A

ASA 81 mg/day + Clopidogrel 75 mg/day

PHA 416 - Therapeutics IV (10 decks)

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