40 - Intermittent Claudication Flashcards
key characteristic?
pain is induced by exericse and relieved with rest
non-pharms
- stop smoking
- time (collateral flow develops over 6-12 months)
- non-drug tx of obesity, lipid disorders, HTN and associated conditions that increase risk for PAD
- dynamic leg exercises
- endovascular procedures may be helpful
In this chapter there are drugs to treat reduce ___ risk and drugs to specifically treat intermittent claudication
CV
What are some options we have to decrease CV risk?
- Antiplatelet agents (ASA, clopidogrel, ticagrelor)
- Ramipril
- Beta blockers
- Statins
______ agents decrease RR of vascular death in high risk patients by about 25%
antiplatelets
How does ramipril help intermittent claudication?
decreases ischemic events and increases walking time and distance
How does beta blockers help?
- Decreases risk of MI and death in those with atherosclerosis but may worsen PAD symptoms
- Does not help with walking
- Ok for treating HTN in this population but not for those > 60 yo unless other indication
How can statins help intermittent claudication ?
statins decrease CV risk in patients with atherosclerosis and may improve symptoms and walking distance
Specific therapy for intermittent claudication:
List 2 drugs
- Pentoxifylline
- Cilostazol
Specific therapy for intermittent claudication:
How does pentoxifylline work?
alters erythrocyte deformability and reduces blood viscosity, platelet reactivity and plasma hypercoagulability
*not recommended for mild claudication
Specific therapy for intermittent claudication:
How long do you give pentoxifylline for?
give for 24 weeks then 8 week drug period can decrease or eliminate the need for pentoxifyllin
Specific therapy for intermittent claudication:
How does Cilostazol work?
- inhibits platelet aggregation by selectively inhibiting phosphodiestase 3
- vasodilator
- improves maximal treadmill walking distance
- not available in Canada
Which specific therapy for intermittent claudication is available in Canada?
pentoxifylline
