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

Exam 1 - Peripheral Arterial Disease Flashcards

(60 cards)

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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
T/F: There are no antihypertensive agents specified for PAD.
TRUE
26
T/F: Beta blockers are first line therapy in treatment for HTN patients diagnosed with PAD.
FALSE - Beta blocker are 2nd line therapy
27
Which drugs can be used for treating patients with dyslipidemia diagnosed with PAD?
- Statins - PCSK9 inhibitors - Ezetemibe - EPA-only Om-3 FA if triglycerides >150 mg/dL
28
What is the PAD treatment for all patients?
- CV event reduction - Next, antiplatelet therapy - -ASA - -Clopidogrel alone (P2Y12 inhibitor) - -Dual antiplatelet (Clopidogrel + ASA) -Statin (high-intensity)
29
What is the treatment for symptomatic PAD patients?
- Exercise training program (12 weeks or longer) | - Can consider Cilostazal (Pletal)
30
What is the treatment for refractory PAD?
Vascular surgery
31
What are the recommended agents for Cardiovascular Risk Reduction treatment of PAD in asymptomatic (ABI <0.9) patients?
1) ASA 75-325 mg/day | 2) Statin
32
What are the recommended agents for symptomatic patients in the treatment of PAD for cardiovascular risk reduction?
Preferred: ASA 75-325 mg/day Alternative: Clopidogrel 75 mg/day Select patients: ASA + Clopidogrel Statin
33
T/F: All patients should be given a statin.
TRUE
34
For symptom relief, if exercise program is not effective for symptom control, what can be added to the treatment regimen?
Cilostazol 100 mg BID
35
What is the MOA for Cilostazol (Pletal)?
It is a PDE-3 inhibitor - increases cAMP - Decreases platelet aggregation - Direct arterial vasodilator
36
What is Cilostazol (Pletal) metabolized by?
CYP3A4, 2C19 | -Potential interactions
37
Name the adverse effects for Cilostazol (Pletal).
HA, diarrhea, edema, palpitations, dizziness, other GI issues
38
What is a contraindication to using Cilostazol (Pletal)?
HF
39
Name two other antithrombotic options for treatment of PAD.
1) Vorapaxar (Zontivity) | 2) Rivaroxaban
40
What is the MOA for Vorapaxar (Zontivity)?
PAR-1 antagonist | -decreases platelet aggregation
41
What does Vorapaxar (Zontivity) do?
Causes a reduction in vascular events in PAD
42
Why is Vorapaxar (Zontivity) not used a lot?
Because of increased bleeding events (ICH)
43
What is the name of the factor X inhibitor that could also be used as an antithrombtic option in the treatment of PAD?
Rivaroxaban
44
How is Rivaroxaban given as an anti-thrombotic option in the treatment of PAD?
2.5 mg BID with low-dose aspirin
45
What does Rivaroxaban do as an anti-thrombotic option for the treatment of PAD?
Reduction in vascular events
46
Why is Rivaroxaban not used a lot as an anti-thrombotic option in the treatment of PAD?
Increase in bleeding events | -A trade-off between decreased CV events and increased bleeding
47
T/F: Surgical intervention is the treatment in refractory PAD or Critical Limb Ischemia.
TRUE
48
What are the surgical interventions available in refractory PAD or Critical limb ischemia?
- PTA (Percutaneous Transluminal Angioplasty) - Stent placement - PABG (Peripheral Artery Bypass Graft)
49
What does it mean when PAD is refractory?
The patient didn't respond to exercise or anti-platelet therapy
50
What is Carotid Atherosclerotic Disease?
A form of PAD
51
What are the symptoms of Carotid Atherosclerotic Disease?
- Unilateral weakness/numbness - Vision disturbances - Inability to speak
52
What is one sign (the only one listed) that a patient might have Carotid Atherosclerotic Disease?
Carotid bruit
53
What are the tools used in the diagnostic evaluation of Carotid Atherosclerotic Disease?
- Angiography - Duplex ultrasound - MRA - CTA
54
Name the risk factors for Carotid Atherosclerotic Disease.
- Age - Smoking - DM - HTN - Dyslipidemia
55
What are the goals of treatment in Carotid Atherosclerotic Disease?
- Improve control of co-morbid conditions | - Reducing cerebrovascular complications and death
56
What is the treatment for Carotid Atherosclerotic Disease?
- Risk factor modifications - Medical management - Endarterectomy - Carotid artery stenting
57
What is the treatment for antiplatelet medical management in Carotid Atherosclerotic Disease in asymptomatic patients?
ASA 81 mg/day
58
What is the treatment for antiplatelet medical management in the treatment of Carotid Atherosclerotic Disease in patients that are symptomatic?
ASA 81 mg/day + Clopidogrel 75 mg/day
59
What is the recommended agent for antiplatelet therapy for mechanical interventions in pre- and post-carotid endarterectomy?
ASA 81 mg/day
60
What are the recommended agents for antiplatelet therapy for mechanical interventions in post-carotid artery stenting?
ASA 81 mg/day + Clopidogrel 75 mg/day

PHA 416 - Therapeutics IV (10 decks)

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