PAD

Question 1

Non-modifiable risk factors:

Answer 1

age
sex
race/ethnicity
FH of CVD

Question 2

Modifiable risk factors:

Answer 2

smoking
DLD
DM
HTN
microalbuminuria
obesity/overweight
alcohol
stress
physical inactivity
poor diet/nutrition

Question 3

What age is the main marker for ASCVD risk?

Answer 3

> 40

Question 4

What diagnostic is used for PAD?

Answer 4

ankle-brachial index (ABI)

Question 5

> 50% occlusion

Answer 5

intermittent claudication

Question 6

> 80% occlusion

Answer 6

critical limb ischemia (CLI)

Question 7

Fontaine PAD classification stage I

Answer 7

reduced pulses

Question 8

Fontaine PAD classification stage II

Answer 8

intermittent claudication

Question 9

Fontaine PAD classification stage III

Answer 9

pain even when resting

Question 10

Fontaine PAD classification stage IV

Answer 10

ulcers

Question 11

What age is high risk?

Answer 11

> = 65 yrs

should be tested

Question 12

What age is high risk with risk factors for atherosclerosis (DM, DLD, HTN, smoking)?

Answer 12

50-64

should be tested

Question 13

What age is high risk with DM + 1 additional ASCVD risk factor?

Answer 13

<= 50

Question 14

non compressible ABI?

Answer 14

> 1.40

requires further diagnostics

Question 15

mild to moderate ABI?

Answer 15

0.41-0.90

abnormal

Question 16

severe PAD?

Answer 16

<= 0.40

abnormal

Question 17

Used to establish PAD Dx in symptomatic pts when resting ABI is normal-borderline?

Answer 17

exercise ABI testing

Question 18

Used to establish PAD Dx in pts wit non compressible arteries (ABI > 1.40)?

Answer 18

toe-brachial intex (TBI)

Question 19

What is most important modifiable risk factor?

Answer 19

smoking cessation

advise them to quit at every visit

Question 20

Exercise prescription?

Answer 20

30-45mins/session 3 or more times/week for 12 or more weeks

walk at incline/speed to produce IC Sx within 3-5mins

Question 21

High intensity statin therapy?

Answer 21

lower LDL by >= 5o%

atorvastatin 40-80mg
rosuvastatin 200-40mg

Question 22

BP goal?

Answer 22

< 130/80

ACEi or ARB

Question 23

HbA1c goal?

Answer 23

< 7 %

Question 24

Preferred diabetes meds?

Answer 24

SGLT2i and GLP1 receptor agonists

added after metformin

Question 25

antiplatelet therapy is reasonable in what pts?

Answer 25

asymptomatic with ABI < 0.90 aspirin 75-325mg PO QD clopidogrel 75mg PO QD

Question 26

antiplatelet therapy is recommended in what pts?

Answer 26

symptomatic with ABI < 0.90 aspirin 75-325mg PO QD clopidogrel 75mg PO QD

Question 27

When may dual antiplatelet therapy be reasonable?

Answer 27

after lower extremity revascularization

Question 28

The clinical benefit of what agent added to existing antiplatelet therapy is uncertain?

Answer 28

vorapaxar used in addition to aspirin and/or clopidogrel

Question 29

Preferred first line PAD antiplatets?

Answer 29

aspirin or clopidogrel

Question 30

Should anticoagulants be used in pts with PAD?

Answer 30

no no benefit and increased bleeding risk with warfarin + antiplatelet therapy

Question 31

What is an effective therapy to improve Sx and increase walking distance in pts with claudication?

Answer 31

cilostazol FDA approved in combo with antiplatelet therapy

Question 32

Cilostazol is contraindicated when?

Answer 32

HF of any severity

Question 33

Is pentoxifylline recommended for treatment of claudication?

Answer 33

no

Question 34

How often is ABI monitored?

Answer 34

q 3-6 months Measurements to assess ASCVD: - fasting lipid panel - HbA1c - BP

Question 35

How often is treadmill testing done in pts with IC?

Answer 35

q 3-6months

Question 36

Exercise Sx improvement? ASCVD risk reduction?

Answer 36

Sx improvement: yes | ASCVD: no

Question 37

smoking cessation Sx improvement? ASCVD risk reduction?

Answer 37

Sx: yes ASCVD: yes

Question 38

statins Sx improvement? ASCVD risk reduction?

Answer 38

Sx: yes ASCVD: yes

Question 39

BP control Sx improvement? ASCVD risk reduction?

Answer 39

Sx: no ASCVD: yes

Question 40

ACEi and/or ARB Sx improvement? ASCVD risk reduction?

Answer 40

Sx: yes ASCVD: yes

Question 41

glycemic control Sx improvement? ASCVD risk reduction?

Answer 41

Sx: no ASCVD: yes

Question 42

antiplatelets Sx improvement? ASCVD risk reduction?

Answer 42

Sx: no ASCVD: yes

Question 43

cilostazol Sx improvement? ASCVD risk reduction?

Answer 43

Sx: yes ASCVD: no