Section 1
Preview this deck
Definition of PAD
Front
| 5 | 0 | ||
| 4 | 0 | ||
| 3 | 0 | ||
| 2 | 0 | ||
| 1 | 0 |
Active users
0
All-time users
0
Favorites
0
Last updated
6 years ago
Date created
Mar 1, 2020
Cards (171)
Section 1
(50 cards)
Definition of PAD
atherosclerosis leading to occlusion of lower extremity arterial lumen
What is the pharmacological management of PAD?
cilostazol
Why should repeat ABI measurements be assessed at each visit?
determine if there has been stabilization or progression of disease process
What are two ways to diagnose PAD?
resting and exercise ABI
In the setting of increased blood flow demand (exercise), occlusive atherosclerotic lesions lead to ischemia which leads to ___
pain
Grade 1, 2, 3 PAD (Rutherford)
mild, moderate, and severe claudication
What happens to pain during exercise ABI if person has PAD?
should remain normal or unchanged
Cilostazol is recommended to improve ____ symptoms and increase ____
claudication walking distance
What patients is cilostazol contraindicated in? Why?
HFrEF (heart failure with reduced ejection fraction) increased risk of arrhythmias/death
What are some risk factors for PAD?
over 65 HTN high cholesterol diabetes impaired renal function CAD/CVD smoker family history
What was the proposed MOA by which pentoxifylline was supposed to help IC?
xanthine derivative and improves peripheral blood flow and tissue oxygenation through vasoactive effects
What causes death in most patients with PAD?
CV disease
Tissue loss in PAD is associated with ____, ____, or _____ or _______ that is not salvageable and extends above the ____ region
nonhealing ulcer, focal gangrene, pedal ischemia nonfunctional foot trans metatarsal region
Patients with PAD have a significant _____ in ABI after exercise
drop
What might you have a patient do for exercise ABI?
5 minutes on treadmill or 30-50 repetitions of heel raises
What is a method of non-pharmacological management of PAD?
supervised exercise program
Stage 1 PAD (Fontaine)
asymptomatic
Critical limb ischemia
pain at rest
Pressures obtained at the ___ and ___ are averaged and divided by the mean measurement taken at ____
dorsalis pedis and posterior tibial arteries both brachial arteries
What are some clinical presentations of PAD?
asymptomatic claudication critical limb ischemia tissue loss
Is PAD an ASCVD?
yes
What is a major complication of PAD that leads to lower limb amputations and a 25% mortality rate at 1 year?
critical limb ischemia
About 1/3 of PAD patients experience what symptom?
intermittent claudication
Patients in an exercise program should walk until they experience ____, alternating with _____
moderate to maximum claudication, alternating with periods of rest
Grade 4 PAD (Rutherford)
ischemic rest pain
What is considered a normal ABI?
1-1.4
Two general mechanisms by which cilostazol works
vasodilates peripheral arteries and inhibits platelet aggregation
Stage 2 PAD (Fontaine)
non-disabling IC disabling IC
What are some things that can indicate critical limb ischemia?
pain at rest for 2+ weeks nonhealing ulcers gangrene
What two classification systems are used for PAD?
Fontaine and Rutherford
What drug is not effective for claudication and is not recommended in the guidelines?
pentoxifylline
Stage 3 PAD (Fontaine)
ischemic pain at rest
What is the dosage of cilostazol? How often is it taken?
100 mg oral tablet bid
ABI
ankle-brachial index
How should a patient be positioned in resting ABI?
supine
What is considered a borderline ABI?
.91-.99
What can relieve intermittent claudication?
rest
PAD
peripheral arterial disease
Stage 4 PAD (Fontaine)
ulceration or gangrene
What are the four places systolic BP is measured in resting ABI?
both brachial arteries dorsalis pedis posterior tibial arteries
What is considered a noncompressible ABI?
over 1.4
Resting ABI is a ___, ____ test
noninvasive quantitative
What is considered an abnormal ABI value?
under .9
Adverse effects of cilostazol
headache diarrhea dizziness palpitations
What is the exercise program for PAD like?
30-45 min/session more than 3x week more than 12 weeks
Grade 5-6 PAD (Rutherford)
minor and major tissue loss
Grade 0 PAD (Rutherford)
asymptomatic
What are the two ways used to measure systolic BP in resting ABI?
standard sphygomomanometer continuous wave Doppler device
What is a complication of PAD with a 25% mortality rate at 1 year?
chronic limb ischemia
Cilostazol is a nonselective ______ inhibitor
PDE3
Section 2
(50 cards)
What kind of statin is recommended for secondary prevention of events in patients with PAD who are over 75?
moderate intensity
The benefit of ____ therapy in PAD is not well established
anticoagulant
When should you reassess someone with elevated BP for HTN?
3-6 months, recommend lifestyle change
What are the initial first line therapies for stage 1 HTN?
thiazide diuretics CCBs ACEs/ARBs
What is the goal BP of someone with confirmed HTN without additional markers of increased CVD risk?
under 130/80
T/F: statins do not improve IC pain and maximal walking distance
false (they do)
When should dual antiplatelet therapy (aspirin + clopidogrel) be used for PAD?
only if compelling indication (like receiving cardiac stents)
What is an alternative antiplatelet drug to aspirin?
clopidogrel 75 mg daily
What is the BP target if someone has known CVD or 10-year ASCVD event risk is over 10%?
under 130/80
How much can aerobic activity lower BP?
5-8 mmHg
When would you use a B blocker for PAD?
if another compelling indication is present
What is the general recommended dose of aspirin for PAD?
81 mg per day
How often should you do an exercise treadmill walking test for PAD patients?
twice a year
EUCLID study
showed ticagrelor was not better than clopidogrel in reducing CV risk in patients. Ticagrelor is not recommended by guidelines.
Can statins limit adverse limb events in patients with lower extremity arterial disease?
yes
Use of BP lowering medications is recommended for primary prevention in ____ and ____
adults with 10-year ASCVD risk of over 10% and BP of over 130/80 adults with 10-year ASCVD risk under 10% and BP over 140/90
What does elevated LDL-C do in PAD?
accelerate development of atherosclerosis with more severe symptoms
How much can increased potassium lower BP?
4-5 mmHg
What classes of HTN drugs have been shown to improve walking distance in lower extremity arterial disease due to peripheral arterial dilation?
CCBs ACEs/ARBs
What two therapies are not beneficial for claudication?
chelation therapy homocysteine lowering
ASCVD definition
plaque buildup in any major artery in the body
Decision to manage HTN using non-pharmacological or BP lowering agents should be guided not only by ___, but also ____
BP ASCVD risk
ASCVD
atherosclerotic CV disease
How much sodium should someone with HTN eat per day?
less than 1500 mg per day
When should you reassess someone after starting them on a BP medication?
1 month
How much can DASH diet lower BP?
11 mmHg
CAPRIE trial
showed clopidogrel may be better than aspirin in reducing CV risk with similar bleeding rates in symptomatic PAD
When should you reassess someone with normal BP for HTN?
1 year later
How much can limiting alcohol intake lower BP?
4 mmHg
How much K should someone with HTN have per day?
3000-5000 mg
How much can reduced sodium intake lower BP?
5-6 mmHg
What are the initial first line therapies for stage 2 HTN?
two of the following drugs: thiazide diuretics, CCBs, ACEs/ARBs
The 2013 ACC/AHA cholesterol guidelines classified PAD as a ___ risk equivalent and at the highest risk of recurrent ASCVD and ASCVD death
CHD
The benefit of aspirin in which PAD patients has not been established?
asymptomatic with borderline ABI
What are the two high dose statins recommended for PAD patients?
atorvastatin 80 mg rosuvastatin 20 mg
What are 3 things that can result from ASCVD?
coronary heart disease ischemic stroke peripheral artery disease
How much activity should someone with HTN get per week?
120-150 minutes per week
What kind of statin therapy is recommended for secondary prevention of events in patients under 75 with PAD?
high intensity statin
Use of BP lowering medications is recommended for secondary prevention of ____
recurrent CVD events in patients with clinical CVD and an average BP of over 130/80
Prasugrel for PAD
no published data not recommended in guidelines
Aspirin may help reduce MI, stroke, and death in patients with ____ or ______
symptomatic PAD asymptomatic patients with ABI under .9
What are some things that should be monitored in a follow up for PAD patients?
HbA1C FBG PPG renal function blood pressure lipids
Example of antiplatelet therapy used for PAD
aspirin
It is typical to see a ___ mmHg reduction in BP per ___ kg of weight lost
1 and 1
What is the recommendations for alcohol intake for men and women with HTN?
men - 2 or fewer drinks per day women - 1 or fewer drinks per day
Prior to diagnosing someone with HTN, you should use an average based on ____ readings obtained on ____ occasions
more than 2 (both)
After the 1 month reassessment, when should you monitor someone on BP medication again?
3-6 months
What other general class of pharmacotherapy is recommended for PAD?
antiplatelet therapy
How can you eliminate possibility of white coat HTN?
daytime ambulatory or home BP monitoring prior to diagnosis
How do statins work?
inhibit conversion of HMG-CoA into mevalonate, the rate limiting step in cholesterol synthesis also increase LDLr in liver
Section 3
(50 cards)
Varenicline plus ___ was found to be more effective than varenicline alone
NRT
Brand name of bupropion used for smoking cessation
Zyban
3 microvascular complications of diabetes
neuropathy retinopathy nephropathy
How does bupropion work?
dopamine and NE reuptake inhibitor decreases cravings and symptoms of nicotine withdrawal
5 A's in patient assessment of smoking
ask advise assess assist arrange
Does smoking increase ASCVD event risk?
yes, significantly
2 hour plasma glucose for diabetics
over 200
When should you start taking bupropion for smoking cessation?
1-2 days prior to quit date
Side effects of varenicline
N/V insomnia constipation flatulence
Assist
assist patients who are ready to quit with pharmacological and nonpharmacological therapies
When should you not take bupropion? Why?
not at bedtime can cause insomnia
The 10 year fatal risk of CVD is ____ times higher in smokers (and ____ times higher in adults over 50 who smoke)
2x 5x
Nicotine addiction is both a ___ and ___ addiction
physical and psychological
How can you avoid N/V with varenicline?
take with a full glass of water after food
Weight and nicotine withdrawal
weight gain
Type 2 diabetes
insulin resistance with progressive insulin secretory defect, patients may be asymptomatic for years
Light smokers
1-10 cigarettes a day
BBW for varenicline
neuropsychiatric symptoms and suicide risk
When should you start taking varenicline?
1 week before quit date
Heavy smokers
more than 25 cigarettes a day
Ask
ask about tobacco use at every visit
Diabetic FPG
over 126 mg/dL
What two B blockers are safe in patients with IC?
metoprolol nebivolol
There is a ____ greater prevalence of PAD in smokers than non-smokers
2.2
OGGT
oral glucose intolerance test
Warnings of varenicline
associated with CV events seizures enhanced effects of alcohol angioedema/hypersensitivity/skin reactions
How does varenicline work?
partial nicotine receptor agonist, binds to neuronal nicotinic ACh receptors and decreases withdrawal symptoms (also reduces reward of smoking)
FPG
fasting plasma glucose
Type 1 diabetes
absolute insulin deficiency caused by beta cell destruction
BBW for bupropion
neuropsychiatric symptoms and suicide risk
Advantages of bupropion
may delay weight gain oral dosing good for adherence can help patients with depression
2 hour plasma glucose for pre-diabetes
140-199
Symptoms of nicotine withdrawal may begin within ___ hour and last ___ weeks
24 1-2 weeks
Side effects of bupropion
insomnia dry mouth
Purpose of nicotine patches/gum
minimize risks of nicotine withdrawal
What is first line therapy for smoking cessation?
nicotine patch and gum
Arrange
arrange for follow up preferrably within the first week (phone or in-person)
What is A1c in pre-diabetic patients?
5.7-6.4%
Contraindications of bupropion
seizures bulimia/anorexia alcohol withdrawal benzodiazepines barbiturates/antiepileptics MAOIs
Heart rate in nicotine withdrawal
reduced
Pharmacological management for smoking cessation can be in combination with ___
cognitive behavioral therapy
What is random blood glucose in someone with diabetes?
over 200 mg/dL and symptomatic
Advise
give clear, strong, and personalized advice to try to get patient to quit smoking
what is A1c in diabetic patients?
over 6.5%
Neuropathy is the leading cause of ____
non-traumatic lower extremity amputations
Moderate smokers
11-24 cigarettes a day
5 R's to enhance future quit attempts
Relevance risks rewards roadblocks repetition
Risk factors for diabetes
overweight physical inactivity gestational diabetes HTN hyperlipidemia CVD polycystic ovary syndrome
NRT
nicotine replacement therapy
Prediabetes FPG
100-125 mg/dL
Section 4
(21 cards)