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PAD and IC
Overview
27
Astronomy
5th Grade
02/09/2014

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Term
"Athero"
Definition
gruel
Term
"sclerosis"
Definition
hardening
Term
"claudicare"
Definition
limp
Term
a progressive narrowing (atherosclerosis) of peripheral arteries that limits the blood flow to the lower limbs
Definition
Peripheral Arterial Disease (PAD)
Term
a symptom of PAD characterized by pain, discomfort, cramping, aching, or fatigue due to insufficient blood flow to meet the metabolic demands of working skeletal muscles while walking (ischemic muscle/lactic acid build-up)
Definition
Intermittent Claudication (IC)
Term
thromboangitis obliterans
Definition
Buerger's Disease
Term
Historical clues and physical findings of Chronic Critical Limb Ischemia
Definition
ischemic rest pain; ischemic ulceration; gangrene
Term
acute pain, numbness of arch and toes with leg elevation; most uncomfortable at night while resting in bed, interferes with sleep; Relief with dependent positioning of limb
Definition
Ischemic rest pain
Term
distally at ends of toes, over bony prominences on feet; dry, devitalized, black; intense pain
Definition
ischemic ulceration
Term
functional limitation of IC
Definition
occurs in muscle groups, not joints; reproducible from one day to the next resolves completely within 2-3 minutes; many patients unable to walk more than 1/2 to 4 blocks
Term
Diagnosis of PAD
Definition
vascular history; physical exam; ankle-brachial index; noninvasive vascular laboratory; ateriography
Term
lower extremity systolic pressure/brachial artery systolic pressure
Definition
ankle-brachial index (ABI)
Term
ABI
Definition
95% sensitive and 99% specific for PAD
Term
normal ABI
Definition
0.95-1.2
Term
PAD BI
Definition
<0.90
Term
Rest pain/ulceration ABI
Definition
<0.40
Term
IC treatment options
Definition
exercise rehabilitation; pharmacologic intervention
Term
both tests validated for claudication clinical trials (treadmill protocols)
Definition
Constant load test; graded test
Term
Drug Therapy for PAD
Definition
Clopidogrel (prevents ischemic CV events); Cilostazol (improves claudication symptoms)
Term
Treatment of ICS symptoms
Definition
Pentoxifylline (Trental); Cilostazol (Pletal)
Term
methylxanthine derivative; hemorrheologic agent; mean improvement walking: 48 meters
Definition
Pentoxifylline (Trental)
Term
phosphodiesterase III inhibitor; platelet aggregation with lipid and vasodilatory effects; mean improvement walking: 106 meters
Definition
Cilostazol (pletal)
Term
side effects of Pentoxifylline
Definition
dizziness, HA, N/V, stomach discomfort
Term
reduction of symptoms in patients with intermittent claudication, as indicated by increased walking distance; Inhibits phosphodiesterase II (increased CAMP)
Definition
Cilostazol
Term
CYP3A4 inhibitors
Definition
Cimetidine, erythromycin, ketoconazole/itraconazole, fluconazole/miconazole; diltiazem; grapefruit juice
Term
3A4 inducers
Definition
carbamazepine, rifampin, st. johns wort
Term
Cilostazol Black Box Warning
Definition
decreased survival compared to placebo in pts with class III-IV congestive heart failure; is CI in pts with CHF of any severity
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