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Spring Therapeutics Exam #4 - Peripheral Arterial Disease
n/a
29
Health Care
Graduate
05/14/2010

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Term
Coronary Artery Disease (CAD)
Definition
presence of atherosclerosis in coronary arteries which supply heart muscle with blood
Term
Peripheral Arterial Disease (PAD)
Definition
presence of systemic atherosclerosis in arteries distal to arch of aorta
Term
Intermittent Claudication (IC)
Definition
pain in one or both legs on walking, taht does not go away with continued walking & is relieved with rest
Term
Risk Factors
Definition
Age (elderly);
Race;
Cigarette Smoking;
Glycemic Control;
Dyslipidemia;
HTN;
Elevated homocysteine levels;
Term
Consequences of PAD
Definition
functional disability;
rest pain;
skin breakdown;
muscle atrophy;
amputation;
ischemic events;
Term
Classic IC Symptoms
Definition
aching, cramping pain, fatigue in leg muscles with exertion;
relieved with resting;
discomfort usually develops in muscle group distal to arterial obstruction;
Term
Differential Diagnosis
Definition
spinal stenosis;
hip arthritis;
nerve root compression;
venous claudication;
Term
Critical Leg Ischemia
Definition
rest pain sx, at night when limbs are horizontal;
if untreated, can lead to nonhealing wounds, gangrene, amputation;
Term
Physical Findings of PAD
Definition
absent or diminished pedal pulses;
presence of bruits over areas of stenosis;
shiny colored skin;
unilaterally cold extremity;
hair loss;
thickened, brittle toenails;
Term
Ankle-Brachial Index (ABI)
Definition
comparison of SBP measurements from arm & ankle: ankle SP > brachial SP - Ankle:Brachial ratio >1;
Lower the Score --> greater risk for cardiac events, stroke, CV death;
Term
ABI > 0.90
Definition
Normal ABI
Term
ABI = 0.71-0.90
Definition
mild obstruction
Term
ABI = 0.41-0.70
Definition
moderate obstruction
Term
ABI = 0.00-0.40
Definition
Severe Obstruction
Term
Right ABI
Definition
higher right ankle pressure/higherarm pressure
Term
Left ABI
Definition
higher left ankle pressure/higher arm pressure
Term
Goals of PAD Therapy
Definition
relieve symptoms of IC;
improve functional status & exercise tolerance;
prevent thrombotic events in circulation;
Term
Risk Factor Modification in Tx of PAD
Definition
Smoking cessation;
Proper Tx of DM;
Tx HTN;
Tx of Dyslipidemia;
Term
Cigarette Smoking
Definition
advise to stop smoking;
program of physician advice, group counseling sessions, and NRT;
Term
Diabetes Mellitus
Definition
screen & diagnose Type 2 DM;
Use antidiabetic therapy;
Goal: hemoglobin A1c <7%;
Proper foot care: appropriate footwear, skin cleansing/moisturizing, daily foot inspections, podiatry referral PRN;
Term
Hypertension
Definition
initiate lifestyle modification in ALL pts w/ elevated BP: weight control, physical activity, sodium restriction, alcohol moderation;
Administer antihypertensive therapy to achieve goal BP: <140/90 mmHg or <130/80 mmHg if DM or renal insufficiency, <130/80 (AHC);
1st line: ACE-I;
Beta-blockers: no effect on claudication symptoms;
Term
Dyslipidemia
Definition
screening for lipid abnormalities important;
implement therapeutic lifestyle changes;
HMG-CoA reductase inhibitors (statins) are primary agents to lower LDL-C:
- Target LDL-C <100 mg/dL & non-HDL cholesterol <130 mg/dL;
- Optional goal: Target LDL-C <70 mg/dL & non-HDL cholesterol <100 mg/dL;
Fibrates and/or niacin to raise HDL-C & lower TGs;
Term
Exercise
Definition
considered a cornerstone of therapy for IC;
supervised rehabilitation programs are recommended;
Recommended:
- Time: >30 min;
- Schedule: >3 sessions/wk;
- Length: >3 months;
use treadmill and track walking;
Improves maximal walking time & overall walking ability;
Term
Aspirin
Definition
antiplatelet therapy;
preferred due to lower cost, high incidence of concomitant CAD w/ PAD;
Dose: 75-325 mg PO daily;
low dose is protective, probably safer;
CHEST and ACC/AHA recommended 1st line;
Term
clopidogrel (Plavix)
Definition
antiplatelet therapy used in pts who are allergic or intolerant to aspirin;
Dose: 75 mg PO daily;
ADRs: thrombocytopenia;
Term
cilostazol (Pletal)
Definition
used for lifestyle-limiting intermittent claudication;
Dose: 100 mg PO BID;
ADRs: HA, diarrhea, palpitations;
MoA: phosphodiesterase inhibitor;
C/I: congestive heart failure;
Improves maximal walking distance within 4-24 wks;
Term
pentoxifylline (Trental)
Definition
MoA: improves RBC deformability, lowers fibrinogen levels, retard platelet aggregation;
Dose: 400 mg PO TID;
ADRs: HA, dizziness, palpitations;
Conflicting results in clinical trials:
- CHEST does NOT recommend use;
- ACC/AHA says to consider as 2nd-line alternative to cilostazol to improve walking distance in pts;
Term
Angioplasty
Definition
balloon-tipped catheter guided into artery, advanced to narrowed/blocked vessel and then inflated to open a vessel; stenting may also be used;
shorter hospital stay & faster recovery compared to bypass surgery;
Term
Bypass Surgery
Definition
blood is re-routed from above an obstruction in artery to below an obstruction;
typically requiers general anesthesia & potential for systemic complications exist;
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