PAD- Carlson

Make sure to memorize the dosing!!!

What is Peripheral Arterial Disease (PAD)?

a condition where narrowed arteries cause reduced blood flow to the outer parts of your body (peripherals)

What causes narrow arteries in PAD?

plaque build up

What part of the body is most commonly effected by PAD?

a. legs

b. heart

c. brain

d. arms

a. legs

What are the risk factors for PAD?

• HISTORY OF SMOKING

• age

• black ethnicity

• HTN

• Diabetes

• Hyperlipidemia/ Artherosclerosis

In the early stages of PAD, what are the symptoms, if any?

asymptomatic in the early disease

What is the MAIN symptom of PAD? Describe this symptom.

Intermittent claudication

• discomfort, pain, or numbness in affected lower extremities during physical activity

  • resolves w/in 10 min of rest

What is the name of the test used to diagnose PAD?

Ankle-brachial index (ABI)

What is the nonpharm treatment for PAD?

• smoking cessation

• exercise

  • 30-45 min, 3x a week

What are some ways to quit smoking?

non-pharm: counseling, programs

pharm: nicotine replacement therapy, bupropion, varenicline

If nonpharm tx doesn’t work, what can we do for PAD?

revascularization

• basically we physically open up that narrow artery

PAD is a form of ASCVD. What pharm tx is recommended for management of hyperlipidemia?

high intensity statin

What are the 2 high intensity statins and their dosing?

1. Atorvastatin 40, 80 mg

2. Rosuvastatin 20, 40 mg

For HTN management, what is the recommended 1st line therapy and bp goal?

1st line therapy- ACEIs/ARBs, thiazides, CCBs

bp goal- <130/80 mmHg

What is the target HbA1c for diabetes management?

a. <4%

b. <5%

c. <6%

d. <7%

d. <7%

For Asymptomatic and Symptomatic PAD which of the following is recommended/reasonable?

a. thrombolytics

b. antiplatelet therapy

c. anticoagulant therapy

d. ACEIs/ARBs

b. antiplatelet therapy

What are the 2 options for antiplatelet therapy for PAD?

1. Aspirin

2. Clopidogrel (if can’t take aspirin)

What is the dosing for Aspirin for PAD?

• KNOW

75-325 mg PO daily

What is the dosing for Clopidogrel (Plavix) for PAD?

• KNOW

75 mg PO daily

MOA, Contraindications, and ADRs of Aspirin:

• not that important

MOA: bind COX enzymes, prevent formation of TxA2

Contraindications: hemophilia, thrombocytopenia, active bleeding

ADRs: GI bleeding/ulcer/upset, and dyspepsnia

MOA, Contraindications, and ADRs of Clopidogrel:

• not that important

MOA: blocks P2Y12 component on ADP receptors= reduce platelet aggregation

Contraindications: active bleeding

ADRs: GI bleed, angioedema, TTP (rare)

Should anticoagulants be used to reduce the risk of CV event in PAD? What is the one exception to this?

NOOOOOOO

• one exception: rivaroxaban—-special conditions

When is rivaroxaban indicated in PAD?

FOLLOWING REVASCULARIZATION

Rivaroxaban MUST be combined with what in PAD?

Aspirin!!!

• Rivaroxaban CANNOT BE GIVEN ALONE!!!

What is the dosing for Rivaroxaban+ Aspirin?

Rivaroxaban 2.5 mg PO BID in combo w/ Aspirin 75-100 mg PO daily

In PAD, Rivaroxaban can only be taken if you have a low or high bleeding risk?

low

What is recommended in addition to antiplatelet therapy in patients with PAD for INTERMITTENT CLAUDICATION?

Cilostazol

Cilostazol is stopped at ____ weeks if NO SYMPTOMATIC IMPROVEMENT is seen.

12 weeks!

Is Pentoxifylline recommended for Intermittent claudication treatment?

no