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What is Peripheral Artery Disease (PAD)?
progressive narrowing of the arterial lumen d/t atherosclerosis
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What are the risk factors for PAD?
- over 40yo
- smoking
- DM
- hypercholesterolemia
- HTN
- hyperhomocysteinemia
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What are the 2 most common characteristics of PAD?
- intermittent claudication
- pain at rest in lower extremities
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What is intermittent claudication?
- fatigue
- discomfort
- cramping
- pain or numbness
- occurs in the affected extremities (buttock, thigh, calf) during exercise and resolves within a few minutes of rest
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What are the potential physical exam findings of PAD?
- cool foot skin temp
- shiny skin
- thickened toenails
- lack of hair on calf, feet and/or toes
- visible sores or ulcers
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What is the standard diagnostic test for PAD?
- ABI (ankle-brachial index):
- simple, non-invasive, quantitative test
- pt lies supine, systolic BP is measured at brachial arteries in both arms and the dorsalis pedis and posterior tibial arteries of the legs. pressures are averaged and divided by the mean measurement of the brachial arteries
- 1= normal
- 0.7 - 0.9 = mild
- 0.4 - 0.7 = moderate
- < 0.4 = severe
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What are the treatment goals for PAD?
- increase maximal walking distance and duration
- increase amount of pain-free walking
- increase control of comorbidities that contribute to morbidity
- increase quality of life
- decrease cardiovascular complications and death
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What are 2 non-pharmacological therapies for PAD?
- smoking cessation
- exercise
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What is the recomendation for use of cilostazol in pts with any form of heart failure?
don't do it!
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What is the MOA for cilostazol?
increase cAMP by inhibition of PDE 3 which increases vasodilation and decreases platelet aggregation
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What are the CI of cilostazol?
CHF, hemostatic disorders or active pathologic bleeding
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What are the SE of cilostazol?
- HA
- nausea
- diarrhea
- dizziness
- edema
- back pain
- rhinitis
- pharyngitis
- infection
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What is cilostazol used for in PAD?
for intermittent claudication in pts with lifestyle-limiting claudication and no hx of heart failure (unless they cannot have surgical interventions)
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What is the MOA for pentoxifylline?
increase blood flow by decreasing viscosity, increasing leukocyte deformability, and decreasing neutrophil adhesion
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What are the CI for pentoxifylline?
- recent cerebral and/or retinal hemorrhage
- previous intolerance to pentoxifylline or methylxanthines (caffeine, theophylline, theobromine)
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What are the SE of pentoxifylline?
- flushing
- blurred vision
- dizziness
- HA
- dyspnea
- NVD
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