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What is the 1st line drug for PAD?
What benefits does ACEI have in PAD?
Increases pain free walking
What treatment would you use for a patient with PAD and is Asymptomatic (ABI<0.9)?
ASA 75-325 mg/day
If a PAD patient has Raynaud’s, what drugs are recommended?
Peripheral vasodilatory CCBs = amlopidine or nifedipine
If a patient has Critical leg ischemia, what PAD drugs should you avoid?
BBs (reduce CO further)
What treatment would you use for a patient with symptomatic PAD
- Preferred: ASA 75-325 mg/day
- Alternative: Clopidogrel 75 mg/day
- High CV risk: ASA + clopidogrel
What treatment would you use for a patient with Refractory IC PAD?
- Add: cilostazol 100 BID
- Potential 2nd line agent: pentoxifylline 400mg TID
Cilostazol (Pletal) has what MOA?
- PDE inhibitor
- Suppresses platelet aggregation
- Direct artery vasodilator
What are the Adverse effects of Cilostazol (Pletal)?
HA (in 1/3 of patients), diarrhea, edema, palpitations, dizziness, other GI
What are the Contraindications of Cilostazol (Pletal)?
- Heart failure
- Drug interactions ( CYP3A4 metabolized)
Cilostazol (Pletal) cannot be used in what group of patients?
When should you take Cilostazol (Pletal)?
- Take it 30 minutes before or 2 hours after eating
- B/c fat increases its absorption
Can Cilostazol (Pletal) be taken with aspirin or clopidogrel?
How do we treat acute critical leg ischemia in PAD?
- Systemic anticoagulation: UFH
- Reperfusion therapy
- Catheter-based thrombolytics
What dose of UFH would be used for acute critical leg ischemia in PAD?
80 units/kg bolus (max 10,000 units) and 18 units/kg/hr CI (2,300 U/hr max)
After a stent, bypass or angioplasty of PAD, what are the options for treatment?
ASA 81 mg QD and/or Clopidegrel 75 mg/day (1 year)
How should you treat a patient with Asymptomatic PAD?
ASA 81 mg
How should you treat a patient with Symptomatic CAD?
- Clopidegrel 75 mg/day
- ASA-ER dipyrimadole 25/200 mg BID
- ASA 81 mg/day
- (In order of presference)
What would you like to do?
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