progressive narrowing of the arterial lumen d/t atherosclerosis
What are the risk factors for PAD?
What are the 2 most common characteristics of PAD?
pain at rest in lower extremities
What is intermittent claudication?
pain or numbness
occurs in the affected extremities (buttock, thigh, calf) during exercise and resolves within a few minutes of rest
What are the potential physical exam findings of PAD?
cool foot skin temp
lack of hair on calf, feet and/or toes
visible sores or ulcers
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
0.7 - 0.9 = mild
0.4 - 0.7 = moderate
< 0.4 = severe
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
What are 2 non-pharmacological therapies for PAD?
What is the recomendation for use of cilostazol in pts with any form of heart failure?
don't do it!
What is the MOA for cilostazol?
increase cAMP by inhibition of PDE 3 which increases vasodilation and decreases platelet aggregation
What are the CI of cilostazol?
CHF, hemostatic disorders or active pathologic bleeding
What are the SE of cilostazol?
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)
What is the MOA for pentoxifylline?
increase blood flow by decreasing viscosity, increasing leukocyte deformability, and decreasing neutrophil adhesion
What are the CI for pentoxifylline?
recent cerebral and/or retinal hemorrhage
previous intolerance to pentoxifylline or methylxanthines (caffeine, theophylline, theobromine)