40 - Intermittent Claudication

Question 1

key characteristic?

Answer 1

pain is induced by exericse and relieved with rest

Question 2

non-pharms

Answer 2

• stop smoking
• time (collateral flow develops over 6-12 months)
• non-drug tx of obesity, lipid disorders, HTN and associated conditions that increase risk for PAD
• dynamic leg exercises
• endovascular procedures may be helpful

Question 3

In this chapter there are drugs to treat reduce ___ risk and drugs to specifically treat intermittent claudication

Answer 3

CV

Question 4

What are some options we have to decrease CV risk?

Answer 4

• Antiplatelet agents (ASA, clopidogrel, ticagrelor)
• Ramipril
• Beta blockers
• Statins

Question 5

______ agents decrease RR of vascular death in high risk patients by about 25%

Answer 5

antiplatelets

Question 6

How does ramipril help intermittent claudication?

Answer 6

decreases ischemic events and increases walking time and distance

Question 7

How does beta blockers help?

Answer 7

• Decreases risk of MI and death in those with atherosclerosis but may worsen PAD symptoms
• Does not help with walking
• Ok for treating HTN in this population but not for those > 60 yo unless other indication

Question 8

How can statins help intermittent claudication ?

Answer 8

statins decrease CV risk in patients with atherosclerosis and may improve symptoms and walking distance

Question 9

Specific therapy for intermittent claudication:

List 2 drugs

Answer 9

• Pentoxifylline

- Cilostazol

Question 10

Specific therapy for intermittent claudication:

How does pentoxifylline work?

Answer 10

alters erythrocyte deformability and reduces blood viscosity, platelet reactivity and plasma hypercoagulability

*not recommended for mild claudication

Question 11

Specific therapy for intermittent claudication:

How long do you give pentoxifylline for?

Answer 11

give for 24 weeks then 8 week drug period can decrease or eliminate the need for pentoxifyllin

Question 12

Specific therapy for intermittent claudication:

How does Cilostazol work?

Answer 12

• inhibits platelet aggregation by selectively inhibiting phosphodiestase 3
• vasodilator
• improves maximal treadmill walking distance
• not available in Canada

Question 13

Which specific therapy for intermittent claudication is available in Canada?

Answer 13

pentoxifylline