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Chapter 4: Peripheral Arterial Disease

A 42-year-old smoker with hypertension, diabetes, hypercholesterolemia, and PAD complains of pain in his calves when he walks two to three blocks. What therapy might offer him the greatest benefit in symptom reduction and in overall mortality?

a. Limb revascularization procedure

b. Cilostazol

c. Smoking cessation

d. Pravastatin

Answer c is correct. Tobacco cessation is the most important intervention to improve cardiovascular morbidity and mortality in high-risk patients and to improve claudication symptoms.

Answer a is incorrect. A limb revascularization procedure is indicated with an acute arterial occlusion that threatens limb viability.

Answer b is incorrect. Cilostazol may help with claudication symptoms but will not affect cardiovascular mortality.

Answer d is incorrect. Pravastatin will not help with claudication symptoms.

Which of the following is recommended as an alternative antiplatelet therapy for patients who do not tolerate aspirin?

a. Pentoxifylline 400 mg twice daily

b. Clopidogrel 225 mg daily

c. Clopidogrel 75 mg daily

d. Pentoxifylline 400 mg three times daily

Answer c is correct. The recommended dosage of clopidogrel in the treatment of PAD is 75 mg daily orally.

Answer b is incorrect. The recommended dosage of clopidogrel in the treatment of PAD is 75 mg daily orally.

Answers a and d are incorrect. The use of pentoxifylline in the treatment of PAD is for symptoms of claudication, not to reduce cardiovascular risk. It is not a replacement for aspirin in patients who do not tolerate aspirin.

A 61-year-old man with peripheral arterial disease, hypertension, hyperlipidemia, and New York Heart Association class III heart failure is noted to have significant functional impairment due to intermittent claudication. Which of the following pharmacologic interventions has a medication/disease state interaction with the patient?

a. Aspirin

b. Clopidogrel

c. Simvastatin

d. Cilostazol

Answer d is correct. Cilostazol may not be used in patients with any stage/degree of heart failure.

Answers a, b, and c are incorrect. Aspirin, clopidogrel, and simvastatin are not expected to interact with his comorbidities.

Which of the following antiplatelet agents should be monitored with periodic complete blood count testing related to ...

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