Chapter 8. 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
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 with PAD 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 and no longer recommended for claudication symptom relief due to lack of efficacy.
Which of the following antiplatelet agents is not generally used in the treatment of PAD and should be monitored with periodic complete blood count testing related to potential hematologic complications that include agranulocytosis and aplastic anemia?
d. Dipyridamole plus aspirin
Answer c is correct. Ticlopidine has a black box warning for potential life-threatening hematologic reactions, including neutropenia, agranulocytosis, thrombotic thrombocytopenic purpura (TTP), and aplastic anemia. Routine monitoring is required for ticlopidine. Monitor for signs and symptoms of neutropenia and thrombocytopenia. Discontinue therapy if the absolute neutrophil count falls less than 1200/mm3 or if the ...