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24 Cards in this Set
- Front
- Back
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Module 4 - logbook 7: definition PAD |
Significant narrowing of arteries distal to the arch of the aorta |
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Module 4 - logbook 7: epidemiology |
PAD affects 4% to 12% of people aged 55 to 70 years and 15-20% of people aged over 70 years. Women catch up in older age groups |
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Module 4 - logbook 7: risk factors |
Smoking, diabetes, hypertension, cholesterol, physical inactivity and obesity |
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Module 4 - logbook 7: common presentation |
Symptoms: Intermittent claudication. Generally worse in one leg and when walking uphill. Signs: affected leg may be pale, cold, with a loss of hair and with skin changes, ulcers and non-palpable pulses |
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Module 4 - logbook 7: investigations |
ABPI, duplex ultrasonography and potentially MR/CT angiography |
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Module 4 - logbook 7: pathophysiology |
Atherosclerosis: fatty streak > plaque > plaque rupture/partial occlusion |
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Module 4 - logbook 7: anatomy |
Upper limb: Aorta > subclavian - carotid and vertebral axilliary > brachial > radial + ulnar > palmar
Lower limb: aorta > common/external iliac > femoral > popliteal > AP/PO tibial > Arcuate artery |
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Module 4 - logbook 7: prognosis |
Increased risk for all-cause mortality and from cardiovascular mortality. CAD is main cause of death. 50% improve, 25% stay the same 25% worsen.
Prognosis after amputation is poor |
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Module 4 - logbook 7: management |
Modification of cardiovascular risk factors and antiplatelets
Surgery: disabling claudication, critical limb ischaemia or weak/absent femoral pulses. Bypass or EVAR
Amputation |
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Module 4 - logbook 7: drugs - ASPIRIN |
Antiplatelet - Acetyl donor to COX rendering it inactive which reduces thromboxane A2 |
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Module 4 - logbook 7: drugs - AMITRIPTYLINE |
Tricyclic antidepressant - inhibits reuptake of norepinephrine + serotonin |
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Module 4 - logbook 7: drugs - RAMIPRIL |
Hypertension - ACE inhibitor: stops ATI converting to ATII. ATII is a potent vasdoilator. Dry cough. Monitor renal function eGFR |
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Module 4 - logbook 7: drugs - ATORVASTATIN |
Hypercholesterolemia - enzyme inhibitor HMG coA reductase, reducing quantity of mevalinic acid, a precursor of cholesterol |
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Module 4 - logbook 7: drugs - DALTEPARIN |
LMWH. Increases activity of ATIII. Inhibits formation of Xa and thrombin |
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Module 4 - logbook 7: aetiology |
Chronic: atherosclerosis. Acute: thrombus or embouls |
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Module 4 - logbook 7: drugs - TAZOCIN |
Antibiotic. Penicillin like. Inhibits 3rd/;ast stage of bacterial cell wall synthesis |
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Module 4 - logbook 7: drugs - GLICLAZIDE |
Anti-diabetic: Stimulates beta cells to secrete insulin by opening calcium channels |
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Module 4 - logbook 7: drugs - METFORMIN |
Anti-diabetic: improved insulin binding leading to improved uptake |
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Module 4 - logbook 7: drugs - MORPHINE MR |
Analgesic: acts on mu opioid receptors. Increases pain inhibition pathway by inhibiting GABA inhibitory neurons |
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Module 4 - logbook 7: drugs - PREGABALIN |
Neuropathic pain. Unknown but reduces calcium dependent release of neurotransmitters |
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Module 4 - logbook 7: drugs - PARACETAMOL |
Acts on COX 1, 2 and maybe 3. Reduces prostaglandin synthesis |
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Module 4 - logbook 7: drugs - ORAMORPH |
Analgesic: acts on mu opioid receptors. Increases pain inhibition pathway by inhibiting GABA inhibitory neurons |
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Module 4 - logbook 7: ABPI |
Ankle/Brachial. 1 = normal. 0.6-0.9 = claudication. Rest pain = 0.3-0.6. < 0.3 = impending gangrene |
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Module 4 - logbook 7: acute vs chronic vs critical |
Acute: 6ps: pulseless, paralysed, pale, 'perishingly' cold, painful and paresthetic
Chronic: Postural/dependant colour change, punched out ulcers, long history, not rest pain.
Critical: rest pain (skin ulceration) |
