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Adenosine diphosphate receptor antagonist
23%
31/133
Glycoprotein IIb/IIIa receptor antagonist
11%
15/133
Irreversible inhibitor of cyclooxygenase
8%
10/133
Phosphodiesterase III inhibitor
27%
36/133
Vitamin K epoxide reductase inhibitor
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This patient who experiences lower extremity pain on exertion that is relieved by rest most likely has vascular claudication and has had negative reactions to aspirin and ticlopidine. He should therefore be given a phosphodiesterase inhibitor such as cilostazol. Phosphodiesterase III (PDE) is an enzyme in platelets that degrades cyclic adenosine monophosphate (cAMP). Inhibition of this enzyme raises cAMP levels in platelets, and higher levels of this second messenger result in decreased platelet aggregation. PDE inhibition also results in direct arterial vasodilation because it decreases contraction of arteriolar smooth muscle. These drugs, such as cilostazol and dipyridamole, are primarily used for vascular pathologies such as intermittent claudication, angina, and prevention of stroke and transient ischemic attacks in combination with other antiplatelet agents such as aspirin. Claudication is caused by ischemia resulting from obstruction of the peripheral arteries typically from atherosclerosis and will present with lower extremity pain with prolonged exertion that is alleviated by rest. Incorrect Answers: Answer 1: Adenosine diphosphate receptor antagonists such as clopidogrel and ticlopidine are also indicated for the treatment of claudication; however, they have a side effect of thrombotic thrombocytopenic purpura that this patient experienced leading to treatment discontinuation. Answer 2: Glycoprotein IIb/IIIa receptor antagonists such as abciximab prevent platelet aggregation and are commonly used in acute coronary syndromes or after coronary angioplasty; however, they are not as commonly used to treat claudication. Answer 3: Irreversible inhibitor of cyclooxygenase describes the mechanism of action for aspirin, which could definitely be used to treat claudication; however, this patient is allergic to aspirin. Answer 5: Vitamin K epoxide reductase inhibitor describes the mechanism of action for warfarin, which is an anticoagulant that can be used to prevent clot formation. This drug would not be used for claudication. Bullet Summary: Phosphodiesterase inhibitors can be used in the treatment of intermittent claudication.
3.2
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