Ease Into Prep with a PANCE^® Question of the Day

The correct answer is C. Propranolol, a beta-blocker, is considered to be relatively contraindicated in patients who have peripheral arterial disease with claudication. Although beta-blockers are excellent medications in patients who have coronary heart disease, the beta blockade may decrease the amount and force of blood going into the peripheral circulation. Because the heart is not contracting as strongly, there is less blood being propelled into the peripheral vascular system. The dose of beta-blockers in this patient should therefore be reduced or gradually eliminated.

Decreasing diltiazem (choice A) would not be of value, because calcium-channel blockers such as diltiazem tend to cause arterial vasodilation.

The decreased use of hydrochlorothiazide (choice B) would have no effect on arterial vasodilation.

Increasing aspirin (choice D) does not reduce the symptoms of claudication. Although the most common cause of peripheral vascular disease is atherosclerosis, using aspirin therapy would not immediately improve the symptoms associated with peripheral vascular disease.

Increasing isosorbide dinitrate (choice E) would increase venodilation but would not have an influence on the arterial vascular bed.

PEARL: Peripheral vascular disease is most commonly caused by atherosclerosis. Most patients are asymptomatic, but when they become symptomatic claudication is the most common manifestation of the peripheral vascular disease. Risk factor reduction is essential in treating this condition. Exercise to improve claudication symptoms is indicated. Useful medications include cilostazol (Pletal), a phosphodiesterase (platelet aggregation) inhibitor and pentoxifylline (Trental), an agent used to improve the red blood cell flexibility to deform in order to fit smaller diameter vessels. Beta-blockers should not be used in patients who have peripheral arterial disease, as they interfere with the delivery of blood to the peripheral circulation because of their negative inotropic effects.