Drugs Used to Treat Peripheral Vascular Disease Chapter 26 Drugs Used to Treat Peripheral Vascular Disease Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 26 Lesson 26.1 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives Discuss peripheral vascular disease List the baseline assessments needed to evaluate a patient with peripheral vascular disease Identify specific measures that the patient can use to improve peripheral circulation and prevent complications from peripheral vascular disease Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives (cont’d) State both pharmacologic and nonpharmacologic goals of treatment for peripheral vascular disease Develop measurable objectives for patient education of patients with peripheral vascular disease Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Peripheral Vascular Disease Diseases of blood vessels in the extremities Arterial Obstructive: arteriosclerosis obliterans Vasospastic: Raynaud’s disease Primary (unknown cause) Secondary (known triggers) Venous Deep vein thrombosis See Chapter 27 for further discussion Primary cause of arteriosclerosis obliterans is buildup of atherosclerotic plaque, resulting in narrowing of the lower aorta and the major arteries that provide circulation to the legs. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Peripheral Vascular Disease (cont’d) Symptoms occur with significant narrowing in blood vessels Aching, cramping, tightness, weakness during exercise Ischemia or lack of blood to tissues occurs (intermittent claudication) Pain results from lack of oxygen to muscles Progresses to pain at rest, numbness, and paresthesias (numbness with tingling) Blood often becomes more viscous, or thicker Patients tend to remain symptom-free until there is 75% to 90% occlusion in key locations of the major arteries and arterioles of the legs. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Nonpharmacologic Treatment of Peripheral Vascular Disease Control of diet, reduce hypercholesterolemia Daily exercise and weight control Cessation of smoking Control of diabetes and hypertension Proper foot care, especially for diabetics Elevation of the head of bed to increase circulation to extremities Arterial angioplasty and surgery Raynaud’s disease is best treated by avoidance of triggers, such as cold temperatures, emotional stress, and tobacco or other drugs known to induce attacks. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Pharmacologic Treatment of Peripheral Vascular Disease Approved by the FDA to treat intermittent claudication due to chronic occlusive arterial disease of the limbs Pentoxifylline (Trental) – hemorheologic agent; enhances RBC flexibility Cilostazol (Pletal) – platelet aggregation inhibitor Even though pharmacologic therapy is added, nonpharmacologic measures must still be implemented for optimum benefit; nonpharmacologic treatment is more successful in treating the underlying disorder. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Potential Classes of Drugs to Treat Raynaud’s Disease Calcium ion agonists Diltiazem (Cardizem) Nifedipine (Procardia) Verapamil (Calan, Isoptin) Adrenergic antagonists Prazosin (Minipress), reserpine Guanethidine (Ismelin), methyldopa ACE inhibitor Captopril (Capoten) Direct vasodilator Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur) Nifedipine is the calcium ion agonist with the greatest success in reducing the occurrence of spasms. Captopril has been extensively studied and successful in reducing frequency and severity of attacks. Adrenergic antagonists have moderate success and many adverse effects. Nitroglycerin has adverse effects such as dizziness, headache, and hypotension. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Baseline Assessments for Peripheral Vascular Disease History of risk factors such as hypertension, high serum lipids Dietary habits, obesity Smoking Assessment of tissues Level of exercise tolerated and ability to control stressful situations Assessment of tissues includes oxygenation, temperature, edema, peripheral pulses, limb pain. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Patient Education for Peripheral Vascular Disease Self-care measures that promote circulation Smoking cessation Avoid tight-fitting clothing Diet designed to control obesity and lipid levels Check extremities for infection, meticulous care Avoid sitting or standing for long periods Maintain and foster maximum mobility Medication education and expectations Check with the health care provider before elevating extremities; it is contraindicated in patients with arterial insufficiency. Set short-term goals to control pain and symptoms. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 26 Lesson 26.2 Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Objectives State both pharmacologic and nonpharmacologic goals of treatment for peripheral vascular disease Identify the systemic effects to expect when peripheral vasodilating agents are administered Explain why hypotension and tachycardia occur frequently with the use of peripheral vasodilators Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Hemorheologic Agents Drug: pentoxifylline (Trental) Actions Increase erythrocyte flexibility, decrease amount of fibrinogen in blood, prevent aggregation of RBCs and platelets Uses Treat intermittent claudication Common adverse effects Nausea, vomiting, dyspepsia; dizziness, headache Serious adverse effects Chest pain, dysrhythmias, shortness of breath Decreases the viscosity of blood and improves tissue perfusion, which results in increased blood flow. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Vasodilators Drug: papaverine hydrochloride Actions Vasodilation of the smooth muscles of blood vessels Uses Treat symptoms of vasospasms, cerebral vascular insufficiency, arteriosclerosis Common adverse effects Flushing, tingling, sweating, nausea, vomiting Serious adverse effects Hypotension, tachycardia, rash, nervousness Little objective evidence that papaverine has any therapeutic value. OTC cold and cough preparations may counteract its effect. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Drug Class: Platelet Aggregation Inhibitor Drug: cilostazol (Pletal) Actions Allow increased levels of cAMP, which result in vasodilation and inhibit platelet aggregation Uses Treat intermittent claudication Common adverse effects Dyspepsia, diarrhea; dizziness, headache Serious adverse effects Chest pain, palpitations, dysrhythmias, shortness of breath Therapeutic outcomes: improve tissue perfusion; reduce pain; improve tolerance of exercise; improve peripheral pulses. Mosby items and derived items © 2010, 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.