1. Drugs Used to Treat Peripheral Vascular Disease
Chapter 26
Drugs Used to Treat
Peripheral Vascular Disease
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2. Chapter 26
Lesson 26.1
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3. 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
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4. 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
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5. 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.
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6. 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.
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7. 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.
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8. 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.
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9. 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.
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10. 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.
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11. 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.
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12. Chapter 26
Lesson 26.2
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13. 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
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14. 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.
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15. 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.
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16. 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.
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