Drugs in peripheral vascular disease Flashcards
what can PVD affect?
veins or arteries
-common in 65 yr olds
varicose veins
- aching and heaviness
- Homan’s sign-> calf pain
- discolored, tortuous, dilated veins visible under surface of skin
- primary cause of pulmonary emboli
- valves in veins are working anymore
- stasis in dilated veins
- generation of oxidative products
sclerosing agents
- Na tetradecyl sulfate
- laser therapy
- protein precipitating agent, new tissue can form
Buerger’s disease
thromboangiitis obliterans
- affects legs mostly
- inflammation of triangular sheath including femoral artery, vein and nerve
- claudication (leg cramps on walking), skin ulcers, cold feet and numbness
- 95% men who smoke
what is recommended for Buerger’s disease
exercise, cessation of smoking help and drug of some value
Homan’s sign
calf pain on dorsiflexion
primary Raynauds disease
mostly affects hands, especially 3 middle fingers
- 75% patients women
- excess vasoconstriction in response to cold or emotion
- ischemic pain then throbbing vasodilation (reddening) which is also painful
Secondary Raynaud’s phenomenon
associated with lupus, vibration injury, ect
Perino (chilblains)
vascular disorder accompanied by pruritis, a burning sensation and sores of the dorsum of the hands and feet, can also occur on ears
- associated with cold, damp weather
- may be chronic with aging
Drugs used in PVD
- block PVD vasoconstriction
- Ca channel blockers-> do not affect heart, just blood vessels
- Felodipine, amlodipine
drugs for Raynaud’s, Perino
- Felodipine
- amlodipine
Calcium channel diseases
Raynauds
migraine
prinzmetals
alpha-1 blockers in PVD
effective for Raynaud’s-> excessive adrenergic activity
- Prazosin
- Perino can also respond to alpha-1 blockers
Blood thinner for PVD
Pentoxifylline
Pentoxifylline
-decreases blood viscosity by decreasing blood protein (mainly fibrinogen)
-takes 2 weeks for onset of effect and for decreased blood viscosity
-also increases RBC deformability
-increased distanced walked before cramps
(works even with atherosclerosis)
side effects of Pentoxifylline
GI upset
bleeding (especially with anticoagulants)
vasodilator for PVD
cilostazol
best drug for claudication
cilostazol (better than pentoxifylline)
-greater dilation of femoral
cilostazol
phosphodiesterase 3 inhibitor increases cAMP-> vasodilation
-onset 2-4 weeks
best drugs for Buerger’s
pentoxifylline
cilastazol
best drugs for Raynauds
CCB’s
Prazosin
Pentoxifylline
best drugs for Perino
CCB’s
Prazosin
Pentoxifylline
other drugs for PVD but don’t extend life
nitrates
diuretics
anticoagulants
Drugs NOT FOR PVD
sympathomimetics
nicotine
ergot
what can reduce morbidity and mortality
- antiplatelets drugs like aspirin
- ACE-I
- antilipid drugs
- Beta-blockers
what can PVD progress to?
gangrene
- prognosis related to heart function
- healing in 15% with good therapy
what percent do drugs help for PVD?
25%
how do vasodilators help with erectile dysfunction?
-block phosphodiesterase (PDE5) specific for cGMP in corpus cavernosum
( normally, Ca/calmodulin activates eNOS-> increases NO->cGMP-> vasodilation)
selective PDE5 inhibitors
sildenafil
taldalafil
side effects of PDE5 inhibitors
headache
flushing
nasal congestion
myalgia
optic neuropathy with sildenafil (also blocks PDE6) loss blue green, blurring
-may cause extreme decrease BP with nitrates
