Drugs in Peripheral Vascular Disease

Question 1

What vessels can peripheral vascular disease (PVD) effect?

Answer 1

Arteries, veins, or both

Question 2

How are varicose veins treated?

Answer 2

Destroyed with sclerosing agents, either

1. Na+ tetradecyl sulfate
2. Lasar therapy

Question 3

What is the purpose of treating varicose veins?

Answer 3

1. valves don’t function anymore anyways
2. stasis
3. generation of oxidizing products

Question 4

Buerger’s disease

• aka
• affects ..
• what does it cause
• who is most affected?

Answer 4

Thromboangiitis Obliterans

Affects legs mostly

• Inflammation of triangular sheath including femoral artery, vein, and nerve
• claudication
• skin ulcers
• cold feet
• numbness

95% of pts are men who smoke

Question 5

Raynaud’s disease

• mostly affects?
• what is it?

Answer 5

Mostly affects hands
–75% of pts are women

Excess vasoconstriction in response to cold or emotion

Ischemic pain then throbbing (vasodilation and reddening) which is also painful

(Excess sympathetic activity - so alpha 1 blockers are especially helpful here!)

Question 6

Pernio

• aka
• what is it?
• what is it associated with?

Answer 6

Chilblains

Vascular disorder accompanied by pruritus, a burning sensation, and sores on the dorsum of the hands and feet
–some vasoconstriction may be involved

Associated with cold, damp weather

Question 7

What drugs are used in PVD to block vasoconstriction?

Answer 7

CCBs - use the ones most affective on blood vessels
—nifedipine type
Alpha 1 blockers - Prazosin

Question 8

Aside from drugs that block vasoconstriction, what other drugs are helpful in PVD?

Answer 8

Blood thinner - pentoxifylline

Vasodilator - cilostazol

Question 9

Pentoxifylline

• -what affect does it have? how?
• -S/E

Answer 9

Decreases blood viscosity by decreasing blood protein
–It takes 2 weeks for onset of effect and for decrease in blood viscosity

Also increases RBC deformability (aka makes them more flexible)

S/E

• GI upset
• bleeding

Question 10

Cilostazol

• -better than pentoxifylline for claudiation. why?
• -how does it act?
• -how long for onset?

Answer 10

Better for claudication because it causes a greater dilation of femoral

Its a phosphodiesterase 3 inhibitor
It increases cAMP which leads to vasodilation

Onset 2-4 weeks

Question 11

So which drugs are used in Buerger’s?

Answer 11

Pentoxifylline

Cilastazol

Question 12

So which drugs are used in Raynaud’s?

Answer 12

CCBs
Prazosin
Pentoxifylline

Question 13

So which drugs are used in Pernio?

Answer 13

CCBs
Prazosin
Pentoxifylline

Question 14

What other dugs are used for PVD but don’t extend life?

Answer 14

Nitrates
Diuretics
Anticoagulants

Question 15

What drugs are bad for PVD?

Answer 15

Sympathomimetics
Nicotine
Ergot

Question 16

Morbidity and mortality with PVD is reduced by …

Answer 16

Antiplatelet drugs like aspirin
ACE inhibitors
Antilipid drugs
Beta blockers

Question 17

PVD can progress to …

Answer 17

gangrene

Prognosis is related to heart fxn (good CO, good healing)

Question 18

Vasodilators can also be used for erectile dysfunction. Explain

Which specific drugs are used?

Answer 18

Block phosphodiesterase (PDE5) “specific” for cGMP in corpus cavernosum

• -sildenafil
• -taldalafil

Question 19

S/E of PDE5 inhibitors

Answer 19

Headache
Flushing
Nasal decongestion
Myalgia
Optic neuropathy with sildenafil
Loss of blue green vision
Blurring

If used with nitrates may cause extreme decrease in BP