Raynaud's Phenomenon Flashcards
What is Raynaud phenomenon?
Blanching of digits after exposure to cold environment –> second cyanotic phase –> reactive hyperemia phase
Raynaud phenomenon is visible through colour changes. Progresses from _______ to ________ to _______ in lightly pigmented skin.
White
Blue
Red
Besides the cold, what else can trigger Raynaud Phenomenon?
Emotional stress
What drugs can cause secondary Raynaud Phenomenon?
- Antineoplastic agents
- Beta blockers (limited evidence -> unlikely)
- Central nervous system stimulants
- Cyclosporine
- Ergot derivatives
- Interferon alfa, beta
What are some non-pharms for Raynaud Phenomenon?
- Minimize cold exposure
- Avoid medications with vasoconstrictive potential unless needed (Ex: beta blockers in CAD)
- Warming exercises (windmill arms)
- Dress warmly
- Stop smoking
- Avoid vibrating tool
What are complications that may arise from Raynaud phenomenon?
No complications. Reassure patient
Is acupuncture effective for secondary Raynaud phenomenon?
No
What does drug therapy help reduce in patient populations?
Frequency
Intensity
Duration
Frequency
What is first-line therapy for Raynaud’s phenomenon?
DHP CCB
- Amlodipine
- Felodipine
- Nifedipine
Is there a drug of choice amongst the DHP CCBs?
Nifedipine is the best studied
How do we administer DHP CCBs for Raynaud’s?
30-60 min before cold exposure or regularly during winter months
What if patient does not tolerate DHP CCB?
Can consider non-DHP CCB, but it is less effective
What other drug classes can be used if CCB’s are not effective or contraindicated for the patient?
Losartan
Peripheral alpha blockers (prazosin)
- less effective
- hypotension is the main side effect
If patient has severe/resistant primary or secondary Raynaud phenomenon, what drugs can we consider?
PDE5
- sildenafil
- vardenafil
- tadalafil
Bosentan
- for patients with systemic sclerosis
These drugs are not currently approved yet, costly, and have a number of contraindication (side effects)
Is fluoxetine a recommended treatment for Raynaud phenomenon?
No
Are ACEi recommended for Raynaud phenomenon?
No
Does pregnancy improve or worsen Raynaud phenomenon?
Improves substantially and lasts for a few months following delivery
How do we manage Raynaud in pregnancy and postpartum if therapy is needed?
Non pharms are first-line
Nifedipine can be considered if drug therapy is needed
How do we manage Raynaud in breastfeeding?
Avoid meds if possible
CCB not safe, as it can be passed into breast milk
Nifedipine can be used if needed
Do patient with primary and secondary Raynaud’s Phenomenon respond equally to pharmacotherapy?
Yes
If one type of vasodilator is ineffective, is it reasonable to switch to a different vasodilator?
No, ineffectiveness of one is likely to infer that other vasodilators are also ineffective.
