Chapter 25

Chapter 25 Drugs Used to Treat Peripheral Vascular Disease

• Source: Clayton’s Basic Pharmacology for Nurses, 19th edition by Michelle Willihnganz, MS, RN, CNE

Lesson 25.1 Overview

• Focus: Examining drugs for the treatment of Peripheral Vascular Disease (PVD)

• Goals:

  • Assess patients effectively for PVD.

  • Identify measures for improving peripheral circulation.

  • Understand treatment goals and expectations regarding vasodilating agents.

Peripheral Vascular Disease (PVD)

Types of PVD

• Arterial:

  • Obstructive: Arteriosclerosis obliterans

  • Vasospastic: Raynaud disease

  • Primary: Unknown cause

  • Secondary: Known triggers

• Venous:

  • Example: Deep vein thrombosis

Symptoms

• Occur with significant blood vessel narrowing:

  • Aching, cramping, tightness, weakness during exercise

  • Ischemia leading to intermittent claudication

  • Pain due to oxygen insufficiency to muscles

  • Possible progression to rest pain, numbness, and paresthesias (tingling)

  • Increased blood viscosity (thickness)

Raynaud Disease

• Cause: Vasospasm and ischemia of arteries in extremities

• Signs and Symptoms:

  • Numbness, tingling, skin tightness

  • Blanching with vasoconstriction followed by vasodilation

  • Progression typically starting at fingertips and moving toward hands

Treatment Goals for PVD

• Objectives:

  • Reversing atherosclerosis progression

  • Improving blood flow

  • Pain relief

  • Preventing skin ulceration

  • Preventing gangrene

Nonpharmacologic Treatment

• Methods:

  • Diet control to lower hypercholesterolemia

  • Regular exercise and weight management

  • Smoking cessation

  • Control of diabetes and hypertension

  • Proper foot care, crucial for diabetics

  • Elevating the head of the bed to help circulation

  • Surgical options, such as arterial angioplasty

Drug Therapy for PVD

• Cilostazol (Pletal): FDA approved for treating intermittent claudication from chronic occlusive arterial disease in limbs

• Mechanism: Acts as a platelet aggregation inhibitor

Potential Drug Classes for Raynaud Disease

• Calcium-Channel Blockers:

  • Examples: Diltiazem, Nifedipine, Verapamil

• Adrenergic Antagonists:

  • Examples: Prazosin, Reserpine, Guanethidine, Methyldopa

• ACE Inhibitor: Captopril

• Direct Vasodilator: Nitroglycerin (various forms)

Baseline Assessments for PVD

• Key assessments include:

  • History of risk factors (hypertension, high serum lipids)

  • Dietary habits, obesity, smoking history

  • Tissue assessments (oxygenation, temperature, peripheral pulses, pain levels)

  • Exercise tolerance and stress management capabilities

Audience Response Questions

• Question 1: Symptoms occur with what percentage of vessel narrowing?

  • Choices: 25%-30%, 40%-50%, 55%-70%, 75%-90%

• Question 2: Condition causing leg pain due to activity but relieved by rest?

  • Intermittent claudication

• Question 3: Assessment finding associated with PVD?

  • No hair growth on shins, pulses 1+, pale feet

Patient Education for PVD

• Self-Care Measures:

  • Promote circulation; avoid tight clothing

  • Diet to control obesity and lipids

  • Regularly check extremities for infection and provide meticulous care

  • Limit prolonged sitting/standing for optimal circulation

  • Maintain mobility, educate on medication.

Patient Teaching Guidelines

• Practical Tips:

  • Test water temperatures before immersion

  • Alternate pairs of shoes for drying

  • Wear layers to avoid frostbite

  • Drug therapy complements other management strategies

Adverse Effects of Cilostazol

• Common Effects:

  • Dyspepsia, diarrhea, dizziness, headache

• Serious Effects:

  • Chest pain, palpitations, dysrhythmias, shortness of breath

Summary

• Peripheral vascular disease requires multifaceted treatment involving lifestyle modifications, pharmacologic interventions, and comprehensive patient education. Understanding the associated symptoms, the importance of risk assessments, and effective treatment plans is vital for successful management.