Chapter 25 - Drugs Used to Treat PVD

3 (Rationale: Nifedipine is a calcium antagonist that reduces smooth muscle contractibility by inhibiting the movement of calcium ions in slow channels. Its side effects include headache, flushing, peripheral edema, and postural hypotension. Overdose of the medication produces nausea, drowsiness, confusion, and slurred speech. If signs of overdose occur, the health care provider is notified.)

Nifedipine (Procardia) has been prescribed for a client with Raynaud's disease, and the nurse reinforces medication instructions with the client about the medication. Which statement by the client indicates a need for further teaching? 1. "I will contact my doctor if I get short of breath." 2. "I will call my doctor if I get headaches that worsen." 3. "Nausea and drowsiness are expected, and if they occur, I don't really need to worry about it." 4. "I need to get up slowly when I change positions because the medicine causes hypotension."

origin

PVD can have arterial or venous:

intermittent claudication

Pain secondary to lack of oxygen to the muscles during exercise

Raynaud's

Peripheral vascular disease caused by arterial vasospasm is known as ______________ disease -primary cause unknown

inhibition

Platelet aggregation inhbitor cilostazol Pletal Action: vasodilation & platelet aggregation _____________

cilostazol

Platelet aggregation inhibitor ________________ Pletal

extremity, cyanosis

Raynaud's disease (r/t arterial vasospam, PVD) S & S -numbness, tingling & sense of the skin tightness in affected ______________ -blanching of the skin followed by ______________

cold, trauma, women

Raynaud's disease (r/t arterial vasospam, PVD) Secondary causes -exposure to ________ -obstructive arterial disease -occupational _______ (pianists), certain drugs (beta blockers) -more frequent in _____________

coldness

Raynaud's disease is thought to be caused by vasospasm (vasoconstriction of blood vessels) and subsequent ischemia of the arteries of the skin of the hands, fingers, and sometimes, toes. Sudden __________ applied to the extremity, such as cold water, can induce an attack

cilostazol

Should not be used to treat patients with heart failure of any severity

GI, headache, dizziness

Side effects of pentoxifylline (Trental): -__-n/v, dyspepsia -__________ -_____________

pain, dysrhythmias

Side effects to report with pentoxifylline (Trental): -chest ___________ -______________ -SOB

arteriosclerosis obliterans, legs

The most common form of obstructive arterial narrowing disease is __________________ ___________ (loss of function) -Atherosclerotic plaque build up & narrowing of the lower aorta & major arteries that provide circulation to the _______

2 (Rationale: Emotional stress stimulates vasoconstriction)

*A 36-year-old client with a 7-year history of Raynaud's disease comes to donate blood during a community blood drive.* When preparing the client's teaching plan, the nurse should include information on the importance of avoiding which one of the following? 1. Wearing gloves 2. Emotional stress 3. Drinking alcoholic beverages 4. Bathing with perfumed soap

A (Rationale: Calcium channel blockers and adrenergic antagonists are used to treat Raynaud's disease. Calcium ion antagonists such as nifedipine (Procardia) are most beneficial in patients with Raynaud's disease because they greatly reduce vasospastic attack. Adrenergic antagonists such as prazosin (Minipress), reserpine (Serpalan), and methyldopa (Aldopam) are also used to treat Reynaud's disease, but they are only moderately successful due to the adverse effects associated with these medications.)

A patient is newly diagnosed with Raynaud's disease. Which medication is most beneficial for the patient? A. Nifedipine (Procardia) B. Methyldopa (Aldopam) C. Prazosin (Minipress) D. Reserpine (Serpalan)

catopril

ACE inhibitors -end in "pril" -cause an increase in bradykinin -has been shown to reduce the frequency & severity of Raynaud's attacks

pentoxifylline, cilostazol

Are the only agents approved by the US Food and drug administration that are specifically indicated for the treatment of intermittent claudication cause by chronic occlusive arterial disease of the limbs

narrowing, Raynaud's

Arterial disorders are subdivided into those that result from: 1. Arterial ___________ & occlusion= *obstructive* 2. Those caused by arterial spasm= *vasospastic* ________________

rest, paresthesias

Arteriosclerosis obliterans As the disease progresses & without treatment patient may develop: -Pain at ________ -_________________ (numbness with a tingling sensation)

75 to 90

Arteriosclerosis obliterans Patients tend to remain free of symptoms until there is significant narrowing __% to __% in key locations of the major arteries & arterioles of the legs

decrease, waxy, bruits, viscosity

Arteriosclerosis obliterans Physical findings on the lower extremities are -___________ pulse -____________ pale dry skin -_____________ over the involved arteries -decreased skin temp -weakness -increased blood _________ which causes numbness to sensation (thickness of blood)

HTN, smoking

Arteriosclerosis obliterans Risk factors: -___ -_________ -increasing triglycerides & cholesterol -diabetes mellitus

pain, aching, cramping

Arteriosclerosis obliterans S & S -_______ -__________ -____________ -tightness -weakness -intermittent claudication

xanthine

Before starting pentoxifylline (Trental) therapy patient should be asked about intolerance to _____________ derivatives -pentoxifylline is a xanthine derivative -caffeine -theophylline -theobromine

Peripheral vascular disease

Broad group of illnesses associated with blood vessels *outside of the heart* (peripheral vessels) -generally BV of the *arms & legs*

200

Cholesterol levels need to be under

papaverine hydrochloride pavagen TD

Direct vasodilator: relaxes smooth muscle, vasodilates cerebral and coronary blood vessels -also an antidysrhythmic

angina, pentoxifylline, cilostazol, vasodilator

Drug therapy for PVD -treat the underlying pathology example DM, HTN, hyperlipidemia, ______ -___________________ Trental -____________ Pletal -______________ therapy

nifedipine, inhibitors, nitroglycerin

Drug therapy for Raynaud's -Ca+ channel blockers _____________ is DOC -Adrenergic antagonists (not too successful- many side effects) -ACE _____________ -Direct vasodilators _________________ (for extremities)

nitroglycerin

For more than 50 years ____________ a direct vasodilator has been applied as an ointment base to the hands of patients with Raynaud's disease

decrease, increase, prevent, decreased

Hemorrheologic agents Actions of pentoxifylline Trental: -____________ the concentration of fibrinogen in blood -_____________ erythrocyte flexibility -____________ aggregation of RBCs & platelets -____________ viscosity & improves blood flow- resulting in enhanced tissue oxygenation -decreased pain

pentoxifylline

Hemorrheologic agents _______________________ Trental *NOT AN ANTICOAGULANT*

C (Rationale: Pentoxifylline (Trental) is a hemorheologic agent that increases red blood cell flexibility. This action reduces blood viscosity and provides better oxygenation to muscle tissues to stop intermittent claudication. Pentoxifylline (Trental) decreases blood viscosity. Angiotensin-converting enzyme (ACE) inhibitors increase bradykinin levels. Pentoxifylline (Trental) decreases the concentration of fibrinogen in the blood.)

How does pentoxifylline (Pentoxil) stop intermittent claudication? A. By increasing the concentration of fibrinogen in the blood B. By increasing blood viscosity C. By increasing red blood cell flexibility D. By increasing the bradykinin level

nifedipine

This calcium channel blockers has had the greatest success in reducing the frequency of Raynaud's vasospastic attacks in about two thirds of patients

relief, flow

Treatment of PVD -try to reverse the progression of atherosclerosis -pain __________ -improve blood ___________ -prevent ulcers to skin (foot care prevent gangrene) -get other disease under control (DM, HTN, angina, hyperlipidemia) -establish diet/smoking/exercise regime

150

Triglyceride levels need to be under

pentoxifylline

Used as an adjunct treatment of intermittent claudication

cilostazol

Used for treatment of intermittent claudication & should be used as an adjunct with: weight loss, smoking cessation, exercise, bypass surgery, & or removal of arterial obstructions

DVT, varicosities, diabetes

Venous PVD -___ -_______________ -_______________ mellitus

C, E (Rationale: Pentoxifylline (Trental) is a hemorheologic agent that is used to treat peripheral vascular disease. Chest pain and shortness of breath are serious adverse effects of pentoxifylline (Trental). Diarrhea is a common adverse effect of cilostazol (Pletal). Dizziness and dyspepsia are common adverse effects of pentoxifylline (Trental).)

What are the serious adverse effects of pentoxifylline (Trental)? (Select all that apply.) A. Diarrhea B. Dyspepsia C. Chest pain D. Dizziness E. Shortness of breath

C (Rationale: Pentoxifylline is used to treat intermittent claudication, which is characterized by leg pain on walking. Urinary output, allergy symptoms, and motor coordination are not associated with the use of pentoxifylline.)

When evaluating a patient's response to pentoxifylline (Trental), which sign/symptom does the nurse assess? A. Allergy symptoms B. Urinary output C. Leg pain D. Motor coordination

B (Rationale: Angiotensin-converting enzyme (ACE) inhibitors cause an increase in bradykinins, a potent vasodilator. Direct vasodilators such as nitroglycerin (Nitrostat) are used to reduce the frequency and severity of attacks in patients with Reynaud's disease. Adrenergic antagonists are used in moderation to treat Reynaud's disease because of adverse effects associated with these drugs. Calcium channel blockers reduce the frequency of vasospastic attacks in patients with Reynaud's disease.)

Which class of drugs used to treat Raynaud's disease causes an increase in bradykinins? A. Adrenergic antagonists B. Angiotensin-converting enzyme (ACE) inhibitors C. Calcium channel blockers D. Direct vasodilators

C (Rationale: Palpitations, along with angina, dysrhythmias, and shortness of breath should be reported to, and further evaluated by, a healthcare professional. Cilostazol does not affect urine output and may cause diarrhea, but not constipation. Tingling of the hands and feet is not a side effect of cilostazol.)

Which serious adverse effect of cilostazol (Pletal) must be evaluated further by the healthcare provider? A. Tingling of the hands and feet B. Constipation C. Palpitations D. Increased urine output