Claudication, intermittent

Aggravation of cardiovascular disease (i.e., decreased exercise capacity in patients with angina pectoris, intermittent claudication, or peripheral arteriosclerosis)... 

The PDE3 inhibitor, cilostazol, has been used as an antithrombotic agent and is currently being used in patients being treated for intermittent claudication. Cilostazol is also used for the prevention of restenosis after treatments such as angioplasty. Another PDE3 selective inhibitor, milrinone, has been used in the treatment of congestive heart failure. Milrinone also has been shown to increase the conductance of the CFTR transporter in vitro. 

PI (adenosine) receptors were explored as therapeutic targets before P2 receptors. Adenosine was identified early and is in current use to treat supraventricular tachycardia. A2a receptor antagonists are being investigated for the treatment of Parkinson s disease and patents have been lodged for the application of PI receptor subtype agonists and antagonists for myocardial ischaemia and reperfusion injury, cerebral ischaemia, stroke, intermittent claudication and renal insufficiency. 

Interleukins Intermediate Filaments Intermediate-density Lipoprotein (DDL) Intermittent Claudication Internalization... 

Intermittent claudication is a group of symptoms characterized by pain in the calf muscle of one or both legp, caused by walking and relieved by rest. It is a manifestation of peripheral vascular disease, in which atherosclerotic lesions develop in the femoral artery, diminishing blood supply to the lower leg. Cilostazol is used to treat intermittent claudication. 

Therapeutic results obtained from the administration of a peripheral vasodilating drug may not occur immediately. In some instances, results are minimal. The nurse assesses involved extremities daily for changes in color and temperature and records die patient s comments regarding relief from pain or discomfort. The nurse should monitor die blood pressure and pulse one to two times per day because tiiese dru may cause a decrease in blood pressure The anticipated result of tiierapy for cerebral vascular disease is an improvement in die patient s mental status. When die drug is taken for intermittent claudication, the nurse assesses the patient for increased walking distance without pain. 

In patients treated for secondary intervention, symptoms of atherosclerotic cardiovascular disease, such as angina or intermittent claudication, may improve over months to years. Xanthomas or other external manifestations of hyperlipidemia should regress with therapy. 

M29. Molgaard, J., Klausen, I. C., Lassvik, C., Faergeman, O., Gerdes, L. U., andOlsson, A. G., Significant association between low-molecular-weight apolipoprotein(a) isoforms and intermittent claudication. Arteroscler. Thromb. 12, 895-901 (1992). 

A systematic literature review showed ten controlled studies of ginkgo for treatment of intermittent claudication (Ernst 1996). Many studies... 

Ernst E. (1996). [Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature]. Fortschr Med. 114(8) 85-87. 

A 42-year-old man presents with a chief complaint of intermittent claudication during exercise. His fomHy history is significant for the presence of cardiovascular disease on his fether s side, but not on his mother s side. Physical exam reveals xanthelasmas and bilateral tendon xanthomas. A plasma lipid profile reveals a cholesterol level of 340 mg/dL, with a high LDL/HDL ratio. He is given instructions for dietary modifications and a prescription for Zocor (simvastatin). 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

Atherosclerosis and coronary heart disease are amongst the most intensively investigated subjects in medical science. Despite this, it must be pointed out that atherosclerosis is not itself a disease but a process that connibutes to diseases, such as an intermittent claudication, coronary arterial disease and stroke. 

Exposure to 50 ppm for 90 minutes may cause aggravation of angina pectoris exposed anginal patients may show a negative inotropic effect (weakened force of myocardial contraction) 50 ppm for 120 minutes may cause aggravation of intermittent claudication. ... 

M/sce//aneons - Asthenia, back pain, bacterial infection, chest pain, fever, flu-like symptoms, flushing, hot flushes, intermittent claudication, leg ulcer, malaise, moniliasis, ptosis, rigors, varicose vein, viral infection. 

WARNING Renal impair is the major tox foUow administration instructions Uses CMV retinitis w/ HIV Action Selective inhibition of viral DNA synth Dose Rx 5 mg/kg IV over 1 h once/wk for 2 wk w/ probenecid Maint 5 mg/kg IV once/2 wk w/ probenecid (2 g PO 3 h prior to cidofovir, then 1 g PO at 2 h 8 h after cidofovir) X in renal impair Caution [C, -] Contra Probenecid or sulfa allergy Disp Inj SE Renal tox, chills, fever, HA, NA /D, thrombocytopenia, neutropenia Interactions t Nephrotox W/ aminoglycosides, amphot icin B, foscar-net, IV pentamidine, NSAIDs, vancomycin t effects W/zidovudine EMS Monitor ECG for hypocalcemia (t QT int val) and hypokalemia (flattened T waves) OD May cause renal failure hydration may be effective in reducing drug levels/effects Cilostazol (Pletal) TAntiplatelet, Arterial Vasodilator/ Phosphodiesterase Inhibitor] Uses Reduce Sxs of intermittent claudication Action Phosphodiesterase in inhibitor t s cAMP in pits blood vessels, vasodilation inhibit pit aggregation Dose 100 mg PO bid, 1/2 h before or 2 h after breakfast dinner Caution [C, +/-] Contra CHE, hemostatic disorders. 

Upper GI bleeding Intermittent claudication Urinary retention Falls, injuries... 

Cilostazol is a selective cAMP phosphodiesterase inhibitor. It inhibits platelet aggregation and is a direct arterial vasodilator. It is used for the symptoms of intermittent claudication in individuals with peripheral vascular disease. Side-effects of cilostazol include headache, diarrhea, increased heart rate, and palpitations. Drugs similar to cilostazol have increased the risk of death in patients with congestive heart failure. 

Intermittent claudication appears to benefit from ginkgo therapy many studies demonstrate improved walking distance and decreased pain. One meta-analysis of eight studies documented statistically significant improvement but questioned its clinical relevance. In some studies, the high doses (240 mg) appeared more effective. 

For cogifitive function, total daily doses of 120 to 240 mg divided into 2 or 3 doses of ginkgo leaf extract are recommended. For intermittent claudication, 240 mg a day would be preferable. 

Isoxsuprine has been used to arrest premature labor, where it is given in a loading dose of 0.2-1 mg/min for 10 minutes and then reduced to 0.1-0.3 mg/min [40, 41], It has been also used in the treatment of cerebral and peripheral vascular diseases [42], intermittent claudication [43], and obliterative arterial diseases [44]. 

Mectianism of Action A phosphodiesterase III inhibitor that inhibits platelet aggregation. Dilates vascular beds with greatest dilation in femoral beds. Therapeutic Effect Improves walking distance in patients with intermittent claudication. Pharmacokinetics Moderately absorbed from the GI tract. Protein binding 95%-98%. Extensively metabolized in the liver. Excreted primarily in the urine and, to a lesser extent, in the feces. Not removed by hemodialysis. Half-life 11-13 hr. Therapeutic effect is usually noted in 2-4 wk but may take as long as 12 wk. 

Intermittent claudication PO 100 mg twice a day at least 30 min before or 2 hr after meals. 50 mg twice a day during concurrent therapy with clarithromycin, diltiazem, erythromycin, fluconazole, fluoxetine, omeprazole, or sertraline. 

Statistically, but not always, clinically significant effects in intermittent claudication however, other drugs less impressive will not replace surgical options... 

Unlabeled Uses Prevention of postoperative deep vein thrombosis (DVT), protection of aortocoronary bypass grafts, reduction of graft loss after renal transplant, treatment of intermittent claudication, sickle cell disease, subarachnoid hemorrhage, diabetic microangiopathy, ischemic heart disease... 

Peripheral vascular disease P-blockers Intermittent claudication... 

It is indicated in premature infants exposed to high concentration of oxygen, correction of established vitamin E deficiency, in patients at risk of developing vitamin E deficiency, nocturnal muscle cramps, intermittent claudication, fibrocystic breast disease, coronary artery disease and as an antioxidant. 

The recommended dosages of an oral standardized dry extract of ginkgo (24% ginkgo flavonol glycosides and 6% terpene lactones) are 120 to 240 mg daily for dementia and memory impairment, and 120 to 160 mg daily for intermittent claudication and tinnitus. Adverse effects include gastrointestinal disturbances, diarrhea, vomiting, allergic reactions, pruritus, headache, dizziness, and nose bleeds. 

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