Peripheral vascular diseases

Antithrombotic therapy for acute peripheral occlusive disease is largely empirical. Thrombolytic therapy typically is reserved for patients in whom the occlusion is not amenable to surgery and for those in whom a possible delay between the initiation of therapy and thrombolysis would not jeopardize the viability of the limb. Evidence that antithrombotic therapy changes the natural course of the peripheral disease is sparse, but these patients are at an increased risk of cardiovascular mortality and should receive long-term aspirin therapy. Initial trials suggest that ticlopidine may improve the symptoms of chronic arteriosclerotic arterial insufficiency and also reduce fatal and nonfatal cardiovascular events, but further studies are needed. 

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Other cardiovascular diseases cover a long Hst of circulatory problems, including heart faHure, peripheral vascular disease, cardiomyopathy, and arrhythmias. 

Nitroglycerin remains the dmg of choice for treatment of angina pectoris. It has also been found useful for the treatment of congestive heart failure, myocardial infarction, peripheral vascular disease, such as Raynaud s disease, and mitral insufficiency, although the benefits of nitroglycerin in mitral insufficiency have been questioned. 

Patients having high plasma renin activity (PRA) (>8 ng/(mLh)) respond best to an ACE inhibitor or a -adrenoceptor blocker those having low PRA (<1 ng/(mLh)) usually elderly and black, respond best to a calcium channel blocker or a diuretic (184). -Adrenoceptor blockers should not be used in patients who have diabetes, asthma, bradycardia, or peripheral vascular diseases. The thiazide-type diuretics (qv) should be used with caution in patients having diabetes. Likewise, -adrenoceptor blockers should not be combined with verapamil or diltiazem because these dmgs slow the atrioventricular nodal conduction in the heart. Calcium channel blockers are preferred in patients having coronary insufficiency diseases because of the cardioprotective effects of these dmgs. 

Nifedipine (Table 3) is a potent vasodilator that selectively dilates resistance vessels and has fewer effects on venous vessels. It does not cause reflex tachycardia during chronic therapy. Nifedipine is one of the first-line choices for black or elderly patients and patients having concomitant angina pectoris, diabetes, or peripheral vascular diseases. Nifedipine, sublingually, is also suitable for the treatment of hypertensive emergencies. Nifedipine does not impair sexual function or worsen blood Hpid profile. The side effects are flushing, headache, and dizziness. 

Peripheral vascular disease, often one of the sequelia of atherosclerosis, is characterized by markedly decreased circula-... 

Peripheral vascular disease. An insufficiency of blood flow to the extremities. 

This drug is used cautiously in patients with peripheral vascular disease, neuropathy, chronic pancreatitis, or impaired liver function. Didanosine is a Pregnancy Category B drug and is used cautiously during pregnancy and lactation. There may be a decrease in the effectiveness of dapsone in preventing Pneumocystis carinii pneumonia when didanosine is administered with dapsone Use of didanosine with zalcitabine may cause additive neuropathy. Absorption of didanosine is decreased when it is administered with food. 

Diseases of the arteries can cause serious problems, namely coronary artery disease, cerebral vascular disease, and peripheral vascular disease Drug therapy for vascular diseases may include dragp that dilate blood vessels and thereby increase blood supply to an area... 

Peripheral vasodilating drugs are chiefly used in the treatment of peripheral vascular diseases, such as arteriosclerosis obliterans, Raynaud s phenomenon, and spastic peripheral vascular disorders. Short-term use is rarely beneficial or permanent. Improvement, if it occurs, takes place gradually during weeks of therapy. 

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. 

For peripheral vascular disease, follow the primary health care provider s recommendations regarding exercise, avoiding exposure to cold, keeping the extremities warm, and avoiding injury to the extremities. 

Therapeutic effects when taking the drug for peripheral vascular disease may not be seen for 2 weeks and may take up to 12 weeks. 

Mr. Crawford has peripheral vascular disease and is prescribed isoxsuprine hydrochloride (Vasodilan). Discuss the important aspects of the preadministration and ongoing assessment for Mr. Crawford. 

A. that drains used to treat peripheral vascular disease may take 2 to 4 weeks before improvement is seen... 

A topical enzyme aids in the removal of dead soft tissues by hastening the reduction of proteins into simpler substances. This is called proteolysis or a proteolytic action. The components of certain types of wounds, namely necrotic (dead) tissues and purulent exudates (pus-containing fluid), prevent proper wound healing. Removal of this type of debris by application of a topical enzyme aids in healing. Examples of conditions that may respond to application of a topical enzyme include second- and third-degree bums, pressure ulcers, and ulcers caused by peripheral vascular disease An example of a topical enzyme is collagenase (Santyl). 

Figure 12.2 Diabetic macroangiopathy severe peripheral vascular disease and gangrene of the foot.

Blockers may be used by those with reactive airway disease or peripheral vascular disease, but should be used with considerable caution or avoided if patients display active respiratory symptoms. Care must also be used in interpreting shortness of breath in these patients, as the etiology could be either cardiac or pulmonary. A selective (3 r -blocker such as metoprolol is a reasonable option for patients with reactive airway disease. The risk versus benefit of using any (3-blocker in peripheral vascular disease must be weighed based on the severity of the peripheral disease. 

Blockers are contraindicated in patients with severe bradycardia (heart rate less than 50 beats per minute) or AV conduction defects in the absence of a pacemaker. (3-Blockers should be used with particular caution in combination with other agents that depress AV conduction (e.g., digoxin, verapamil, and diltiazem) because of increased risk for bradycardia and heart block. Relative contraindications include asthma, bronchospastic disease, severe depression, and peripheral vascular disease. (3,-Selective blockers are preferred in patients with asthma or chronic obstructive pulmonary... 

Inflammatory conditions of the prostate Coronary and peripheral vascular disease Neurologic disorders (e.g., Parkinson s disease and multiple sclerosis)... 

Acute myocardial infarction Angiopathy Aortic aneurysm Aortic balloon assist devices Giant hemangiomas Peripheral vascular disease Postcardiac arrest Prosthetic devices Raynaud s syndrome Infectious Arbovirus Aspergillus Candida albicans Cytomegalovirus Ebola virus... 

I NF can affect any age group. Although the risk of NF is higher in patients with underlying diseases (specifically diabetes, alcoholism, cardiac disease, and peripheral vascular disease), healthy hosts can become infected as well.20... 

MRSA, methicillin-resistant S. aureus PVD, peripheral vascular disease IJTI, urinary tract infection. 

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