Raynaud’s disease

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. 

Norepinephrine NE transporter Human cDNA Depression, Alzheimer s disease, epilepsy, anxiety, attention deficit hyperactivity, angina, asthma, cardiac arrhythmia, cardiac hypertrophy, congestive heart failure, myocardial ischemia, hypertension, artherosclerosis, narcolepsy, orthostatic hypotension, prostatic hyperplasia, rhinitis, diabetes, diarrhea, glaucoma, impotence, obesity, opiate withdrawal pain, Raynaud s disease, preterm labor pain Modulation of norepinephrine concentration in the neuronal synaptic clefts, neuroprotection... 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

Isoxsuprine HCl is a p-agonist with a slight selectivity for the P2" adrenoreceptors. However, a considerable portion of the vasodilator actions is attributable to a non-selective depression of vascular smooth muscles. It is considered to be possibly effective in Raynaud s disease, thromboangilitis daliterans, obliterative arteriosclerosis, and cerebrovascular insufficiency. In the management of premature labor, it has been superseded by more selective p-agonists [1]. 

Contraindications Coronary artery disease, hypertension, impaired liver or renal function, malnutrition, peripheral vascular diseases, such as thromboangiitis obliterans, syphilitic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease, sepsis, severe pruritus... 

Unlabeled Uses Bladder instability complex regional pain syndrome (CRPS), pros-tatic obstruction, Raynaud s disease... 

It is used in the management of pheochromocytoma and also to treat peripheral vasospastic conditions e.g. Raynaud s disease and shock syndrome. 

Adverse effects include nausea, vomiting, fever, anaphylactic reactions, hypokalemia, hypomagnesaemia, haemolysis, renal damage, sterility, teratogenesis, ototoxicity, peripheral neuropathy, Raynaud s disease and bone marrow depression. 

Rheumatic arthritis, rheumatoid arthritis, cervical or lumbar spondylosis, osteoarthritis, sciatica, Raynaud s disease, vasculitis, pulmonary heart disease, rheumatic heart disease, coronary heart disease, migraine, hemiplegia after cerebrovascular accident, paralysis, facial paralysis, facial spasm, skin diseases that are influenced by changes in the weather and are characterized by itchy, weeping, red or dry skin lesions. 

Giovanni B, GiuseppinaCM, Susanna F, Roberto M (1984) Altered regulator mechanisms of presynaptic adrenergic nerve a new physiopathological hypothesis in Raynaud s disease. Microvasc Res 27 110-13... 

Gordon, M.D. and Lindsay, R.K. 1996. Toward discovery support systems A replication, reexamination, and extension of Swanson s work on literature-based discovery of a connection between Raynaud s disease and fish-oil. Journal of the American Society for Information Science, 47(2) 116-128. 

A number of other cardiovascular indications have been suggested, based mainly on the observation of raised endothelin levels and the known pharmacological effects of endothelin. Among the proposed indications are hypertension [207,208], pulmonary hypertension [209], atherosclerosis [210] congestive heart failure [211], shock [212] and Raynaud s disease [213]. 

Ketanserin appears to act principally to block serotonin vasoconstrictor (subtype 5-HTj) receptors but also has significant a-adrenoceptor blocking activity (its affinity ratio for the two receptors is 1 5). The latter explains its hypotensive action and use in Raynaud s disease. It is not available in many countries and offers no advantages over pure a-blockers such as doxazosin. 

A possible role of ciclosporin in the exacerbation or development of Raynaud s disease has been suggested on one occasion such an effect could be hnked to endothelial damage or changes in platelet function (12). 

Women taking oral contraceptives and pregnant women are more susceptible to the vasospastic effects of the ergot alkaloids, as are patients in shock, with sepsis, and with Raynaud s disease or Buerger s disease. The risk of severe vascular reactions is increased in the presence of peripheral vascular disease or when sympathomimetic agents are given at the same time. 

Some beta-blockers demonstrate p, selectivity. At low doses, metoprolol and atenolol predominantly antagonize the receptors on cardiac tissues with less activity on P2-receptors. Therefore, they are less likely to cause bronchospasm in patients with COPD or asthma. The nonselective beta-blockers also have the disadvantage of masking hypoglycemic symptoms, especially in insulin-dependent diabetics. Blocking P2-receptors also leaves the alpha-mediated vasoconstriction unopposed and, as a result, may worsen Raynaud s disease or peripheral vascular disease. Some beta-blockers, such as labetolol and carvedilol, also possess alpha-blocking properties. 

Assess fingers for color, numbness (Raynaud s) disease. 

Use To increase circulation due to peripheral vascular disease (Raynaud s disease, arteriosclerosis obliterans) and cerebrovascular insufficiency Half-life 1.25-1.5 hours Onset 0.5 hour Peaks Duration 1 hour 3 hours... 

Indications 1) Yang qi insufficiency with concomitant blood vacuity, external invasion of cold evils, 2) cold entering the channels and network vessels. Thromboangiitis obliterans, varicose veins, frostbite (before skins swells and cracks or after healed), callouses and corns, dysmenorrhea, hernia, colic testalgia, chronic rheumatoid arthritis, Raynaud s disease, fibromyalgia, sciatica, peptic ulcer, chronic urticaria, midline pain, chilblains, and gangrene... 

Nifedipine also has a use in the treatment of Raynaud s disease. In Raynaud s disease, there is inappropriate vasoconstriction in the fingers and toes, usually in response to cold. The condition can be mild or severe leading to ulceration and possibly gangrene of the digits. Raynaud s disease can occur on its own, or as a consequence of systemic sclerosis or systemic lupus erythematosus, both chronic inflammatory diseases (see Chapter 7). 

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