44 - Raynaud Phenomenon Flashcards Preview

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Flashcards in 44 - Raynaud Phenomenon Deck (19):

Characterized by what?

White to blue to red

Blanching of fingers (normally when exposed to cold), followed by a second cyanotic phase then by a reactive hyperhemia phase


What drugs can cause RP ?

-Antineoplastics (bleomycin, vinblastin, and cisplatin)
-BBs (unlikley but controversial)
-CNS stimulants (dexamphetamine, methylphenidate)
-Cyclosporine - not dose related
-Ergot derivatives
-Interferon alfa or beta



minimize cold exposure, avoid meds with VASOCONSTRICTIVE potential, teach warming exercises, dress warmly in winter, stop smoking

*meds for treatment of RP are focused on vasodilation


What type of calcium channel blockers are first line?

DHP (ex. nifedipine)

*Nifedipine is best studied


How should they use nifedipine?

30-60 mins before cold exposure or regularly during winter months


Can you use non-DHP CCB's for RP?

you can but they are less effective than DHPs


What is another option?

peripheral alpha blockers (ex. prazosin)

* less effective than CCBs


What type of ointment can you try?

nitroglycerin 2% ointment but may be difficult to use due to s/e of headache and hypotension


What IV drug may be good for short-term use for severe secondary RP ?

IV iloprost (PG analogue)

*the oral form is less effective

*not available in Canada


Can also use Ketanserin (5HT antagonist) to reduce duration of symptoms. Problem with this ?

not available in Canada


________ heals digital ulcers and decreases RP in patients with systemic sclerosis

Bosentan (endothelin-1-inhibitor)


What drugs used for ED can also be useful in RP ?

PDE5 inhibitors decrease severity of RP and may heal ulcers

(ex. sildenafil, vardenafil, tadalafil)


Only consider PDE5 inhibitors or Bosentan in what case?

severe secondary RP


How is RP affected in pregnancy?

primary and secondary RP usually decreases in frequency and severity during pregnancy and for at least a few months after delivery


Can use _______ in pregnancy

nifedipine if previous clear benefit has been experienced with 30mg XL

*NOTE: nifedipine can be used in pregnancy but is NOT approved for use during pregnancy in Canada


What should you tell patient while on nifedipine?

only decreases symptoms and not complications such as digital ulcers


How do you handle RP in breastfeeding women?

-avoid meds if possible
-CCBs go through milk but in small amounts
-Can use nifedipine in breastfeeding


What is most likely to be reduced with effective drug treatment?

frequency of attacks


What are risks for RP ?

female gender, age > 30, repetitive damage to arteries and nerves, hypothyroidism or SLE

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