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
-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
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