Peripheral Vascular Disease

A common problem in the elderly is peripheral vascular disease. It is characterized by numbness and coolness of the extremities, intermittent claudication

(pain and weakness of limbs when walking and symptoms are absent at rest), and possible leg ulcers. The primary cause is hyperlipemia resulting in atherosclerosis and arteriosclerosis. The arteries become occluded.

Peripheral vasodilators increase blood flow to the extremities and are used for venous and arterial disorders. They are more effective for disorders resulting from vasospasm (Raynaud's disease) than from vessel occlusion or arteriosclerosis (arteriosclerosis obliterans, thromboangiitis obliterans [Buerger's disease]). Some of the drugs that promote vasodilation include tolazoline (Priscoline), an alpha-adrenergic blocker (Chapter 15); isoxsuprine (Vasodilan) and nylidrin (Arlidin), beta-adrenergic agonists (Chapter 15); and cyclandelate (Cyclan), nicotinyl alcohol, and papaverine (Cerespan, Genabid), direct-acting peripheral vasodilators. The alpha blocker prazosin (Minipress) and the calcium channel blocker nifedipine (Procardia) have also been used.

A list of vasodilator drugs is provided in the Appendix. Detailed tables show doses, recommendations, expectations, side effects, contraindications, and more; available on the book's Web site (see URL in Appendix).

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