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Thromboangiitis Obliterans Medication

  • Author: Naiem Nassiri, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
 
Updated: Nov 19, 2015
 

Medication Summary

The goals of pharmacotherapy are to treat pain and reduce morbidity. Oral nonsteroidal anti-inflammatory drugs (NSAIDs) and narcotic analgesics can be administered to palliate ischemic pain.

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Nonsteroidal Anti-Inflammatory Drugs

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Naproxen (Naprosyn, Aleve, Naprelan, Anaprox)

 

Naproxen is used for the relief of mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing COX activity, which results in decreased prostaglandin synthesis.

Ibuprofen (Motrin, Advil, Addaprin, Caldolor)

 

Ibuprofen is the drug of choice (DOC) for patients with mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Indomethacin (Indocin)

 

Indomethacin is used for relief of mild to moderate pain; it inhibits inflammatory reactions and pain by decreasing the activity of COX, which results in a decrease of prostaglandin synthesis.

Diclofenac (Voltaren XR, Cataflam, Zipsor, Cambia, Zipsor, Zorvolex)

 

Diclofenac inhibits prostaglandin synthesis by decreasing COX activity, which, in turn, decreases formation of prostaglandin precursors.

Ketoprofen

 

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

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Analgesics

Class Summary

Pain control is essential to quality patient care. It ensures patient comfort, promotes pulmonary toilet, and aids physical therapy regimens. Many analgesics have sedating properties that benefit patients who have sustained trauma.

Acetaminophen (Tylenol, FeverAll, Aspirin Free Anacin)

 

Acetaminophen is the DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, who have upper GI disease, or who are taking oral anticoagulants.

Acetaminophen and codeine (Tylenol #2, Tylenol #3, Tylenol #4)

 

This combination is indicated for the treatment of mild to moderate pain. The available dosage strengths are as follows:

•Tylenol #2: 300 mg Tylenol/15 mg codeine

•Tylenol #3: 300 mg Tylenol/30 mg codeine

•Tylenol #4: 300 mg Tylenol/60 mg codeine

Hydrocodone and acetaminophen (Vicodin, Lorcet, Lortab, Norco)

 

This drug combination indicated for moderate to severe pain.

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Contributor Information and Disclosures
Author

Naiem Nassiri, MD RPVI, Instructor in Vascular Surgery, Rutgers Robert Wood Johnson Medical School; Founder and Director, Vascular Anomalies and Malformations Program, Vascular Center of New Jersey and Bristol Myers Squibb Children’s Hospital Center for Advanced Surgery

Naiem Nassiri, MD is a member of the following medical societies: American College of Surgeons, Society for Vascular Surgery, American Venous Forum, Society for Clinical Vascular Surgery, International Society for the Study of Vascular Anomalies

Disclosure: Nothing to disclose.

Chief Editor

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Society for Vascular Surgery, Vascular and Endovascular Surgery Society, Society for Clinical Vascular Surgery, Pacific Coast Surgical Association, Western Vascular Society

Disclosure: Nothing to disclose.

Acknowledgements

Matthew Carpenter, MD Program Director, Department of Internal Medicine, Department of Internal Medicine, Keesler Medical Center; Assistant Clinical Professor, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Disclosure: Nothing to disclose.

E Jerry Cohn Jr, MD, FACS Vascular Surgeon, The Vein Center at Savannah Vascular Institute

E Jerry Cohn Jr, MD, FACS is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Eric J Hanly, MD Fellow, Department of Surgery, The Johns Hopkins University School of Medicine

Eric J Hanly, MD is a member of the following medical societies: American Medical Association, Association of Military Surgeons of the US, MedChi, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Ozanan R Meireles, MD Instructor in Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School

Ozanan R Meireles, MD is a member of the following medical societies: American College of Surgeons, American Society for Gastrointestinal Endoscopy, and Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Nothing to disclose.

Brian D Peyton, MD Chief of Vascular and General Surgery, Keesler Medical Center; Assistant Professor, Department of Surgery, Associate Program Director, Department of General Surgery, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References
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Feet of patient with thromboangiitis obliterans (Buerger disease). Note ischemic ulcers on distal portion of left great, second, and fifth toes. Although patient's right foot is normal in gross appearance, angiography demonstrated compromised arterial flow to both feet.
Superficial thrombophlebitis of great toe in patient with thromboangiitis obliterans (Buerger disease).
Tobacco smoke stains on male patient's fingers suggest diagnosis of thromboangiitis obliterans (Buerger disease). Patient presented with small, painful ulcers on tips of thumb and ring finger.
Lower-extremity arteriogram of peroneal and tibial arteries of patient with thromboangiitis obliterans (Buerger disease) demonstrates classic findings of multiple small and medium-sized arterial occlusions with formation of compensatory "corkscrew collaterals."
Table 1. Scoring System for Diagnosis of Thromboangiitis Obliterans [11]
Positive Criterion Positive Points
Age at onset < 30 y (+2)



30-40 y (+1)



Foot intermittent claudication Present (+2)



By history only (+1)



Upper extremity Symptomatic (+2)



Asymptomatic (+1)



Migrating superficial thrombophlebitis Present (+2)



By history only (+1)



Raynaud phenomenon Present (+2)



By history only (+1)



Angiography; biopsy If typical, both (+2)



Either(+1)



Negative Criterion Negative Points
Age at onset 45-50 y (−1)



>50 y (−2)



Sex; smoking Female (−1)



Nonsmoker (−2)



Location Single limb (−1)



No lower extremity involved (−2)



Absent pulses Brachial (−1)



Femoral (−2)



Arteriosclerosis, diabetes, hypertension, hyperlipidemia Discovered 5.1-10 y after diagnosis (−1)



Discovered 2.1-5 y later (−2)



Table 2. Numerical Scores Defining Probability of Diagnosis of Thromboangiitis Obliterans
No. of Points Probability of Diagnosis of Thromboangiitis Obliterans
0-1 Diagnosis excluded
2-3 Diagnosis suspected (low probability)
4-5 Diagnosis probable (medium probability)
≥6 Diagnosis definite (high probability)
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